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Hintergrund: Zur psychotherapeutischen Inanspruchnahme von Kindern und Jugendlichen in Deutschland liegen bislang kaum Ergebnisse vor. Im Allgemeinen ist die Inanspruchnahme von psychotherapeutischen Versorgungsangeboten vor dem Hintergrund erheblicher Barrieren zu sehen, die sowohl von den Eltern als[for full text, please go to the a.m. URL], 12. Deutscher Kongress für Versorgungsforschung

RICHE was the response to a call under HEALTH-2009-3.3-5, with the title of 'European child health research platform'. The call text asked us to “address the diversity and fragmentation in child health research in Europe in an inclusive multidisciplinary way, identifying existing research programmes in Member States, recent advances and identification of gaps to explore road maps for the future of child health research in Europe”. Project structure A consortium, with a final total of 23 partners, and two associate (i.e. unfunded) partners, responded to this call. We designed a project with a linear structure, where the main focus of activity moved from work on the Inventory, and Indicators and Measurement, in Year 1, to work on Gaps in Year 2, finishing with the preparation of the Roadmap in year 3. The final 6 months (Year 4) were largely dissemination. The Platform, which is instantiated in our website, supported all of the other parts,, and was a focus for communication and dissemination throughout the project. Each workpackage focused on a specific area of work, but each fed into its successors, and all leaders and partners worked closely together. Each group produced a number of technical reports and other outputs. The final output was a Roadmap for future investment in European child health research. This has been widely disseminated, and has fed at Commission level and National level into the Horizon 2020 call preparation process. RICHE Roadmap The RICHE Roadmap is based upon a sound, scientific evidence base, which we had gathered as part of our earlier work. The project prepared an inventory of child health research and of measurements and indicators of child health in Europe (WP1 and WP2) . This was collated using a web platform – which can be found at www.childhealthresearch.eu. In addition to this exercise, a formal study of the gaps in child health research was undertaken by carrying out surveys and interviews of researchers and research users across Europe (WP3). This allowed our initial views on the research gaps to be refined and corrected by an iterative process, involving, both project partners, and the wider scientific community, so seeking grounding and validation for this key phase. These results formed the basis for the RICHE Roadmap. The Roadmap is based on a life-course perspective. It covers the important phases of a child’s development, including maternal health, and pregnancy, through to adolescence and the protective and risk factors, and health services encountered throughout childhood and adolescence as he or she moves towards adulthood. RICHE looked upstream to identify where more work needed to be done to prevent avoidable physical and mental ill-health, disability and death in the population of European children aged 0-18 years. This shows how the many influences and outcomes of children’s health are interrelated; a pattern reflected in the Roadmap. The work necessarily involved a series of value judgements, especially on setting priorities, because there are no objective and unconditionally valid answers to the question “Is there enough research on this topic?”, nor to the question “Is this a topic of significance?”. Nevertheless, the RICHE Roadmap uses an inclusive and transparent process to explain the recommendations it made, and the subjects it chose, making our values, and the reasons for judgements as explicit as possible. The report is organised into broad subject areas, that reflect the key ‘gaps’ in knowledge about children and young people, or about particular aspects of their lifestyle and health. These key areas, and selected findings within each area, are briefly summarised here. Life Course and Lifestyle This section focuses on children as they age, and recognises the importance of continuing to research how factors before conception, during gestation and in the very early years of life can affect present and future health. The challenges that children face as they grow up are also highlighted – these can be created because of policy decisions that fail to take account of children and young people’s lives or because of the pervasive influences of individual circumstances that act ask protective or risk factors for children’s actions. The concept of resilience in childhood is also highlighted, and how research needs to focus on this important and powerful means of improving children’s lives. A key issue, throughout the life course, is mental health and well-being. Fostering well-being in children from birth, and throughout childhood will provide numerous individual and societal benefits. It deserves a greater research focus. Socio-economic and Cultural Factors The socio-economic and cultural environment in which a child is born and grows up has a potent effect on a child’s health and well-being. Inequity and inequalities in health, between and within nations depending on socio-economic circumstances, are known to affect health outcomes. Those in the poorest areas have worse health, and shorter lives than those in the wealthiest areas. Other groups are at risk of marginalisation from health services and from opportunities that can maximise their health. These include migrant children where the question is how best to support their integration into their new societies and communities, while retaining their individual identity; children in the state care system have poor health and social outcomes, so improving these, by focused research is important for the future health of these children; children from minority population groups, in particular those who travel across nations, such as the Roma, need to have focused attention, to ensure that their health outcomes begin to match those of the general European child population. Social and Community Networks The main influences on children and young people are their immediate family and community networks. This extends from the influence of the family as a warm and nurturing environment in which to grow up – and conversely a place of the most profound danger and threat if such a family environment is toxic; to the wider influence of school, and finally the broader community. Becoming engaged and involved in community life is beneficial