Bernt. h.e.p. Verlag AG. Oehme An). (2007): Schulvlrwelgerung: s ub)r~tive ..... WOLFGANG OELSNER. HEAOTEACHER AT ]OHANN-CHRISTOPH-WrNTERs- ...
11.
30
SPEECHES
7th European HOPE Congress 20H
Hoan!! Mar lin., Bauf Wernt(, Blel'ler Weme'. Thümmler Raffio n, & Kipp:er Christoph (20091: Untfllitht in
In Oe uln hland. Bundeszenlr.le für gesundheitliche Au fkläru ng. Bellin In d Co lo&n e (c l. hltp:/I ...."IIW.kiU l
ps}'chl.lri$Cheri KHnikHl'lulen. p, &U 40.,.11 In Opp Günther. Theunlnen Geor& (ed.) in cooperat/on wi ll'!
de/exp erten/downloads/dokumente/KIGGSßPA(1 j.pdl, s latus as 01 I 1/0'0' 2010]
lana Ttlc hrnann: Handbuch schulische Sonderpädagik, Bad Hellbrunn, VerI" Klinki'lardl
Singer Kuli (2000) : Wenn SChule krank. ma Chl. lVie macht s ie gesund und lernbere il1
Hürher Ger,ld (2009): fnlwlcktunasnturob lololl5Che AnsäUe und
Per~pekti\'en.
Pign 106· 11210 Al'lrbeck
Be/nd, WilimaM Mare (ed.) (2009): Päd'IO,ik bel VerhaltenUl(5rungfn , Ein Handbuch. Stultgarl. Verla,
leI. http://www.prof·kurl·)lngel.de/buech e r4.h!m,stllu sn 01 2
11 0~
20 10)
Ölsner WolIg!ng (2005): Wenn Schule k. ank m.chl . Ar licle in Stern, pub. 26 Apr 2005,
Kol'ltl'l.mmer
Pages 15:29
Hülher Gefall:! & Mlchels/n,e (2009): GehIrnforschung für Klndff · Felix und Fellne entd ecken dn Gehirn.
(cl. http:// ....-...-w.slern.de/ ..... issen/menscll/studie· ..... enn·s ellu l e ·k ra n k·macht·~39622.html, s tatus u 01 I
I.lunich. VerlaI Köse!
tlo'o' 2010)
Krinotlt Mur 0" Campos Jouph., Soree /emu F., Emde Robert 1/., & SI'eJda I.\, rylin (1963): Emotions as
\'/üst~o l
betuvior regul,tou in rnl. ney: Socl.1 relerentlng In Infaney. P.ges
~7·86
In Plutc hlk. Robert & KeUerman
AChim (2006):
K"n~hel t
i mich! Sc hult. Art'c!e from ZE IT O/llllif . pub. 29 Jun 2006 - 1:37a.m. jcl
hllp://.........·w.leit.de/2006/26/t.I· Klin ikschu le. ,Ialus n of I flov 2010]
I
HenlY (ed.): EmOllon: Theory, resurch and uperiencr. /l ew YOlk: Acatlrmlc Press
i
I.IüUer AndreilS 110071: Wenn nic hlleh, ...1 Und ..... ei tele unbequeme Fragen lum lernen in Schule und Beruf. Bernt. h.e.p. Verlag AG Oehme An). (2007): Schulvlrwelgerung:
s ub)r~tive
I
Theorien von Jugend lic hen lU den Bedingungen Ihres
SCHOOL-BASED PREVENTION OF PSYCHOLOGICAL DISORDERS
SchullbsenUsmus. HJmbUflJ:. Ver lJ, Kovae Roth GerhJrd 12010): Verst.nd od er Geliihl - wem soll en ..... ir lolgen. PJgu
1~ · 2 1In
Rolli Gtrha ld, Grün
I
i
Klaus·j(lrgen. Fl iedm.n Mlc llel (2010) (Id.): Kopf oder Bluchllur Biologie der Enlcheldung. GÖltingen. Vrrlag
PROF. DR, CLEMENS HILLENBRAND
Vand enlloeck & RupIechI
UNI VERS)TY OlDENBURG , INSTITUTE FOR S PECIA L AHD
SChile t E. Ge rd (ed.) (2003): Bildung beginn t mit dtf Geburt. Ein oHener Bildungsplan für Klndena gesell\'
REHABI LITATION EOU CATlQN
