: Background: Child maltreatment is a major global public health concern with severe physical, psychological, and developmental consequences. Physicians across many medical specialties may encounter affected children, making child protection an important component of medical education. However, many medical students and early-career physicians feel insufficiently prepared to recognize and manage suspected cases. Methods: We conducted a cross-sectional online survey using self-developed questions among medical students at the University of M & uuml;nster (September-November 2025). The survey assessed experiences with child protection, perceived preparedness, and preferences regarding curricular content and teaching formats. Of the 376 respondents, we analyzed 323 complete responses (11.4 % of enrolled students). Via descriptive statistics, ANOVA, and MANOVA, we examined differences across academic years. Results: Students strongly supported integrating child protection as a mandatory standalone course (92.3 %). Preferred teaching formats were communication training (88 %), simulations (83.3 %), and case-based discussions (82 %). Many students reported uncertainty in handling suspected cases, particularly regarding communication with affected children and caregivers (84.8 %) and legal aspects (80.2 %). Perceived preparedness increased significantly with academic progression (p < .001). Conclusions: Medical students demonstrate a strong interest in structured child protection education. Practice-oriented and interdisciplinary teaching approaches may strengthen competencies required to recognize and manage suspected child maltreatment.
Abstract: Objective: The 2017 amendment to § 1631b of the German Civil Code (BGB) reformed the legal framework regarding coercive measures, distinguishing them from involuntary hospitalizations in children and adolescents. In response, the Intensive Therapy Unit of the Würzburg Department of Child and Adolescent Psychiatry underwent a comprehensive restructuring. This study examines the effects of this conceptual restructuring on closed inpatient care, with particular focus on length of stay. It also presents data on coercive measures documented since 2020. Methods: This retrospective study compares the involuntary commitment of all patients before (2012 – 2016) and after the amendment (10/2016 – 2025) and evaluates coercive measures documented since 2020. Results: Length of involuntary hospitalization decreased (median 7 vs. 1 day), while 43.9 % more patients per year were treated ( n = 189 vs. n = 272). F3 and F9 diagnoses decreased (–7.3 %, –17.8 %), while F4 and F6 diagnoses increased (+8.6 %, +8.2 %). On average, 7.8 % of cases involved at least one coercive measure, with marked differences by setting: Mechanical restraint predominated on the Intensive Therapy Unit (48.0 %), while physical holding predominated on open wards (65.5 %). Diagnoses of developmental disorders, intellectual disability, and personality disorders (OR 2.0 – 2.39) were associated with coercive measures. Conclusions: A substantial reduction in length of stay in the closed setting accompanied the conceptual restructuring. As it is difficult to clearly disentangle societal trends and the effects of the restructuring, these findings should be interpreted with caution. However, this evaluation of coercive measures provides metrics rarely reported in Germany.
Zusammenfassung: Der im September 2026 veröffentlichte Abschlussbericht der Unabhängigen Expertenkommission „Kinder- und Jugendschutz in der digitalen Welt“, der die 56 zuvor vorgelegten Handlungsempfehlungen bündelt, und der Bericht „Child Safety Online“ des Special Panel der Europäischen Kommission markieren wichtige Schritte hin zu einem entwicklungsorientierten Schutz Minderjähriger im digitalen Raum. Die Ad-hoc-Arbeitsgruppe der DGKJP, des BKJPP und der BAG KJPP begrüßt die Empfehlungen, warnt jedoch vor einer zeitlichen Lücke zwischen kurzfristig umsetzbaren Maßnahmen zur Befähigung und Teilhabe und der längerfristigen Regulierung und Umgestaltung digitaler Plattformen. Aus kinder- und jugendpsychiatrischer Sicht müssen strukturelle Schutzmaßnahmen priorisiert werden. Gefordert werden Safety by Design and by Default, wirksame datenschutzschonende Altersverifikation und vorsorgliche Zugangsbeschränkungen bis zum Sicherheitsnachweis, der Ausbau gestufter Prävention und Hilfesysteme, die frühe Förderung von Selbst- und Emotionsregulation und Medienkompetenz, konsequenter Forschungsdatenzugang sowie die Förderung kindgerechter europäischer Angebote. Effektiver Schutz ist Voraussetzung für wirksame Befähigung und nachhaltige Teilhabe.
Precision medicine has transformed several areas of pediatrics, whereas diagnostic assessment and treatment in child and adolescent psychiatry continue to rely predominantly on syndrome-based classification systems. This narrative review examines the opportunities and limitations of applying precision psychiatry in children and adolescents. We summarize key conceptual frameworks, including the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and developmental psychopathology as well as methodological approaches such as genetics, neurophysiology, digital phenotyping, and machine learning. We further discuss potential clinical applications in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, depressive disorders, and the early detection of psychosis. In addition, this article critically reviews the methodological, developmental, ethical, and practical challenges associated with implementing precision psychiatry in routine clinical care. Although precision psychiatry holds considerable promise for improving early detection, prognostic assessment, and individualized treatment selection, most approaches remain at the research stage. The integration of biological markers with developmental psychopathology and comprehensive clinical assessment appears particularly promising for advancing personalized diagnosis and treatment in child and adolescent psychiatry.
Objective: Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) is one of the few evidence-based treatment programs aimed at reducing child neglect and maltreatment. It has been implemented in the Canton of Basel-Stadt for 10 years. To justify both the high treatment intensity provided to individual families and the comparatively high per-family treatment costs associated with this approach, multisystemic therapy programs have long been required to demonstrate their effectiveness. This study examines the treatment outcomes of MST-CAN in Basel over the past decade. Methods: Using a longitudinal study design with four measurement time points (MTP), we collected sociodemographic data from 124 parent-child dyads (children's age M = 11.2; parents' age M = 43.5), along with primary treatment outcomes, children's emotional and behavioral problems, neglect, and therapist adherence. We analyzed the differences between MTP and three defined time periods using analyses of variance. To examine therapist effects, we calculated multiple linear regressions. Results: The sociodemographic characteristics of the families changed over time. Overall, the primary treatment outcomes met MST standards. Child emotional and behavioral problems as well as neglect decreased with large and moderate effect sizes, showed no differences between the periods, and remained largely independent of the treating therapists. Conclusions: MST-CAN demonstrated consistently high treatment quality over the past 10 years.
