Most nationally and internationally adopted children are well-adjusted, but preadoptive adversity and parental factors can increase the risk of emotional and behavioral problems. Some problems may even arise later in childhood and adolescence. Data analysis from a German longitudinal study aimed to investigate the course of children’s emotional and behavioral problems and examined the impact of both preadoptive and postadoptive factors. We conducted a prospective longitudinal study with 94 children and their adoptive parents. Wave 1 was conducted on average 33 months after placement of the child in the adoptive family, and Wave 2 took place on average 43 months after Wave (1). Adoptive parents provided information about the children’s preadoptive history. Information about emotional and behavioral problems was obtained from the parental version of the Strengths and Difficulties Questionnaire (SDQ). Parental stress and well-being were obtained through the Brief Symptom Inventory (BSI) and a Self-Efficacy Questionnaire. The results indicated that, according to parental reports, adopted children’s emotional and behavioral problems increase over the first six years after placement and tend to persist within the study period. Concerning the longitudinal development, early clinical range problems were the best predictor for subsequent problems. Additionally, adoptive parents’ psychological distress and perceived self-efficacy predicted the level of emotional and behavioral problems at Wave (2). The results highlight the need for early identification of families at risk and underscore the importance of flexible and easily accessible post-adoptive support aiming at strengthening parental well-being and self-efficacy. Emotional and behavioral problems in adopted children increase over the first years after placement and tend to persist. Early clinical range problems increase the odds of subsequent emotional and behavioral problems in adopted children. Psychological distress in adoptive parents increases over time and predicts emotional and behavioral problems in adopted children, while parents’ self-efficacy operates as a protective factor. Adoptive families at risk need to be identified at an early stage.

Background Social workers play a crucial role in addressing the needs of unaccompanied young refugees (UYRs), but the impact of institutional factors on the success of evidence-based programs remains unclear. Objective This study examines factors influencing organisational readiness for change (ORC) in Children and Youth Welfare System (CYWS) facilities caring for UYRs. Participants and setting In a survey of N = 148 CYWS facilities all over Germany, 148 facility directors (Mage = 44.89; SDage = 11.15; 62.7% female) participated. Methods This research utilized a quantitative design to gain a broader and more in-depth understanding of the motivation and institutional capacities needed to support mental health care for UYRs. The participants provided information about the facility structure and characteristics, evaluation of the care provided for mental health within and outside the facility, and preparedness for UYRs’ mental health problems. The ORC was assessed using an adapted (shorter) version of the Readiness Monitoring Tool (RMT). For the analyses, predictors such as preparedness, staff turnover, supervision, and experience with UYRs were used. Results Institutional preparedness for UYRs’ mental health needs was moderate (M = 6.20, SD = 1.78). Gender did not impact ORC. Staff turnover (45.2%) and supervision availability (98.0%) influenced organisational readiness. General capacity correlated with institutional preparedness, staff turnover, and experience, while innovation-specific capacity was linked to preparedness and supervision. Regression analyses showed institutional preparedness as a key predictor for both subscales, explaining significant variance (general: R2 = .494; innovation-specific: R2 = .370). Experience reduced general capacity. Conclusions The results indicated that successful and sustainable change processes within CYWS facilities rely on profound and individually adapted preparation involving all facility members. In terms of policy and implementation of interventions, host country stakeholders must develop strategies to mitigate stressors and foster an environment conducive to effective, high-quality social work, thereby better equipping social workers for organisational change.

Background Child and Youth Welfare Service (CYWS) facilities are an essential source of support and recovery for unaccompanied young refugees (UYRs) with traumatic experiences. Their mental health is affected by pre-, peri-, and post-flight stressors, with the residential setting playing a crucial role in increasing or reducing these risks. Objective This longitudinal study aimed to analyze how institutional factors in CYWS facilities influence UYRs’ mental health over a one-year period. Participants and setting We included N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.7 % male) living in N = 22 residential group homes in Germany. Methods Standardized questionnaires were used to assess posttraumatic stress symptoms (PTSS), depression, and anxiety symptoms. Additionally, facility directors or social workers completed a questionnaire on facility characteristics, and the research team evaluated workload, staffing, and accommodation quality. Findings Lower staff workload predicted lower PTSS, depression, and anxiety scores among UYRs after one year. Living in UYR-specific groups also predicted lower PTSS scores. Open group climate after six months (T1) mediated the association between accommodation quality rating and PTSS, depression, and anxiety, as well as between UYR-specific group and PTSS and depression. Conclusion The institutional environment has an important impact on UYRs’ mental health. An institutional environment with sufficient staff, a high accommodation quality, and UYR-specific groups is beneficial for reducing the mental health burden.

