Problem: What problem is this project trying to address?
Statistics indicate that every 10th child in Germany is exposed to severe physical, sexual or psychological violence at least once during his or her lifetime. The German welfare system takes this problem seriously and sponsors a variety of outpatient and inpatient programs to support these children. The youth welfare office (or “Jugendamt”) in Düsseldorf (pop 500,000), for example, deals with 2,500 cases of children being severely neglected and/or suffering from physical, sexual and psychological violence. For these children, the city spends between €50-70 million a year.
However, more than 30% of children treated in these programs drop out, which results in children being passed on to 5-10 such programs throughout their childhood. Not treating these children properly has severe individual and social consequences. In most cases, children who have experienced violence and abuse behave aggressively, often auto-aggressively. They do not adapt well to structures or rules, lack emotional capacity, develop psychological illnesses and are more susceptible to substance abuse. Studies reveal a higher prevalence of chronic illnesses in their lifetimes, as well as a much higher probability of unemployment. In addition, most violent offenders or sexual abusers have also suffered from abuse in their childhood. If only the symptoms are treated, there is a higher likelihood of these victims becoming offenders in the future, which only accelerates the vicious cycle of violence. Apart from the tragic social repercussions of abuse on children, this situation has extremely costly effects on society.
Modern scientific research indicates that violent behavior against children results in trauma. It also indicates that all relevant stakeholders should be incorporated into diagnosis and treatment. Currently, however, diagnosis and treatment is not inclusive or interdisciplinary. For example, many children that Claus Gollmann treats are suffering from bedwetting. The current course of treatment for bedwetting in Germany involves lengthy medical examinations in the attempt to detect a physical problem as well as behavioral training to punish the child for wetting his/her bed. Trauma research indicates, however, that the cognitive connection between brain and bladder is disrupted as a result of the trauma: bedwetting is in this case not a physical or behavioral problem. Trauma therapy is critical for overcoming this misunderstanding and preventing damage to a child’s self-esteem, yet is not incorporated into current treatment. Another example is that Claus Gollmann often found a way to include even the molesting father in the therapy, allowing the children to have supervised contact with them. Being outrageous a decade ago, this has now been proven as crucial to help children understand and accept that a person they love has done them real harm and thus resolve the feeling of guilt they have internalized.
In Germany, the spheres of long term child care (financed by youth welfare offices and the municipality) and short-term psychiatric diagnosis (financed by health insurance companies) are completely separate from one another. Long term child care does not diagnose children properly for the lack of competence and short term psychiatric care does not diagnose properly because of the lack of time and knowledge about the children’s history and environment. Misaligned financial incentives prevent collaboration and exchange of best practices. Nonetheless, welfare officers, care workers, family courts and other institutions working with difficult youth or troubled families recognize how many of their clients suffer from abuse in their early childhood. Their diagnoses impact children and their families deeply, which places them under a great deal of pressure. As a result, welfare officers, care workers, and family courts are often willing to accept the higher costs of the in-depth diagnoses KiD provides as they realize its prevention potential.
Solution: What is the proposed solution? Please be specific!
During Claus Gollmann’s work with abused children in an outpatient center at a hospital in the late 1980s, he became frustrated with the reality of only a few hours of diagnosis determining a child’s future. He noticed that the solution to a child’s trauma needs to go beyond physical health and be anchored in multi-disciplinary social solutions. In order to buy time for deciding the best next steps for children, Claus began to commit kids to the children’s ward of the hospital for minor physical ailments. He realized that a great deal of important diagnostic information resides in the observations of the nurses and children who spend their days with the kids. Based on these combined insights, he opened an inpatient diagnostic center called Kind in Düsseldorf (KiD), where children stay for up to six months and live together with therapists, social and childcare workers as well as psychologists. This setting and regimen for care brings together several disciplines that were previously separate: it allows them to both delve deeper into the complex psycho-dynamics of the families and understand the root causes of the trauma.
In addition to its diagnostic function, KiD has developed into a center actively reaching out to all players working with abused children. Youth welfare officers, previously unclear about where to place children, now feel relieved to send them to KiD because of the deeper diagnoses it ensures for children. Also, referral institutions, such as children’s homes or foster families, have found a partner in KiD. Even family courts, lawyers and parents appreciate the experience and knowledge of KiD. During its 16 years of existence in Düsseldorf, KiD has become the practical knowledge center for a wide range of institutions, shifting the way the welfare system works. Although the six-month diagnostics and referrals by KiD are much more expensive than “normal” treatment, 50 youth welfare offices throughout Düsseldorf are actively referring children to KiD and are following their recommendations for treatment in a majority of cases. 400 children have been diagnosed by KiD so far. Claus Gollmann is also training welfare officers in intense three day workshops on how to work with traumatized children, giving speeches at conferences for lawyers on this topic as well as training a wide range of other groups, including police officers and child care workers.
In 2008, Claus Gollmann replicated his work in Hannover using a mix of social franchise and open source management and is already planning to start two other facilities in Berlin and Hamburg within the upcoming year. Claus Gollmann is also working to establish national quality standards for youth welfare officers and institutions working with abused children as well as a certification body to guarantee and uphold these standards. He aims to ensure that every child suffering from abuse receives a diagnosis that reflects state-of-the-art standards and meets the child and family’s particular needs.