for the entire population, not just for the children and young people directly involved. It is an aspect of children and young people’s experience that is important for well-being and social inclusion. Environment The term 'environment' covers several different concepts, and the RICHE Roadmap describes the physical, virtual and also the perceived environment – all of which interlink in children’s lives, and have a profound effect on their health and development. These include the physical environment, the virtual (digital) environment, physical safety, including injury prevention, and protection form crime, anti-social behaviour and violence (both as perpetrators and victims). Complex Health Issues The majority of children in Europe are healthy, and ill-health is not a characteristic of this population as it is in, for example, an ageing population. However, there are certain health issues that affect children, and as such can blight an entire lifetime. Our Roadmap does not cover clinical issues, but takes a population perspective. There are certain disorders that have a population-wide effect and are prevalent enough in the child population to warrant particular attention from a public health viewpoint. Four specific areas of concern were identified – overweight and obesity, mental health, sexual and reproductive health, and neuro-developmental disorders. Health Services The main research needs of the health services focuses on the prevention of poor health. Comparing health services across Europe and evaluating the means of conveying health promotion messages are important directions for health research to investigate. Indicators need developing which reflect the effect of preventive actions, particularly among younger children. Vulnerable populations, such as those in deprived communities, need to have health prevention services particularly targeted. There is little systematic evaluation of such interventions, which compromises the development of new interventions and their implementation. Those who do not access services and those who need particular attention can be identified. Public Health Infrastructure Health surveillance is essential so that health needs can be identified and addressed effectively for the benefit of the child population. Yet, many existing sources of data are neither analysed, nor made available in a child-centric way. Children need to be made more visible in the data so that they can have more effective health promotion and health care on a population level. Specific examples include work on autism and morbidity due to injury. Europe also needs to establish proper measures and indicators of children’s health and children’s lives. We cannot act properly without first identifying and measuring the problem. Electronic health records are an emerging technology that has great potential, both for research, and for improved access to care. They need to be developed and investigated further to encourage their use across the European Union. Improving Research Capacity It is necessary to ensure that there are enough resources, both to do research, and to make use of the research findings. To sustain research activity, specialist training for junior child health researchers is needed, as are sufficient resources to maintain a critical mass of researchers and provide attractive career paths for them. Children and young people as subjects of research need to continue to be safeguarded by a consistently ethical framework, and information collected about children needs to be accurate, comprehensive and used intelligently so that interventions and services can be correctly directed. Using the roadmap The roadmap is a complex document, addressed to a number of different stakeholders. One key group are those who make decision bout research finding priorities. We have disseminated the roadmap widely at EU level, to reach into the process of priority setting for Horizon 2020. This has been done thought National Contact Points in each partner country, through relevant NGO's, and by sending copes to and meeting with relevant parts of the European Commission. Readers using the roadmap will most likely use it in two ways, first to make a general case for investment in Child Health Research, and secondly to target that investment, by considering the questions we have identified, and reviewing our justifications for these choices. We do not expect our work to determine future investments in child health, but we are confident that using our work would lead to better decisions overall. Conclusions Our core value is to put children first in our work. We take the rights of the child seriously, and we are conscious that many children do not have the opportunity to exercise the right to health and healthcare that European children they ought to have. The topics in this Roadmap are pragmatic in that they are researchable (within the grasp of presently available research methods and resources) and that are likely to have a significant effect on the lives of European children. This will go a considerable distance in improving the health and well-being of European children who may not have benefited from Europe’s good fortune up until this point. At the very least, the RICHE Roadmap aims to begin a serious conversation across Europe about the need for research to focus on children and how this will ultimately benefit all members of the European population. There is a need for children to become substantially more visible in European society. At present many children’s lives are invisible to health surveillance and to research. Sometimes they are submerged with their families, as in the case of Roma or for children of illegal and undocumented immigrant families. Even in well-documented societies, children’s circumstances are invisible as data are collected from the perspective of economically active adults, or households. Therefore, an overarching recommendation in this road map is the establishment of a European Child Health Observatory with a simple remit to make European Children, and their lives, health and attainment of rights more visible. We also recommend continuing and extending the discussion to the edge of existing child health boundaries, to address topics such as the effects on children’s health of urban design and architecture, fiscal policy (which can affect many health issues), welfare, or health effects of immigration policy. The RICHE Roadmap hopes to point the way in which children can be fully recognised and respected as forming a valuable population and whose health and well-being contributes to the health of our present and future European society.

