Ein neues Therapie-Konzept validiert die besonderen Bedürfnisse geflüchteter Kinder und Jugendlicher: START

Abstract

Zusammenfassung Die besondere Situation psychisch belasteter und geflüchteter Kinder und Jugendlicher erfordert neue Konzepte in der psychotherapeutischen Versorgung. Geflüchtete Kinder leiden häufig an psychischen und körperlichen Symptomen und sind durch traumatische Erlebnisse nachhaltig belastet. Das strukturierte und manualisierte Kurztherapiemanual "START" -Stress-Traumasymptoms-Arousal-Regulation-Treatment wurde im Rahmen der praktischen Arbeit mit unbegleiteten minderjährigen Flüchtlingen in Clearing-und Erstaufnahmekontexten und der klinischen Versorgung der Kinder-und Jugendpsychiatrie entwickelt. Interventionen aus der Dialektisch-Behavioralen Therapie, Psychotraumatherapie und Alptraumtherapie werden in START integriert. Dabei zielen die Interventionen primär auf eine rasche Stabilisierung und Arousal-Regulation bei emotionaler Belastung und ausgeprägtem Stresserleben. Im zweiten Schritt fokussiert START auf Förderung von Selbstwirksamkeit und die Stärkung von Schutzfaktoren. Der folgende Beitrag gibt einen kurzen Über-blick zur Situation der geflüchteten Kinder und Jugendlichen und beschreibt das START-Konzept hinsichtlich klinischer Implikationen und auch der Limitationen. Schlüsselwörter START -Stress-Traumasymptoms-ArousalRegulation-TreatmentSummary Recent research shows that unaccompanied refugeed minors frequently suffer from sleeping disorder, night mares, hyperarousal and emotion dysregulation due to severe traumatic experiences. Furthermore many are in acute stress during the clearing process on arrival in Germany. START was developed to reduce stress and improve psychosocial functioning in this population. It is a short manualized structured intervention for crisis intervention and stabiliziation of children and adolescents suffering from intense posttraumatic tension or desperation. Compounds of START are derived from elements of dialectic behavioral therapy and traumafocused cognitive behavioral therapy for children. The manual can be used by psychotherapists, social workers, physicians, school psychologists as well as qualified caretakers, given the highly self-instructive character of the instrument. In clinical settings, children of all cultural backgrounds can and should be included in the group treatment. Its efficacy and effectiveness is currently target of a standardized pre-post evaluation. Clinical implications as well as limitations of the concept are discussed. Keywords

START adolescents: study protocol of a randomised controlled trial to investigate the efficacy of a low-threshold group treatment programme in traumatised adolescent refugees

“…The manualised Stress-Traumasymptoms-Arousal-Regulation-Treatment (START) programme was developed from clinical work with traumatised unaccompanied refugee minors in Germany to promote coping with traumatic distress and emotional irritability. [18][19][20] An uncontrolled pilot study in 22 traumatised refugee minors showed positive effects on emotion regulation, adaptive strategies, self-control, distress and good feasibility. 18 A subsequent study confirmed the positive effects on adaptive emotion regulation strategies.…”

“…The original START programme was developed from clinical work with highly traumatised unaccompanied refugee minors of different countries of origin, who had recently arrived in Germany. [18][19][20] The adapted and extended version of the programme, that is evaluated in this RCT, was redesigned according to the participants' feedback of the pilot study groups, who were also traumatised refugee minors from different countries of origin. The public was not involved when designing the study.…”

“…The study intervention comprises an adapted version of the START programme. [18][19][20] Languages used in the study for the intervention and the assessments are Arabic, Dari, English, German or Somali. Interpreters are Open access involved if needed.…”

“…Adverse events are assessed at T0-T3 visits and weekly until T1. [18][19][20] was extended by the three additional modules 6-8 and a booster session. The additional modules provide an intensified training of stress reduction skills, mindfulness techniques and additional psychoeducation about emotions and interpersonal effectiveness.…”

Feasibility and Effectiveness of a New Short-Term Psychotherapy Concept for Adolescents With Emotional Dysregulation

“…START (Stress-Traumasymptoms-Arousal-Regulation Treatment) is a manualized short-term (5 weeks) treatment concept of stabilization and emotional regulation for extremely stressed adolescents and also for minor refugees. The intervention was constructed to offer adolescents, who are unmotivated or too unstable for Dialectical Behavior Therapy (DBT), reprocessing treatment, or long-term psychotherapy conditions, a first aid for crisis management and emotional stabilization ( 67 ). The program can be used for adolescents with diverse cultural backgrounds and repeatedly severe emotional distress, as a low-threshold training program to manage emotional dysregulation including skills to reduce self-harming and impulsive aggressive behavior.…”