lichtlnsen In /Ierdrhe ln· \'/utlalen.l'.'elnllelm, Bnel, Berlin. Be lu Verlag Schi Ue r Eckhard & Scllilltf Heldrun (2003): lerng nundheit · Lebensheude und telnlreu de In der Schule und an d ers ..... o.l'lel nll eim und Bas el. Belll Verl ag Sinser Kur l (1991): Krinkung und Krankn in. PsychosomaUk . Isl'/eg lur Selbslwa hrnehmung. MunieIl. Verlag Pipe r. 5tll Ed illon Singe r Kurt (2000 .): Wenn Scllule ~'"nk m,clll. Wein helm. Beltl Ve. lag Volk·l.\oser AndIn (1991):
Zwisc~en Zukunfu~oflnung
liChts am Krankenbetl. Pages
~7·76In
un d Reslgnallon
~
lur Brilekenfunkllon des Unter·
Eflle Christoph (1997) (ed.): Schule bei ~ra n ken KIndeIn und Jugend·
lichen. Wege lU Unterricht uml Schulo rg.nlsatJon In Kl ini ken un d Spelill klanen. Bad Hellblun n. Verla g Klink hard t
Psychological disorders present a great risk fo r the development of child·: ren and ad oJescents, At th e same ti me, the institution of school is expe. ; rieneed by alm ost all persons within these age -groups and therefore pre-: se nts itself as a suitable location for prevention. Through the utiHsation 01 : evide nce-based measures, i.e. those which have been sc ient ifically testedl for their effectiveness, schools can make a positive con tribution "within: the network of education and medicine" (congress motto) to the positive; develop ment of children w1th illnesses er those in danger of developing! psychologica l disorders. ·i
Walke Sophi r (2007): Ambiva lenz und SCh ulw fr ledenlleit: Der EInnuss von schu lb ezogener Ambiva len z auf den
lunmmen~ ,n g
von SChulwfrl ede nhel t und Seh ullrl stungen. Un ll'ersl ty of TOblngen,
Psyc~olo&iea l ln·
stilule
The curren t understanding of psyc hologica l disorders in child ren and ado'; Jescents
9.2 . In tern et Research and Other Information Sourees: R:~!kotrh6hellde
8auer Joacllim 120041: Oie Frelbur&er Schulst udie. Pi lot s ludy
status
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of 211 0'0' 2010]
aeekmann· Kn ~rr ~i5lur ~ra n ke
8rlcill e: Kl lnl hchul t - aHlemeine Sc hul e. Er find!llschesl.!i le ln.nder In gem e lnnm er Pra·
(cf. www.lnlerklinl ksc hule.de.statusuoI12 Fe b 1008/ Kahl Re lnh ard (2010): Ga nz obe n. In DIE ZE IT 10 Ju n 1010. Deutscher Schulpleis: Gl nz oben. ZEn OtlLltlE
leI. ht tp://llww.lell.de/2010/24/C·,llelnativ· Schulprels1page - I, slatus u 01 2 tlov 201 0] :lIle Cll stoph.: Abschlu3bellch l zum int erdisz ipli nären ForschunssploJekt ,Chronisch kran\e Kinde r und
Phasen trMhte l Vune· /ab'tlt
L
'ugendllche in den altgemeinen SCh ulen' - funded by Ihe Rob er t·Boscll·Stiflun& (cf. www.1n te rkl inl bchule. je. stalus
U
01 12 Feb 20081
