Aims and benefits
BETTER CARE is a child and youth welfare project funded by the Federal Ministry of Education and Research. It sets out to improve the psychotherapeutic care of young refugees in Bavaria and Baden-Württemberg. The project was developed jointly by the German Youth Institute, the Catholic University of Eichstätt-Ingolstadt and the University of Ulm. Since autumn 2019, child and youth welfare service (CYWS) facilities interested in participating in the project have been actively sought out.
Interested CYWS facilities are still invited to contact us and join BETTER CARE!
As part of the project, CYWS staff receives training in a trauma-pedagogical group prevention program (“Mein Weg”) and registered psychotherapists are trained in a trauma-focused treatment (TF-CBT). In addition, each participating CYWS facility receives the results of the initial mental health screening for all participating adolescents. The screenings results may serve as a base to search for suitable treatment offers for the participating young refugees. Benefits for participating CYWS facilities include improved contacts with psychotherapists in the local area as well as a stronger trauma profile with appropriately trained staff. Almost all related costs are either covered by the BETTER CARE project or by health insurance / child and youth welfare offices.
We are happy to provide you with more information about our project at one of our information events (via video conference). You can find further information on our website at https://bettercare.ku.de/. In case of any questions, please do not hesitate to contact us by phone or email.
BETTER CARE is a stepped care approach for unaccompanied young refugees with mental health problems and consists of the following steps:
- Screening: First, all participants receive a screening with regard to psychological problems and current quality of life. Depending on the treatment needs inferred from the screening, participants receive treatment recommendations.
- Prevention: For participants with mild to moderate psychological symptoms, we developed and implemented the group prevention program “Mein Weg” (Link zu SP2). The content was derived from evidence-based trauma therapies and adapted to both the target group and the CYWS setting in terms of language and content. Main components include psychoeducation, relaxation, trauma narrative (exposure to the experiences) and cognitive restructuring. “Mein Weg” groups are run by trained CYWS staff, who also receive supervision by BETTER CARE staff. Several studies have already shown that participation in prevention leads to a reduction in post-traumatic stress symptoms (PTSS) and depression in young refugees.
- Psychotherapy: For participants showing clinically significant psychological symptoms we offer trauma-focused cognitive behavioral therapy (TF-CBT). For a more detailed description, see SP3 (Link zu englischer SP3 Version).
Main goals of the project:
- To evaluate the effectiveness of the stepped care approach “BETTER CARE”, 54 CYWS facilities (Ø = 10 UYRs per facility; 540 UYRs in total) will be recruited, randomized (BETTER CARE vs. usual care) and assessed over a 12-month period (timepoints: baseline, 6 months, 12 months). The main outcome is PTSS of UYRs.
- “Mein Weg” (see above) will be carried out and implemented in the facilities in the BETTER CARE condition by trained and supervised CYWS staff.
- Registered psychotherapists in direct proximity to the facilities will be trained in TF-CBT. Additionally an improved contact between CYWS facilities in the BETTER CARE condition shall be established (see SP3; Link zu englischer SP3 Version).
- Assessment and evaluation of the cost of care should be assessed and the cost-benefit ratio of the conditions will be evaluated (see SP4; Link zu englischer SP4 Version).
- The institutional readiness of the CYWS facilities to implement interventions will be evaluated (see SP5; Link zu englischer SP5 Version).
- A subsample of at least 60 adolescents should be monitored over a period of 2 years and questioned about the influence of contextual factors such as post-migration stressors, acculturation and group climate (see SP5; Link zu englischer SP5 Version).
The subproject addresses treatment barriers for unaccompanied young refugees (e.g. . limited number of therapy places for trauma-focused, evidence-based psychotherapy for young refugees in Germany). The project aims to improve the psychotherapeutic care of young refugees through the dissemination and implementation of trauma-focused cognitive behavioral therapy (TF-CBT). Within the subproject, interpreters will be prepared for the specific challenges of translating psychotherapies via a certified online workshop.
This subproject is concerned with the health economic evaluation of BETTER CARE interventions from the societal perspective. For this purpose, the health and psychosocial care services used by the study participants in the will be completely recorded and valued in monetary terms, the participants’ subjective quality of life will be assessed and quality-adjusted life years (QALYs) will be generated. These data form the basis for an incremental cost-utility analysis to determine the necessary maximum willingness to pay for one year of life in full health by the BETTER CARE intervention in addition to routine care.
SP5: Improving Mental Health Care for Unaccompanied Young Refugees through a Stepped Care Approach – Institutional Environment
In order to meet the needs of distressed UYR, collaboration between child and youth welfare system (CYWS) and mental health services is crucial. The aim of SP5 is to find out more about existing structures and collaborations between the relevant actors in the field. Collaboration is especially important in the proposed stepped care approach BETTER CARE, therefore we will assess conditions and motivation in CYWS residential care facilities to successfully implement mental health services for unaccompanied young refugees.
With the joint project "BETTER CARE" we want to contribute to the improvement of psychotherapeutic care for unaccompanied young refugees in Germany. Within the project, a stepped care approach will be developed, implemented and compared with the standard care in Germany with regard to its effectiveness. In SP1, the recruitment of youth welfare institutions that are interested in implementing the stepped care approach in their residential groups will be promoted.
"BETTER CARE" develops a stepped care approach to improve psychotherapeutic care for unaccompanied young refugees in Germany. In the sub-project SP2, screenings are conducted together with SP1, which serve as a basis for the stepped care approach. In addition, SP2 is responsible for the subsequent implementation of the preventive group program "My Way".