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - N. 2 (2010). - p. 87-104. The KIDSCREEN is a European cross-cultural and standardized instrument that assesses ten dimensions regarding quality of life in children, adolescents and their parents. The objective of this study is to use the KIDSCREEN-52 in order to assess interpersonal differences during pre adolescence and adolescence in Portugal. The present study focuses only in the children' and adolescents' versions of KIDSCREEN-52. A sample of 3195 children and adolescents from 5th grade (48,8%) and 7th grade (51,2%), mean age 11,8; SD 1,46; 49,2% boys, were inquired. Using ANOVAs, the differences according to gender, age, socio-economic status, migrant status and health conditions were identified. KIDSCREEN-52 questionnaire is a sensitive instrument to estimate the perception of quality of life in children and adolescents. The differences according to gender, age, socio-economic status, migrant status and health conditions, agree with the literature. The relevance of these findings will be discussed within Portuguese reality. (Tânia Gaspar, [et al.])

Revista de Psicologia da Criança e do Adolescente. - ISSN 1647-4120. - N. 1 (Abril 2010). - p. 49-64. The KIDSCREEN is a European cross-cultural and standardized instrument that assesses ten quality of life dimensions in children, adolescents and their parents. The get validity evidences to support general inferences on quality-of-life measures obtained by Portuguese version of KIDSCREEN-52 for children and adolescents, in the context of a survey research. The present study focuses only in the KIDSCREEN children and adolescents versions. A sample of 3195 children and adolescents from 5th grade (48,8%) and 7th grade (51,2%), mean age 11,8; SD 1,46; 49,2 % boys, were inquired. KIDSCREEN instrument showed a good internal consistency for most of the 10 subscales, with a lower value for a self-perception (á= 0, 60) and the highest for financial resources (á= 0, 88). In order to test the theoretical model fit index an exploratory factor analysis and a confirmatory factor analysis were used. The RMSEA value was 0, 06 can be consider a good fit index. The CFI value is 0, 97 and NNFI is 0,97 reflecting both an excellent fit index.KIDSCREEN-52 questionnaire is a reliable instrument to estimate the perception of quality of life in children and adolescents. (Tânia Gaspar... [et al.])

Udgivelsesdato: 2009-Sep OBJECTIVES: To describe the methodological development of the HBSC survey since its inception and explore methodological tensions that need to be addressed in the ongoing work on this and other large-scale cross-national surveys. METHODS: Using archival data and conversations with members of the network, we collaboratively analysed our joint understandings of the survey's methodology. RESULTS: We identified four tensions that are likely to be present in upcoming survey cycles: (1) maintaining quality standards against a background of rapid growth, (2) continuous improvement with limited financial resources, (3) accommodating analysis of trends with the need to improve and adapt questionnaire content, and (4) meeting the differing requirements of scientific and policy audiences. CONCLUSIONS: While these challenges are not trivial, the structure of the HBSC network and its long-term experience in working through such challenges renders it likely that HBSC can provide a model of other similar studies facing these tensions.