iüther Ge" ld (2006]: Eine neue Kuitul der Anerkennung - PI!do,'el Iill einen Par.di& menwech sell n der ichule. Süd ...·!$trundfun~ SI'/R 2 Aul. - t.llnuskr iptdlens t. Proillmme of 26 Nov 1006 le f. http://www. .wr.de/swr2/pleg •• mm/sendungen/wlssln/·/ld-t8049B4/plope rty -down load/nl d- 660374/leedlh9/ lu2006 11 24_3993.rl l, Slalus U 012 /lov 2010] :lmm1e ASI.id: Chronisch krankt KIndeI und Jugendliche a n den ,Ilgemein bi!d!nden Schulen. A research roject 1 I Ih e ludwlgsbUig College 01 Educatlon, Oep'lmen t 01 SpecIal Educ.lien, Reutlin gen Prol. 01. Chris· ,ph Ertle In coopefi tion ..... ilh Ihe Unil·tr s lty ChUdr en's Hespita l Tüb ln&en "'edical Oireclol Plof. 01. DietriCh liethammn er .nd 01. Aslrid Klmm l, - lunded by lhe Rob erl BOiCh Stalunl ;1. hup:/I-..w.1n terklinihc hu le.de/de/do,,/.b/vortr.! I.pdl, sta tus u oll Nov 20101
oebelt Jehann. (2010): Pra~tlkumsberl e ht l U einem Blockpra~li~um ~n de r Schule fOr Kranke des Olgallos· Ita ls Stult g'r \. Unp ublishe d work . 1 the Oepa rlmenl 01 Special E duc~lio n 01 the Lud ...igsbur! College 01 du ealion, Un ivers ity 01 TOblnCe n In Reu!!ingen. Dctober 1010 'hrm~nn K'lrin (2008): ta nge ..... eile Im Unltllicht. ('Cln,ende DI/stellung des Forschungs·slands: lusam·
enfassung von Elnlt lsludie n I. h t lp ://WW...... WI ~m ann.c om/fileadmlnjmedia/l US a U tex tel 1896elg. pd l, atus n of 2 Uov 20101.
j
(PrirNle
UmgfbungS' belogen
Vu;nelab~U I)
(Ris~olaktor)
I(;ndbtlogtO
psychisch kranke SchOter. In Er!!e, C.: final repOlt 01 the In terdisclplin llY IfSurch projett ,Chron l sc~ Kin der und Jugendliche In d en . lIgemelnen Schulen' -Iunded by the Rober t·80sch·Sliltung
Bed".llgIIn9fn
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{c f. hUp:/ /www.psycholher.ple·plof·bauer.de/5chul stu die deut s eh.pd l,
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I
I
I
SekundIre
Resilient
\ 'T"'" Be!astungen
j Bil anz: Oel.stungen ws. Rnsourcen • Gnamlbe:ulbarke;t des Kind es ur.d s einer FamL:ie • Anstrengungen zur Belulungsbe ..... a:t;gung • E'nm1cklungsprogllOse dn K!ndes
Tra nslation of terms in diagram: Risk-increasing faetors
Risk- reducing faetors Child -focused (primary vu lnerability) Child -focused Envi ronmentally-fo cuse d (risk fa ctors) Environmentally-focused Phases of heightened vulnerability Conditions fostering development Second ary vuln erability Resilienc e Compe tence Pressures Reso urces Balance sheet: press ures v. resources • overa ll resiHence of child and its fa mily • efforts to ove rcome pressu res • prognosis of chHd developm ent
Ildoom ROY5 1on (2006): PIUenlallon on OVO In Kahl Rei hud (ed.] (2006): OIe Entd eckung der IrühenJahre. )okle t Ind DVD. Mehlv der Zukunl t esch~ut. Birbel. Stack elb ec k t.\ arlln, & lan,enhol l Ge erg (2002): Der Mobblng.Rep erl. Ein e Reprisent •.