Unaccompanied young refugees (UYRs) are at an elevated risk of continuing psychological distress, including posttraumatic stress symptoms (PTSS), depression, and anxiety. The post-arrival situation in a host country plays an important role in increasing or reducing mental health risks for UYRs. This study aimed to examine the trajectory of psychological distress and post-migration factors experienced by UYRs in Germany with five assessments every six months over a two-year period. Standardised self-report questionnaires were used to assess PTSS (CATS-2), depression (PHQ-9), and anxiety (GAD-7) symptoms. Material and social stressors (DSSYR), sociocultural adjustment (BSAS), frequency of contact with family members, and distress regarding asylum status were included as post-migration factors. N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.1% male) living in residential care facilities in Germany were included in this study. There was a significant loss to follow up with n = 77 after 12 months at T2 (59% attrition), and n = 37 after 24 months at T4 (28% attrition). At baseline, clinically relevant symptom scores were found in 48.1% for PTSS, 42.0% for depression, and 22.9% for anxiety. Analysis of latent growth curve models revealed that the symptom severity of depression and anxiety did not change substantially over one year, but PTSS showed a significant decline. The number of traumatic events affected initial levels of mental health problems but not their trajectory over time. The impact of post-migration factors varied between measurement points and outcome measures and did not result in a homogeneous pattern. Despite limitations, this study demonstrated the persistence of high levels of psychological distress in UYRs. Effective interventions are required at an early stage to prevent chronic trajectories and support systems should adapt to constantly changing circumstances. Trial registration number/date of registration: DRKS00017453/11th December 2019.

BackgroundUnaccompanied young refugees (UYRs) show elevated levels of mental distress such as post-traumatic stress symptoms (PTSS), depression, and anxiety. The individual post-arrival situation in the host country plays an important role in increasing or reducing mental health risks for these vulnerable children and youth. The study aims at examining the impact of pre- and post-migration factors on the mental health of UYRs.MethodsA cross-sectional survey of N = 131 young refugees (81.7% male, M = 16.9 years old) was conducted in 22 children and youth welfare service (CYWS) facilities in Germany. The participants provided information about pre- and post-flight experiences. Standardized measures were used to assess post-traumatic stress symptoms (CATS-2), symptoms of depression (PHQ-9), and anxiety (GAD-7). Daily stressors were assessed with the Daily Stressors Scale for Young Refugees (DSSYR), sociocultural adaptation with the Brief Sociocultural Adaptation Scale (BSAS), satisfaction with social support with the Social Support Questionnaire (SSQ6-G).ResultsOur results demonstrated clinical levels of PTSS in 42.0% of the participants, depression in 29.0%, and anxiety in 21.4%. Hierarchical regression analyses revealed that a higher number of traumatic events and social daily stressors predicted higher levels in all three domains of mental health problems. PTSS and anxiety were also predicted by the distress related to the residence status, depressive symptoms were additionally predicted by sociocultural adaptation, less family contact and length of stay. The satisfaction with social support was not a significant predictor in the regression models.ConclusionUnaccompanied young refugees in CYWS facilities are a highly vulnerable population. As traumatic events, daily stressors and level of contact to family directly impacted UYRs mental health, interventions should be trauma-focused, but also contain modules on how to cope with daily stressors. On the policy and practical level, stakeholders in host countries are called for establishing measures to reduce post-migration stressors and enhance support for UYRs on all levels.