This paper traces the history of the HBSC study from its origins in the early 1980's to the present day describing how it was first conceptualised scientifically and how this influenced issues of study design. The challenges of managing a cross-national study are explained as are changes and adaptations over time with growth of the study from 3 to over forty country members. The key partnership with the World Health Organisation and its benefits are presented. With developments in scientific management and theoretical perspectives, HBSC has made a substantial contribution to the area of youth health. The last decade has seen increased dissemination to policy makers and evidence that scientific information arising from the study has influenced strategic policy development and practical health improvement programmes. This paper considers some of the key success factors and challenges for the study as it attempts to maximise its scientific output and channels the research findings into health improvement for young people. Future challenges for the study are also considered. peer-reviewed

Objective: There are few health-related quality of life (HRQOL) instruments available that have been validated for use with Turkish children, The Kid-KINDL is a generic measure of children's (8-12 years) HRQOL, which contains 24 categorical items that assess 6 dimensions (physical well-being, emotional well-being, self-esteem, family, friends, and school). The Kid-KINDL is available in many languages. Following on elaborate translation procedure and cognitive focus group interviews, the Kid-KINDL was adopted into Turkish. This paper describes the psychometric properties of the new Turkish Kid-KINDL.

Background The objective of the present study was to compare three different sampling and questionnaire administration methods used in the international KIDSCREEN study in terms of participation, response rates, and external validity. Methods Children and adolescents aged 8–18 years were surveyed in 13 European countries using either telephone sampling and mail administration, random sampling of school listings followed by classroom or mail administration, or multistage random sampling of communities and households with self-administration of the survey materials at home. Cooperation, completion, and response rates were compared across countries and survey methods. Data on non-respondents was collected in 8 countries. The population fraction (PF, respondents in each sex-age, or educational level category, divided by the population in the same category from Eurostat census data) and population fraction ratio (PFR, ratio of PF) and their corresponding 95% confidence intervals were used to analyze differences by country between the KIDSCREEN samples and a reference Eurostat population. Results Response rates by country ranged from 18.9% to 91.2%. Response rates were highest in the school-based surveys (69.0%–91.2%). Sample proportions by age and gender were similar to the reference Eurostat population in most countries, although boys and adolescents were slightly underrepresented (PFR Conclusion School-based sampling achieved the highest overall response rates but also produced slightly more biased samples than the other methods. The results suggest that the samples were sufficiently representative to provide reference population values for the KIDSCREEN instrument.

Objectives: Various health-related quality of life (HRQoL) instruments for children and adolescents have been developed and are applied in clinical and health economic studies with the research focus on the HRQoL of specific groups of responders, comparing these groups respectively. However, if HRQoL assessment aims to contribute on deciding upon a suitable individual treatment and the evaluation thereof, as well as to identify hidden morbidities, an individual diagnostic perspective is required.To date, the majority of HRQoL questionnaires for children and adolescents are not designed for individual diagnostic assessment and comparison. This paper aims to demonstrate that should a particular measurement tool meet specific psychometric requirements - an individual diagnostic assessment on mental health related problems is possible. We investigated whether or not the KIDSCREEN-27 HRQoL instrument for children and adolescents is able to detect mental health problems in general, provided we apply a principal component analysis (PCA) for summative scaling.Methods: The cross-sectional survey of the KIDSCREEN project was carried out in 13 European countries (AT, CH, CZ, DE, EL, ES, FR, HU, IE, NL, PL, SE, UK). The Rasch-scaled