' stud ie!iJ r die 8vndUltpublik Oeul5Chland. Dortmund, Berlin l.htI P:/Iwww.blu •. de/de/Publihlionen/FOlichungsberlchte/2002/Fb951.pdIC_blob-pvblica tionFlle, , tU5 U 01 2 tl o~ 2010] e ilfer Simone 120101: An niheru neen In die Be deulnmhll von Schule und tern en fill Kinder mll on~010' lc hen Er krankungen. Unpubli~hed tclen ti fic term paper for the Oepar tmenl of Special Ed ucalion of the dwilSb u·C College 01 Eduntlon, Unlo;ersilyof Tublngen In Reullingen. Augusl 20 10 bell Kocll InSlilut (2008): Erkenne n - Bewerten - Handelll. Zur Gesundheit \'on Kind ern und Jugend liche n
Fig. 1: Understanding of development This expJanatory model proves to be par ticu larly useful tor expla ining deve lopments at risk and is also helpful for defining prevention and interven tio n measures (Beelmann & Rab e, 20 07). Re sea rch findings on resilience have ins pi red researchers to apply themselves to a new orienta tion in their development of app li cation-oriented ass istance met hods which are nol'l being incorporated in pract ice through ed ueational aids in both sc hools and extracurricul ar environments (Greenberg et al., 2003), For this reaso n, scie ntifjcally ~ based preventio n progra mmes utilise the detailed findings of
11.
71h Euro pean HO PE Congress 2010
more recent research on the basis of the risk~resil ience model for the con· structio n and implementation of specific assistance measures. Currently, research is especially foc used on the encouragement of social·cognitive information processing (Crick & DOdge, 1994; Lemerise & Arsenio, 2000). Prevention - a chance for schools What role can the school play in this process? In our modern industri· al societies, the institution school repres en ts a vital social location for development. Bio·psycho·social problem constellations are particularly precipitated through the strongly normative context of school. Pupils at risk frequently encounter in this situation a social institution which ignores their problems, partially contributes to the exacerbation of these prob· lems (lack of monita ring) and as a rule provides no resources or competen· ces for the solution of these problems (Jack of diagnostic competences, no effective prevention measures and delegation of problem situations). On Ihe other hand, Emmy Werner (1997) refers to the opportunities of sehool and the important role of teaching staft in her list of protective factars on the basis of decades of resilience research. Under what conditions are schools in Germany working? The prevaJence of observed psychological disorders which according to the most recent sludies stands at a level of 14.7 % (Hölling et al., 2007) displays a elose carrelatlo n with the various school types. According to the findings of Remsehmidt and Walter (1990), Ihe highesl levels of slress ean be found in primary school, secondary modern school and in special schools. My :WlO current investigation of 514 pupils in year five at secondary modern schools in Cologne reaches the conclusion that 25 %of female pupils and 3 staggering 51 % of male pupils of these schools can be considered as j isp laying psychological abnormalities as evaluated by the teaching staff )n the basis of the internationally standardised measuring instrument 'Slrenglhs and Oiflieullies Queslionnaire" (SOQ; Goodman, 1997) (Henlemann et aL, 2010). PrevaJence in the various types of special schools is 11so at a high level (Hillcn brn nd, 20090), particularly in schools for children '/ith learning difficulties with a foeus on emotional and socia! development Sehmid et al., 2007). n view of this eurrent situation, all school forms must undertake great ef· 'orts to utilise effective options for action as intensively as possible, particu· arly as the further development of the control groups in the various studies 111 displayed a common trait: if no preventative or intervention al measures vere undertaken, the degree of disruption would either rema in stable or !ven increase significantly (Wilson, Upzey & Derzon, 2003). This means that I lack of any action displays the negation of ethical responsibility! Ivt what measures are really effective? Whereas research on prevention in :chools leads a somewhat shadowy existence in Germany, investigation into he topics "school·based prevention/ intervention" has become a popular leid in English·speaking countries. Extensive meta-analyses (DuPaul & :ckert, 1997, Wilson, Gottfredson & Najaka, 2001; Wilson, Upsey & Derzon, :003) come to largely unanimous conclusions in their description of pro· nising school·based measures. Although preventive measures in schools ;enerally only achieve moderate scales of effect, they can make a conside· able contribution to the promotion of development of pupils and improve he general situation in a school. Successful interventions on the part of the ehool - particularly in the case of externalising disorders include: behaviour and classroom management programmes counselling and/or ease management, cognitive-behaviouraJ programmes and aeademic learning programmes. hese findings suggest that children and adolescents with an increased sk of emotional and behavioural disorders can benefit most tram good lassroom management (Helmke 2009, Hennemann & Hillenbrand, 2010) lrough individually tailored therapeutic measures, cognitive·behavioural vpport programmes arid academic learning support. ~ua l ity criteria for effective prevention can be identified on the basis of variety of meta·analyses for the implementation of effective prevention leasures (Petermann 2003). Early support: prevention work should already begin at nursery school or at the pre·school or primary stage. Langer periods of support: prevention measures are onJy really effective OVer a minimum period of 3 months. Direct encouragement of children: not only parents or educators but also the children themselves should be involved in the measures.
