Multimodal Therapy: Multimodal Therapy

Translated german wikipedia Article

Multimodal therapy in children and adolescents referred to the multimodal psychiatric - psychotherapeutic treatment of children and adolescents in an inter-professional psychotherapeutic center. Synonymous the term "multimodal therapy for children and youth" is used.

Distinction between

The Multimodal children and youth therapy involves the combination of various modalities of treatment. The implementation responsibility of an inter-professional team of child and adolescent therapist. Usually, the multimodal therapy in children and adolescents under specialist medical management performed.
Specific multimodal psychotherapeutic treatment programs and manuals for children and young people often include group modules. Previously targeted multimodal therapeutic programs for children and youth, especially on expansive disorders, such as hyperkinetic disorders , attention deficit disorders , ADHD , ^[1] aggressive behavior, as well as obesity and pain disorders . Multimodal therapy for children and youth is now in Germany, but also in most other child psychiatric disorder applied to images.
Multimodal child therapy / Multimodal Art therapy is an inter-professional psychotherapeutic treatment modality which mainly differs from the policy psychotherapy in individual therapy, that there is no requirement to submit the peer review is and the treatment is in the team and not rely solely on the therapeutic single relationship between doctor and patient. Are centers for children Multimodal Therapy / Youth Multimodal therapy, because of the socio-legal basis of the nationwide Social Psychiatry agreement (SPV), often referred to as social psychiatric practices. In practice, such applications may be made to Policy psychotherapy. The line by appropriately qualified specialists with an authorization for psychotherapy allows.
In Germany there are currently over 500 specialized medical centers, which operate on SPV, to about 100 children and adolescent psychiatric clinics come with sozialpädiatrischem focus and sozialpsychiatrischem supply contract (or social pediatric centers called) with about 500 children and hospital outpatient medical practices. Each of these centers where multimodal therapy is offered to children and young people with an average of approximately 500 treatment sites, which may be assumed that currently treats more than one hundred thousand (estimate Dirscherl Specialist KJPP) children and adolescents with multimodal child therapy in Germany are.
Other forms of multimodal therapy are the multimodal pain therapy , the Multimodal Intenistische therapies (such as Multimodal treatment of diabetes or multimodal therapy of cancer) and the multimodal behavior therapy (by Arnold A. Lazarus ) or psychotherapy , which is not specifically aimed at children and teenagers.

Clinical Application - Modules

Figure Multimodal therapy for children Dirscherl. ^[2]