KIDSCREEN-27 test-data of 22,830 children and adolescents were analysed. To achieve a summative scaling PCA was performed on the correlation between the KIDSCREEN-27 scores. The principal component (PC) values were estimated and used to score the respondents. The reliability and diagnostic quality of this scoring was examined.Results: The first PC accounted for 58.28% of the entire variance within the KIDSCREEN-27 scores. All KIDSCREEN scales loaded high on the first PC. The reliability of the linear combination of KIDSCREEN-27 scores with the PC-values was rr=.94 and thus above the threshold for individual comparison. This value was higher than the values for the original single KIDSCREEN-27 scores (rr=.78-.84). The receiver operating characteristic curve (ROC) was calculated whilst screening for respondents with a mental health problem in general (Strengths and Difficulties Questionnaire). The area under the ROC (AuC) was .80 and statistically significant lower than the AuC issued after a logistic regression analysis employing the 5 original KIDSCREEN-27 scores (AuC=.83). However, according to international conventions, both AuCs denote a "good" discrimination.Conclusion: Specifically for the KIDSCREEN-27 the results show that the application of a specific scoring algorithm leads to fulfil pre-specified demands of high reliability. The applied scoring approach leads to a good discrimination of the measurement, thus enabling to detect a mental health problem in general using the HRQoL test-data. The presented approach can enhance the usability and range of application of HRQoL measurement. Zielsetzung: Diverse Instrumente zur Messung der gesundheitsbezogenen Lebensqualität (HRQoL) von Kindern und Jugendlichen wurden entwickelt und werden in klinischen und gesundheitsökonomischen Studien eingesetzt, mit dem Forschungsschwerpunkt auf der Untersuchung der HRQoL von Gruppen, bzw. entsprechenden Gruppenvergleichen. Sofern die Erfassung der HRQoL zur Entscheidung über- und der Bewertung von- individueller Behandlung sowie zur Identifizierung nicht entdeckter Morbidität beitragen soll, wird jedoch eine individualdiagnostische Perspektive benötigt.Die Mehrheit der heutzutage verwendeten HRQoL Instrumente für Kinder und Jugendliche sind nicht für Individualdiagnostik ausgelegt. In dieser Arbeit wird demonstriert, dass sofern ein Messverfahren bestimmte psychometrische Kriterien erfüllt, eine brauchbare Individualdiagnostische Erfassung von mentalen Problemen möglich ist. Speziell für den KIDSCREEN-27 HRQoL Fragebogen für Kinder und Jugendliche wurde untersucht ob die Anwendung einer Hauptkomponentenanalyse (PCA) zur summativen Skalierung, die Identifizierung von mentalen Gesundheitsproblemen ermöglicht.Methodik: Die als Querschnitterhebung konzipierte Studie des KIDSCREEN Projektes wurde in 13 Europäischen Ländern (AT, CH, CZ, DE, EL, ES, FR, HU, IE, NL, PL, SE, UK) durchgeführt. Die Rasch-skalierten KIDSCREEN-27 Testdaten von 22.830 Kindern und Jugendlichen wurden analysiert. Zwecks summativer Skalierung wurde eine PCA der Korrelationen zwischen den KIDSCREEN-27 Skalen durchgeführt. Die Hauptkomponentenwerte (PC) wurden berechnet und zur Skalierung der Befragten verwendet. Die Reliabilität und diagnostische Qualität dieses Skalierungsansatzes wurde untersucht.Ergebnisse: Die erste PC erklärte 58,28% der Gesamtvarianz der KIDSCREEN-27 Skalen. Alle KIDSCREEN-27 Skalen luden hoch auf der ersten PC. Die Reliabilität der linearen Kombination der KIDSCREEN-27 Skalen zu PC Werten war rr=,94 und lag damit über dem Grenzwert für individuelle Vergleiche und war höher als die Reliabilität der ursprünglichen einzelnen KIDSCREEN-27 Skalen (rr=,78-,84).Die Receiver Operating Characteristic Curve (ROC) wurde berechnet beim Screening nach Befragten mit mentalen Gesundheitsproblemen (Strengths and Difficulties Questionnaire). Die Fläche unter der ROC (AuC) betrug ,80 und war statistisch signifikant kleiner als die AuC berechnet nach einer logistischen Regression unter Verwendung der fünf ursprünglichen KIDSCREEN-27 Skalen. Entsprechend internationaler Konventionen können jedoch beide AuCs als "gute" Diskrimination bewertet werden. Fazit: Spezifisch für den KIDSCREEN-27 zeigen die Resultate dass ein spezifischer Skalierungsansatz dazu führt die a-priori spezifizierten Ansprüche einer hohen Reliabilität zu erfüllen. Der angewandte Skalierungsansatz führt zu einer guten Diskrimination der Messung und ermöglicht die Identifizierung von mentalen Gesundheitsproblemen durch HRQoL Testdaten. Der vorgestellte Ansatz kann die Brauchbarkeit und die Anwendungsbreite der Lebensqualitätsmessung erweitern.