SPEECHES
31
• Intensive measures: an increase in intensity (greater frequency of measures and more intensive exercises) leads to greater suceess. • Active parents: the continuous and committed assistance of parents is extremely helpful. • Multi·modal support: special provisions for the various levels of child development, Le . behaviour, emotions and language, leads to greater success. I Utilisation of soelal resources: support facilities avai!able within the so· cial environment should be identified and used. In the meantime, several German-Ianguage prevention programmes have been developed which target the prevention of emotional and behavioural disorders. All these programmes have up until now been conceived as universally preventative, multimodal intervention measures. The following table provides a summary of these scientifically based prevention programmes and their essential structural characteristics (Hillenbrand 2009b, 144f). Inte rvent ion Faustlos (Cierpka & Schick 2001)
level & target group nursery school! school years 1·3 (51 sessions) 2·3 sesslqns per week (20·30 mlns.J
Ob ectives & conten! empathy control of impu lses handling of emotions such as anger and rage probJem-solvinl1. skills Verhaltenstraining fOr school years 1 or 2 motor calmness/ relaxation Schulanfanger (Gerken et 26 sessions (of 45mlns.) Improvement 01 aud ltory & visual al. 2002) meanwhile also evaluaUons In attention Induced prevention self-percepUon and percepUon by others extension of soclal skills appropriate problem·solvlng behavlour Sozialtraining In der school yea rs 3 differentiated soda I perceptlon Schule (Petermann et al. 9 sessions (01 90 mins.) reasonable self-assertlon 1999) cooperative behaviour empathy lebenskompetenzschool years 1 & 2 encouragement 01 sell·esteem, body training (Aßhauer & contlnuation avallable for consdousness Hanewlnke I 2000) hlgher classes encouragement of social skiUs 20 sessions 0190 mlns. (copJng wlth communlcatlon, stress and anxiety, problem soJ~ing J handlllll! of negative emotions .lubo aus dem AIWgroup level encouragement of emotional Vorschule (Hllienbrand, nursery school knowledge, emotional regulallon, Hennemann & Heckler· 34 sessions of 40- 60 mlns. soclal·cognitive processlng of Schell 2oo9a) Information. emphasis on educatlonal slructure ~ lubo aus dem AIU - school years encouragement 01 emotional 1 and 2 knowledge, emotional regulatlorl, Schu lelnga rlgsphase (Hillenbrarld, Hennemann 30 sessions 01 40 - SO mlns. soclal·cognltive processlng 01 & Hens 2oo9b) Information. emphasls on educatlonal structure KJasseKinderSplel/ Good year level: nursery school up reductlon 01 lesson dlsruption Behavlor Game (Barrish et to 1'1 year of secondary school (-foulsuJ al. 1969, Hillenbrand & all pupils creatlon of peaceful classroom patz 2008) game within lesson context almosphere with competilive charaeter more learnlng time once a day (a lso posslble more also very effective for the preventlon 01 aggression, drug or less Irequenlly) duratlon of Intervention as abuse and criminal aets and required, recommended for 6 addltlonally as Intervention months excellent evaluation results O!weus· Schulprogramm schoolleveJs: • re duetlon of dlrect vlolence (Le. (Olweus 2002) queSllonnalre, educatlo nal physlcal and verbal violence) tra inim: day, school Improvement 01 peer relationshios
,
,
A few comments could aid orientation. The Faustlos programme has been widely distributed and is availabJe for nursery school and school reception classes. It is relatively cost·intensive and methodically not highly variable. Evaluations have up until now only been able to establish effects in anxi· ous children, whereas no effects have been established for externalised problems. Behaviour tra ining for pupils in recep tion class, social training at school and life·skills training are easily obtainable and have proved to be effective according to a few smaller·scale evaluations. The Olweus programme and the Good Behaviour Game/ KlasseKinderSpiel differ from the above·mentioned programmes. The Good Behaviour Game presents a simple method which is extremely effective for the reduction of disruptive situations and long·term protection against problems ranging tram aggression to drug consumption due to its group-structured enhancement of pro· social behaviour patterns during lessons (group con tingeney proeedure) (Kellam et al., 1998; Hillenbrand & Pütz 2008). These effects were established in a number of international studies (T ingstrom et
32
11.
