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Background International studies show that child maltreatment is a widespread but often underestimated problem that causes high individual, social and economic costs. Child maltreatment is an important topic for the medical sector as well. On the one hand, affected persons often seek support and help from healthcare professionals, but on the other hand, assaults can also occur in medical institutions by healthcare professionals. Surprisingly, there is hardly any data on the frequency of child maltreatment by healthcare professionals in general and particularly by nursing staff. Methods Therefore, in a large representative survey of the German population of 2,516 subjects aged between 14 and 91, the experience of child maltreatment in medical institutions by nursing staff was assessed retrospectively. Results Of the 46 subjects who had an inpatient stay in a child and adolescent psychiatry before the age of 18, 33.3% reported to have experienced maltreatment by nursing staff, while 17.3% of the 474 persons who had an inpatient stay in general or pediatric hospitals experienced maltreatment by nursing staff. All forms of maltreatment were significantly more frequent in psychiatric compared to general and pediatric hospitals. Conclusions The results of our representative retrospective survey demonstrate that maltreatment by nursing staff are not rare individual cases, but that medical facilities bear systemic risks for assault. Therefore, it is necessary that all medical institutions, in particular psychiatric hospitals, address this issue. In order to reduce the risk for assaults, it is important not only to implement structural measures but also to develop an attitude that emphasizes zero tolerance for violence against children and adolescents.

Background Child maltreatment and consequently child protection are highly relevant and current issues in our society. Medical institutions are widely regarded as places of healing, care and support. But they also hold risk factors to promote child maltreatment. Efforts have to be taken in order to offer help to victims by medical institutions and to reduce risk factors for child maltreatment. Therefore, health professionals in the field of child protection must be trained and sensitized for these two purposes. The Department of Child and Adolescent Psychiatry / Psychotherapy at the University Hospital of Ulm in Germany is developing E-Learning courses directed to health professionals in order to create flexible advanced training courses for dealing with child abuse, and to increase competences in child protection. Due to their specific role in (institutional) child protection, three courses and their evaluation will be presented in this article. The aim of the studies is to examine if those online-courses are increasing knowledge and skills in child protection and how satisfied participants are with course quality. Methods Randomised Controlled Trials (RCT) were conducted with one wait-list control group and one group participating in the course (= intervention group). The RCTs took place from October 2016 to March 2017 for two courses, and from May 2017 to September 2017 for the other course. Data were analysed with mixed design ANOVA. For evaluation of user satisfaction, descriptive statistics are reported. Results For all three courses, knowledge and practical capacities on the topic of the intervention group raised significantly in comparison to the values of the control group. Furthermore, participants of the course for managers felt better prepared to meet their responsibilities in regard to institutional child protection and came up with ideas on how to implement safeguarding standards in their institution. Overall, participants were very satisfied with the structure and the content of the courses. Conclusions The article shows that the online-courses are an effective and well-accepted approach to train professionals in topics regarding (institutional) child protection by contributing to the participants´ abilities to create medical facilities into a place of competence and protection.

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Social Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.