Gesundheitsbezogene Lebensqualität ist ein relevantes Kriterium zur Erfassung von Wohlbefinden und Funktionsfähigkeit bei chronisch kranken Kindern und Jugendlichen. In der vorliegenden Studie wurde die Lebensqualität von Kinder und Jugendlichen aus 7 Rehabilitationskliniken mit der Diagnose Asthma, atopische Dermatitis oder Adipositas (N = 1020, 8 - 17 Jahre) mit Hilfe des Lebensqualitätsfragebogens (KINDL-R) erfasst. Hinzu kamen psychosoziale und klinische Charakteristika vor und nach einem stationären Rehabilitationsaufenthalt sowie katamnestisch bis zu einem Jahr nach der Rehabilitation. Es zeigten sich geschlechts-, alters- und diagnosespezifische Einschränkungen der Lebensqualität aus Sicht der Kinder. Im Zeitverlauf steigerte sich besonders die Lebensqualität der Kinder mit Adipositas, speziell höheren Schweregrades. Psychosoziale Prädiktoren der Lebensqualität nach einem Jahr waren Krankheitsbewältigung, familiärer Zusammenhalt und Stresserleben. Die Studie zeigt, dass die Lebensqualität von chronisch kranken Kindern und Jugendlichen erfassbar ist und dass diese Kinder von rehabilitativen Maßnahmen profitieren. Um die Bedeutung von Lebensqualität in Prävention und Rehabilitation chronischer Krankheiten zu beurteilen, sind weitere Studien nötig. Schlagwörter: chronische Krankheit - gesundheitsbezogene Lebensqualität - KINDL-R-Fragebogen - Kinder und Jugendliche Health related quality of life (QoL) is a relevant criterion to understand well-being and function in children with chronic health conditions. Approaches to assessing quality of life are presented, based on a revision of the German KINDL questionnaire in the course of rehabilitation in three groups of chronically ill children (with diagnosis of asthma, atopic dermatitis or obesity), aged 8 to 17 years. Psychosocial and sociodemographic characteristics prior to, at the end and 12 months after rehabilitation were also assessed. At baseline, gender-, age- and diagnosis-specific impairments in QoL were found. Over time children improved, most clearly in children with obesity. Psychosocial predictors of QoL one year after rehabilitation were identified. The study shows that QoL assessment in children with chronic conditions is feasible and that children profit from rehabilitation programs. To further assess the QoL benefit in paediatric rehabilitation more studies are needed. Key words: health-related quality of life - chronic conditions - KINDL-R-Questionnaire - children and adolescents - rehabilitation

Erziehungswissenschaft 14 (2003) 27, S. 79-108, Die Autoren berichten über „Konzeption, Methoden und Ergebnisse“ des von der Weltgesundheitsorganisation WHO beauftragten Jugendgesundheitssurveys, der im Herbst 2003 erstmals auch für Deutschland vorgelegt wurde. Der Artikel gliedert sich in die folgenden Unterpunkte: 1. Ziele, Anlage und Methode des Jugendgesundheitssurvey; 2. Ausgewählte Untersuchungsergebnisse des Jugendgesundheitssurvey; 2.1 Gesundheits- und Krankenstatus von Kindern und Jugendlichen (Körperliche Gesundheit, Psychische Gesundheit, Soziale Gesundheit); 2.2 Gesundheits- und Freizeitverhalten von Jugendlichen (Tabak-, Alkohol- und Cannabiskonsum, Körperliche Aktivität und Medienkonsum, Ernährungsverhalten und Körperbewusstsein von Jugendlichen, Ernährungsverhalten, Körperbewusstsein); 2.3 Familie und Gesundheit (Auswirkung der Familienformen auf das Gesundheitsverhalten, Die soziale Lage und Gesundheit von Kindern und Jugendlichen, Soziales Kapital und die Gesundheit von Kindern und Jugendlichen); 2.4 Schule und Gesundheit (Die Analyse der Lebenswelt Schule, Der Zusammenhang von Schulkultur und Gesundheit) und schließlich 3. Konsequenzen für Prävention und Gesundheitsförderung. Im letzten Punkt plädieren die Autoren insbesondere für ein möglichst frühes Einsetzen und eine umfassende Ausrichtung der Gesundheitsförderung sowie eine spezielle Förderung sozial benachteiligter Jugendlicher und eine geschlechtsbezogene Gesundheitsförderung sowie Prävention und Gesundheitsförderung in der Schule. (DIPF/ ssch)