SPEECHES
7th European HOPE Congtess 20
al., 2006). The Olweus-Schulprogramm, also freq uently receiving positive eva luation, targets changes throughout the entlre school and \'/orks on
Conclusion
a variety of levels: with teaching staft, with paren ts and with victims and culprits (Olweus 2002). Both cf these measures have been successful in multiple evaluations and are cons idered to b~ highly effective, particuJarly in the case of externalised disorders.
Psychological disorders in children and adol esce nts require effective mej sures of prevention and intervention wlthin th e cooperative network be ween medicine and education. Here schools have opportunities of whie they are frequently unaware and therefore do not utili se. Oualified trainin for teac hing staft Is a neeessary step , particularly in vi ew of demands fe indusion and more communality \'Iithin the educational system to ensur improvements in developm ent and working conditions. This cou ld mak school for children and adolescents subjected to risks in their develo ~ mental environment into a living spaee tull of opportunities.
And inter vention? Externalised disorders frequently domina te public dis,cussion, but on ly
very few successfully evaluat ed approaches exist. Publicly discussed methods such as boot camps, confrontational procedures and juvenile detention display highly problematic effects according 10 scientific studies, Juvenile deten tion results in a relapse rate of ca , 75 %, Boo t ca mps also cannat significantly reduce this relapse rate and additionally entail a high level of financing, In the USA, seve ral ca ses of youth fatalities have occur· red at boot camps, Confront ationa l proced ures, in as far as these have been evaluated, also do not display more tavourable result s th an any other form of intervention (Hillenbrand 2009a), In view of the risk burden and the th eoretic al model illustrated (transac· tional development model), it is easily und erstood th at interventio n proce· dures promising success mu st take into account the multiple dimensions of pres sure trom a variety of different fields , Multisys temi c Therapy is an internationally well-establi shed and optimally evaluated procedure operating in the variou s systems of adolescents' actual live s, also includ ing the school environment. Multisystemic Therapy is an elaborate but long-term eHective process achieving reduct ions in socia l costs whi eh has undergon e a number of successfu l evaluatations according to scientifie criteria (Heekerens, 2006). In German -speaking eountries however, it has only been utilised up until no\,/ in child and adolescent psych iatrie se rvices in Thurgau in Switzerland. Multi-system therapy was speciaHy developed for juvenile delinquents
(Vierbuchen. Albers & Hillenbrand. 2010) and follo\'15 an exlremely clear st rategy which provides a high intensity of support. It operates within a wide va ri ety of compartments of ado lescents' lives: alongside work in the (am ily, also with friends (peers), with the school and local authorities. The concrete content of Multisystemic Therapy consists of the intensive supervision of the adolescent and his family. A th erapist who can have a wide range of qualifieations undertakes responsibility for betwee n one and five young persons and their families. This therapy interlinks the different as pects of life systems, also involving schoo l and peers and other referen ce perso ns alongside primary activities with the family. The therap ist is sim ultaneously integrated in a smaH working group of therapis ts involved with Multisystemic Th erapy which meets weekly for supervision meetings. A therapeutic session is held daily with the adolescent and the family in which the family works towa rds specific targets eac h day under the supervision of the therapist who interviews participants to identify the problem and then searches equally for st rengths and resources