Knowing, labeling and dealing controlling one's own emotions to increase well-being of children in a residential youth care: A direct, psychoeducative and child-focused component in a complex intervention “Urban Mental Health” (German Center for Mental Health, DZPG, Bochum/Marburg, Germany)

Background: Children residing in residential youth care facilities (orphanages or group homes) face a heightened vulnerability to mental health challenges. These children are frequently required to exhibit significant adaptational efforts as they navigate new environments and complex social dynamics. Concurrently, they often experience a substantial imbalance between protective and risk factors. Protective factors such as financial stability, educational opportunities, and robust social support are typically diminished, while risk factors are often prevalent, including interpersonal trauma, experiences of child endangerment, and the impact of a disrupted family background. This precarious balance underscores the urgent need for targeted interventions and comprehensive support systems to address the unique mental health needs of this population. This group of children needs special support in their emotional development. Due to their precarious living situation, there is often too little room for their own development. In addition, there often has been a lack of a supportive environment. The children should be supported in recognizing and regulating their own emotions and needs. Research in prevention programs that encourage children to understand and control mental processes including the development of symptoms (e.g. stress) shows significant improvements in social-cognitive skills, emotion regulation and mental health, including a reduction in disruptive behaviors, (Chelouche-Dwek et al., 2024). In addition, group training in elementary schools, for example, shows an improvement in social skills and strengths (e.g. Finne et al, 2017) A key protective factor for mental health is to be able to classify and deal with mental processes in ourselves and others (Werner, 1993). The workshop aims at increasing children’s knowledge about: - Recognizing emotions, - Clarifying the connections between thoughts, behavior and feelings, - Distinguishing between thoughts and feelings to become aware of the ability to control behavior, - knowledge of behaviors for dealing with emotions - adopting perspectives, - knowledge of resilience, resources and risks factors. Learning something new about emotional experiences and drawing on one's own experiences can only happen if there is a relationship of trust with the person teaching (Stucki, 2007). In addition, a positive learning environment that offers safety, support, and stimulation is crucial for children's cognitive, social, and emotional development (Blakemore & Frith, 2005). In this group, the content is therefore embedded in a framework that is based on the effectiveness of - the therapeutic relationship (empathy, acceptance and congruence) - a positive learning environment (tolerant of mistakes and validating) the trainers’ guiding principle to strengthen the children's three basic emotional needs of connectedness (playing, having fun, sharing experiences), autonomy (rituals, no pressure to participate) and competence (learning new information) (Ryan et al. 2019). Method: The sample referred to consists of nine children aged between 8 and 13 who live in a semi-residential youth welfare facility (during the week in the facility and at the weekend with their parents). In their uncertain life situation, the children are psychologically in a state of crisis in which knowledge transfer and the strengthening of basic needs are indicated. And no change processes in behavior can be expected. Listening, watching, taking breaks and sensitive adaptation to the needs of the individual children should be explicitly professionally assessed and respected. In order to avoid psychologically stress to the children, who sometimes have to live in precarious, stressful situations, there are explicitly no requirements for active participation. Stress should not be provoked in the children, even if this can be a side effect of change processes. The intervention is implemented by three persons: A licensed therapist for child and adolescent psychotherapy and a colleague in training as a psychological psychotherapist as well as a research assistant (organizational tasks). A caregiver from the children’s home is present during the sessions so that the children have a familiar contact person. However, she is not given an active role. Knowledge is taught to the children in order to foster their understanding of: 1) the function of emotions and how to deal with them and about 2) the development of stressful symptoms (Petermann, et al. 2019). In addition to mere knowledge and transfer, the intervention works through 1) the effectiveness factors of psychotherapy (Wampold et al., 1997) like the therapeutic relationship (Weinberger, 1995) which is characterized by appreciation, empathy authenticity and the control of transference processes and 2) scientifically proven therapeutic techniques such as psychoeducation and mentalization. The aim is not only for children to be recipients of positive relationship offers, but also for them to perceive adults as role models from whom they can learn positive relationship behavior. The content and methods are adapted as needed during the session. This ensures that the best practice evidence-based approach is adhered to. For example, the group is split up if the children are unable to concentrate or content is carried over to the next week. Adjustments to the concept are recorded on an ongoing basis. In addition to knowledge tests, evaluation also includes satisfaction measurements.1) I felt comfortable in the group 2) The therapists explained it today in a way that the children could understand 3) I can recommend this group to other children Research Question (1) Do the children have more knowledge about the function of emotions (e.g. how to deal with them in a helpful and non-helpful) way after the workshop? (2) Do the children have more knowledge about the development of stressful symptoms (basic knowledge: too much and permanent stress makes you ill, diathesis-stress model) after the workshop? (3) What content and methodological adjustments are necessary to carry out the workshop? The children are satisfied with the workshop, i.e., they find the topics important for themselves, thought it was well explained, and would recommend the group to others. Literature Chelouche-Dwek, G., & Fonagy, P. (2024). Mentalization-based interventions in schools for enhancing socio-emotional competencies and positive behaviour: a systematic review. European Child & Adolescent Psychiatry, 1-21. Blakemore, S. J., & Frith, U. (2005). The learning brain: lessons for education: a précis. Developmental science, 8(6). Klasen, H., Woerner, W., Rothenberger, A., & Goodman, R. (2003). Die deutsche Fassung des Strengths and Difficulties Questionnaire (SDQ-Deu)--Übersicht und Bewertung erster Validierungs-und Normierungsbefunde. Praxis der Kinderpsychologie und Kinderpsychiatrie. Finne, J. N., & Svartdal, F. (2017). Social Perception Training: Improving social competence by reducing cognitive distortions. Petermann, F., & De Vries, U. (2019). Psychoedukation. Lehrbuch der Verhaltenstherapie, Band 3: Psychologische Therapie bei Indikationen im Kindes-und Jugendalter, 191-207. Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford publications. Stucki, C., & Grawe, K. (2007). Bedürfnis-und motivorientierte Beziehungsgestaltung. Psychotherapeut, 52(1), 16-23. Wampold, B.E., Mondin, G.W., Moody, M., Stich, F., Benson, K. & Ahn, H. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, „all must have prizes“. Psychological Bulletin, 122, 203-215. Weinberger, J. (1995). Common factors aren’t so common: The common factors dilemma. Clinical Psychology: Science and Practice, 2, 45-69. Werner, E. E. (1993). Risk, resilience, and recovery: Perspectives from the Kauai Longitudinal Study. Development and psychopathology, 5(4), 503-515.