The Children's Therapy and Multimodal Multimodal youth therapy usually include the following seven modules, which are listed in the following section with the associated methods and techniques:
Module 1 includes the medical diagnosis and therapy.
This is according to the detailed medical history , a differential diagnostic classification made. Is also a physical survey findings . Regulation of drugs and / or the regulation of function therapies, ie occupational therapy or speech therapy must be performed by a qualified physician to. Medical mission is to psychiatric crisis intervention to make when it comes around to the assessment of suicidality. For medical appointments for planning the next steps in the multimodal therapy often results in a family therapy treatment that can be used for targeted interventions.
The doctor in an interdisciplinary child and adolescent psychological center of Social Psychiatry agreement make longer-term development assistance in serious disorder images Beeiträchtigung the social function of the offer and parent counseling and psycho-education and targeted psychotherapeutic interventions and through the line of the therapeutic team, which benefits in his provides behalf and under his direct leadership to bring about relief from the discomfort of the patient.
Module 2 covers the diagnostic test which is mainly carried out by non-medical therapeutic staff.
The exam is on learning disabilities in addition to determining the cognitive performance and the search for clues to family dynamic loads and explore socio-emotional interactions through projective tests in the center. There are self Investigation questionnaires used a emotional testing with respect to anxiety and mood to perform can. More standardized elements represent foreign assessments and behavioral observation , and interaction analyzes interpretation creative expression work dar.
Module 3 includes individual therapy by a therapeutic staff, in weekly intervals a more therapeutic for several years building trust , starting already in the Diagnostk phase can with the goal of a viable therapeutic relationship occur.
In individual therapeutic contact space for is confrontation with difficult issues, using appropriate means of access as artistic therapeutic techniques. Behavior therapy techniques, Narrative Therapy / talks, relaxation techniques , art therapeutic techniques , music therapy, role play and theater therapeutic techniques may be used. Also, play , dance and movement therapy techniques , advice , development support for patients and their relatives attention training , and social learning an important role.
The 4th Module of multimodal therapy for children and youth consists of the very important group therapy .
In most cases small groups of about six to patients under kotherapeutischer line (at least two therapists) with a thoughtful group concept for about 10 sessions in a homogeneous group chosen with uniform occupation. The circumscribed target group should with similar problems have to do and a small difference in age of the group members is essential.
In group art therapy methods, therapeutic methods theater, children are in multimodal therapy, music therapy methods , relaxation techniques , body therapy methods and socio-therapeutic methods of using and stimulation applied through scientific manuals. By linking group modules with a resistant individual therapeutic connections with family and therapeutic medical interventions, the children Multimodal therapy can simultaneously use different starting points.
The module 5, the Interdisciplinary case discussion; they do is the key feature of the multimodal therapy Children / Youth multimodal therapy, which is therefore often described in the Anglo-Saxon world as a multi Professional Child Therapy.
The case discussion in interdisciplinary team provides a fruitful meeting various professional groups represent, with ongoing in-depth discussion will take place with the problems of the patient. Thus, a quality assurance with high diagnostic accuracy in the assessment of critical discourse can be achieved. The organization of the networking of the various therapeutic modules, efficient treatment planning and review of previous measures carried out in this module.
Module 6 represent functional therapies, which are often already prescribed to accompany the therapeutic relationship building in the diagnostic phase of multimodal medical therapy for children and youth.
Function therapies are weekly, intense exercises, which especially in learning disorders , motor skills disorders, developmental language disorders , reading and writing difficulties and dyscalculia are provided by outpatient therapists. By networking with the intramural offer in child therapy practice several therapy sessions, in the context of multimodal therapy, children with a very intense therapeutic range, some patients are offered weekly. Function therapies are occupational therapy, speech therapy and educational therapy , the latter has not SGB 5 is refundable and can not be prescribed by a doctor about a health insurance than other payers come here especially the youth services in question.
The module 7 includes specific parent training groups to improve parenting skills parents of children and adolescents with mental disorders. This one should Zusammenfassungder participants by diagnosis and symptoms occur the children. Specific offers for separation anxiety , sibling rivalry , school problems, oppositionality, depression , social anxiety , autism , attention deficit disorder , post-traumatic disorders , enuresis etc. are very useful, so parents get the chance to find a better deal with the disorder-specific difficulties in the education of their children .
Parent-training programs for about ten sessions in a fixed group based on existing manuals under co-therapeutic management with qualified and experienced therapists learning and training of a better deal with krankheitsassoziiertem problem behavior , are next to experience the development of an improved understanding of the child through role play and roles, as well as the analysis of dysfunctional family dynamic structures that promote self-critical awareness of own share of the problem dynamics and placement of a disease model with reasonable ways of healing show.
This module can not be fully financed through the SPV package, it is not offered at many centers for children multimodal therapy or requires self-financing.