within the family wlth th e aid of diagnostic proced ures. The \'lork \'Iith the paren ts is aimed at st rengthening parental educational competence. Social tra ining is also utilised and performed with the ado leseent and his family. Here the dimension of parental monitoring plays a centra l role: the therapists provide strength and support for the pa rents to enable th em to utili se improved and more frequent controls. A central characteri stic of Multisystemic Therapy is the constan t accessibility of support: the responsible therapist or one of his colleagues who is also welHnformed about the process is available 24 hours a day and seve n days a week. The therapeu tic in stitution is also loca ted locally to guarantee swift help and immediate contact. Th is course of therapy lasts tour to five months: an unbelieva bly short pe· riod of intervention, It is however the high intensity of this me as ure wh ich acco rding to well-founded scientific research leads to an extremely high degree of effeet iveness d "" 3.88) whieh demonstrates the greatest efti· cacio usne ss of all measures tor this target group. The procedure entails average costs am ounting to ca. 5,700 US $ per eHent (stat us 1999). Due to the efteetiveness of this measure which halves the relapse rate to only 38 %(!) which mean s tha t this mea su re pays itsell off after aperiod of on ly
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Ht nnem.n n, T. & Hillenbrand, C.(2010). Kfn se nfiihrunl : Effekt ives Clnsroom Mtnagemen t 10 du Schulet; gang5Stllfe. In Ha rth, B" Koch, K. '" 011hl, K. (2009). F5rderung In de r schulischen Eln ga ng Htufe. Stuttg,rl
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Hennemann. T.• Hiflenb r.nd, C., Fra nkl, S., Wi lber t, J., JGrgens, J., Sple3, R. t. GOllens. G. (2010. Im Oruc!.~ Kom pe teolen und Ris iken in der Tlaosftlon In die Haup tschule - eine Ouerschnit\$unlersuchuol von Sch'j.
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Hlilenbrilnd, C. (2009a). SchOfer uni er hohen Ent wlc~lung$ri s lken: Was tun? Sonderpädagogische Förderunl
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Hillenbra nd, C. (2009bl. Förderschwerpunkt Emotionale und SOliale Entwickfung: Stanilards elmöglIche~ FörderungI In: Wembef, F. & Prändl, S. (Hrs g.J: Standards der sonderpäda gog ischen Förderung. M Onche.~ Erns t Relnha,d l, S. 133 - 155 Hii'enbrand, C. & PÜll, K.(2oo8J: KlasseKlnderSp!t1. Sp!elerisch VEfh.:tensrtge:n lernen. Hambu'g: ed-tiM KörbH Hill enbrand, C., Hennem.nn, T. t. Heckfer-Schell, A. (2009J, . lu bo aus dem AlfI" - VOfschufafter. Program,,; lur Forderun8
5 0lial·emollo~a l e r
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Kompetenltn. Munchen: Ernst Reinhlrd t
HiUenbr,nd, C., He nnemann, T. '" Hens, S. (2010J . • lubo lIUS dem AlU" - Schufflngln8sphase. Programm
l lt
Förderune sOl'al-emOlionater Kompelenlen. München: Elnsl Reinhlrdt 20 tO HalTing, H. Er hart, 1.1. Ra\'ens~Si ebe ref, U. '" Schfack, R. (2007): Verh , flensauffälligkeöten bel Kindern u n~ Jug e ndllc~e n .
Er ste Ellebnlss e aus dem Klnder- und Jugendgesundhelts su /\'ey (KIGGSJ. Bundes&uundheIU'
blatt - Gesundh eitslorschung · Ges undhel tsschul l , 50, S. 784·793 Kellem, S.G., Ung, X" 1,ltrisca, R., Sro',,", H.C. t. fllon,o , Il. (1998). The effeet 01 Ihe fe\'f! 01 inrus lon in thr first grade cfassro om on Ih e course and malleabifity of anressive behavlof IMo mlddle schoo!. Dfvelopm ent and Psyehepillhology, 10, S. 165- 185 l aucht, M., Esser, G. & Schmldt. t.tH . (1999). \'/1$ wird aus Risikokindernl Erlebn isse der t.l,nnheimtr lä ngsschnfttsludit Im Oberblick.ln: G. Opp,/,1. finge r fe !.. A. Fr eytag (Hrsg.), Was Kinder s tä rkt - Er l iehu~! zwischen Risiko und Resifielll. Munchen: Ernst Re lnhard t, S. 71- 93 te merise. E. & Arsenio, 1'1. F. (2000). An fnteg ra ted MOde l 01 Emot io n Processes tnd C08nit lon In Socl,! Informalien Processl n8. Ch i?d Dr\'elopmenl, 71, 107-118.