A wide range of studies have shown that unaccompanied refugee minors (URMs) exhibit a high risk of developing mental health problems. During the past two decades, there has been growing research interest in investigating risk factors after arrival in a host country. To date, a systematic understanding of how aspects of the asylum process affect the mental health of URMs remains lacking. In this scoping review, a systematic literature search of four databases and search engines was performed. Ten studies conducted in European countries were included in this narrative review. The asylum process as a risk factor was mainly operationalized through the assessment of asylum or residential status. Mental health outcomes ranged from standardized questionnaires to semi-structured clinical interviews. Refusal of asylum had a negative effect on the well-being of URMs in most of the included longitudinal studies as it produces a situation of instability and fear of return. However, qualitative synthesis of all the study results revealed inconsistent findings on the influence of asylum status and waiting time on PTSD and internalizing symptoms. Therefore, future studies are needed to investigate the role of factors related to the asylum process in the mental health of URMs. Both mixed-methods designs within one country and cross-country studies are recommended.

Background: More than half of the unaccompanied young refugees (UYRs) resettled in Europe report elevated levels of posttraumatic stress symptoms (PTSS) and comorbid symptoms. Earlier studies have highlighted the effectiveness of the trauma-focused preventive group intervention ‘Mein Weg’ (English ‘My Way’), and the feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) for UYRs. Both interventions are deemed to be empirically supported treatments (ESTs). However, UYRs seldom receive ESTs or, in fact, any treatment at all. In view of the high need and the limited treatment resources available, a stepped-care approach is indicated but has not been evaluated so far. The purpose of this trial is to compare the stepped-care approach BETTER CARE with usual care enhanced with screening and indication (usual care+). Methods: In a cluster randomized controlled trial involving N = 540 UYRs living in up to N =54 child and youth welfare service (CYWS) facilities, BETTER CARE will be compared with usual care+. We will randomize clusters comprising a CYWS facility with at least one eligible psychotherapist. BETTER CARE consists of step 1) screening and indication and either step 2) preventive trauma-focused group intervention ‘Mein Weg’ delivered by trained CYWS staff or step 3) TF-CBT delivered by trained community therapists and supported by trained translators if necessary. Participants will be assessed 6 and 12 months after randomization. The primary outcome is the severity of PTSS after 12 months. Secondary outcomes are depressive and anxiety symptoms, quality of life, and proxy reported PTSS. Furthermore, drug use, health costs, benefits and long-term effects on integration/acculturation will be assessed. Discussion: The trial will directly integrate a stepped-care approach into existing structures of the German child welfare and (mental) health system. It could, therefore, serve as a blueprint for how to implement ESTs for UYRs. If successful, screening, prevention and intervention will be sustainably implemented in CYWS in southern Germany. Trial registration : German Clinical Trials Register, ID: DRKS00017453. Registered December 11 th , 2019. URL: https://www.drks.de/drks_web/setLocale_EN.do

BACKGROUND:Early adversity and negative experiences in the adoptive family can put adopted children at risk for emotional and behavior problems.OBJECTIVE:This study analyzes the influence of children's preadoptive history and adoptive parents' characteristics on the psychosocial adjustment of nationally and internationally adopted children in Germany.PARTICIPANTS AND SETTING:The survey included 172 adopted children aged between 24 and 145 months and their adoptive parents.METHODS:Parents provided information about preadoptive history. Information about emotional and behavior problems was obtained from the parental version of the Strengths and Difficulties Questionnaire (SDQ). Parental well-being was obtained through a composite score of three standardized measures (self-efficacy questionnaire, Perceived Stress Scale PSS-4, Brief Symptom Inventory BSI); parenting behavior was assessed with the Alabama Parenting Questionnaire (DEAPQ).RESULTS:12.5% of the adopted children scored in the clinical range of the SDQ. In a multiple regression analysis, the experience of maltreatment and neglect was the most important predictor of emotional and behavior problems at time of assessment, followed by pre- and perinatal risk and parental stress regulation difficulties, R² = .423, F(4, 128) = 28.539. Increases in the number of risk factors present were associated with a greater odd of children scoring in the clinical range of the SDQ.CONCLUSIONS:Most of the nationally and internationally adopted children in this sample were well-adjusted. Prenatal and preadoptive risk as well as stress regulation capacities of the main caregiver contributed to the child's development. An accumulation of risks increased the likelihood of adjustment problems in adopted children.