Concept of multimodal therapy, children / youth multimodal therapy

The linkage and joint use of the best possible treatment methods is the basic idea of multimodal therapy Children / Youth multimodal therapy.
Various therapies, various treatment methods and the expertise of different professional groups can be bundled:
In individual therapeutic treatment, the child or young adult to work with a therapist. Labor issues, the application of psychotherapeutic techniques , tests, discussions , exercises, role plays or his artistic expression work.
In group psychotherapy therapeutic techniques in a group of several children or adolescents are applied. The resonance of peers strengthened thereby the therapeutic processes.
In the family therapeutic treatment is the interaction between the family members in mind. psychoeducation aims to deal with problem behavior to improve.
The treatment team of a modern children's therapeutic center is generally composed of specialists in child and adolescent psychiatry , child psychotherapists , social workers , psychologists , art therapists and possibly other specialist therapists and music therapists , dance therapists , occupational therapists, speech therapists and educational therapists .
The medical management of such a center that allows the patient the best possible differential diagnosis can be clarified and that, simultaneously with the application of psychotherapeutic techniques, the use of as needed medication can be checked. Many studies prove that indication-oriented psycho-pharmacological interventions for serious mental disorder images the effect of psychotherapeutic interventions may increase significantly.

Effectiveness factors

Children's Therapy and Multimodal Multimodal Jugendthertapie starts in the diagnostic phase, because to learn as a circumscribed problem can best be helped, a thorough diagnosis is an essential prerequisite . The therapeutic relationship building and other therapeutic methods can already start in the diagnostic phase.
If the correlations are sufficiently informed of the problem, it is especially important to stress factors by expert advice and therapy to reduce monitoring and simultaneously to strengthen the children and young people specifically.
Therapeutic groups represent a key module to the children and young people in their life world affectively reach. Through the resonance of their peers , a stronger influence on behavior and experience of young people can be achieved than in the exclusive single contact with an adult professional. Therefore, these modules should be optimally combined.
In the therapeutic process done repeatedly multi-professional case conferences and planning of necessary therapeutic modules, which on the current scientific oriented state is continuously adapted to the requirements. In the therapeutic work both techniques and flow findings from psychological and psychiatric science a.
In the context of network integration can help many patients by working with speech therapists , occupational therapists , physical therapists , educational therapists , psychotherapists and medical colleagues in other disciplines to be helped.
Transparency is an important guiding principle of therapeutic work. Patients should as much as possible about their problems be informed to self responsibility to take responsibility for the achievement of jointly agreed target can.
Multimodal therapy, children / youth Multimodal therapy works by linking the various options disciplines with different approaches. By matching the team is a high degree of quality control guarantees.

History of multimodal therapy for children and youth in Germany

The legal basis of multimodal therapy for children and youth, so the multi-professional working in child and adolescent psychiatric child psychologist team under professional medical supervision, the Social Psychiatry agreement dar.
Social Psychiatry agreement applies as Germany-wide scheme for children and young people up to 21 Birthday. In the adult area there is currently no comparable basis. The activities of psychiatric inquiry -led Commission 1984 Recommendation social psychiatric care contracts to be agreed. 1989, the statutory mandate was to create these structures to the health and physicians' associations given and 2009 joined the nationwide Social Psychiatry agreement (SPA) entered into force and will contribute significantly to supply deficiencies in child and adolescent psychiatry field are addressed and that, through intensive and specific outpatient medical treatment to annoy, invasive hospital treatments are rarely necessary.

Literature

Dopfner M., E. Sobanski: Multimodal therapy. In: H.-C. Steinhausen, A. Rothenberger & Dopfner M. (ed.): ADHD. Basic, clinical, treatment and course of attention deficit hyperactivity disorder, Kohlhammerstraße Stuttgart 2010, ISBN 3-170-19290-6 , pp. 272-288.
Multimodal child and adolescent psychotherapy. (presentation)
Arnold A. Lazarus Multimodal behavior therapy. Asanger Publishing, 1978, ISBN 978-3893340675
Arnold A. Lazarus: Behavior Therapy Manual, 2011. Multimodal therapy planning (BASIC ID), Springer 2011 - ISBN 978-3-642-16197-1 , pp. 21-24.
German Society for Child and Adolescent Psychiatry and Psychotherapy and others (ed.). Guidelines for diagnosis and treatment of mental disorders in infancy, childhood and adolescence (Chapter F90.0, 4 interventions) - German doctors-Verlag, Cologne 2000 , ISBN 3-769-10492-7

Multimodal Therapy

Montag, 27. Mai 2013