Iwo years (Vierbuchen el al., 2010).
Ol·.... eu$, D. (200 2J. Ge ..... alt In der Sc hufe. Was lehrer u nd Ellern wissen sollten - und tun können. Bern: Hub er,'
Multisystemic Therapy is now ava ilable as a se rvice and is viewed as one of the few effective procedu res for the target group of highly disturbed de linquent adolescents. ln German-speaking co untri es however, this method
3. Aunage. Opp, G. & Fingerl e, 1,1., (Hrsg.) (20 07). Was Kinder stirk t. Eu iehung lwischen Ris ikO uod Resffielll. 2. Aull'8t,
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11.
SPEECHES
33
Living with a handicap is a great burden for both patients and members of their family. Their living conditions are made more dirticult, but the circumstances are at least clea r. Foilowing initia I re belliou sness, denial and euphorie actionism, their resistance is gradually worn down. Although the handicap does not become any easier, patients and others in their close environment begin to accept how to arrange themselves with this .handicap and in an idea l ca se, also reconc ile themselves to it,
sct,mid, M., Fegtlt, J. M" Schm ec k, K., Kölch, /,1. (2007). Psychische Be lastuns ~on KIndun und Jugendliche n in Schulen WI Elzlehun gsh ille. Zeitschrift für Heilpäd a&oSlk, 58, S. 282·290 Tlogst/om. O.H.; Sle/llne-Turner. H.E. & Wil Clin ski, ~.M. (2006). Th e Good BthniorGame: 1969·2002. Btha· I':or Modilica Uon 30, 2, 225·253 Vie/bu chen, M.·C., Albm. B. & Hillenbrand, C (ZO tO, lm Druck). Efleklive Inter\'entionen be l delinquentem Verhlften I'on Jugendlichen: OIe muTlisystemlsche Therapie. Wern er, E. (1997). Gel'hldete Kindhei t In der Moderne: P'otekti~e Fakto/en. Vltllelja hluschri lt I(lr Heilpld·
~goa:i k undih/e tlachbare eble tt, 66, S, 192 - 203
The situat ion is different in the case of iIIness. Here there is no chance of everything calming down; nobody has thoughts of arranging, reconcll1ng or resigning themselves to their fate: instead there is hope and resistance. The iIIness should disappear as so on as possible and should be no more than a disagreeable episode which should be forgotten as quickly as possible, if possible through a demonstration of t he patient's former performance capacity.
Wrlson, O.B. & Gottfledlon, O.C. & Najaka, S.S. (2001). School· based prel',ntlon of problem behavlors: A mt la·nalys ls. Journal 01 auanlitat;\'e C,imonology, 17, S. 247 ·272 W,lson, 5.'. & lIpsey, M.\'!. &, Der ion, J.H. (2003). The elfeets 01 School·BUtd Int e/ I'entlon Plograms on Aures~ive 8 e ha~ior:
A l.I eta·Ar'lllysls. Joul na l or Consuiting I nd Cllnic al Psycho!ogy, Vol. 71, S. 136 - t49
EoueATloN WITH SIeK CHILDREN AS PEDAGOGY IN AN EXTREME SITUATION WOLFGANG OELSNER HEAOTEACHER AT ]OHANN-CHRISTOPH-WrNTERs-SCHULE HOSPITAL SCHOOL OF THE CITY OF COlOGNE, GERMANY ~nyo ne
who is iII hopes to recover health. IIlness is a tempora ry situation lnd not a handicap, An iIIness can be severe and painful, but ultimately 'emains an episode whose limit at ions are merely exceptions to the rule
)f "good health", 'erms and edicts have preceded my paper wHh these colloquial re marks as they have regvance for the work dynamics in a "sc hool for siek children" . The term ilIness" suggests a short-term period which is however not. the reality in school for siek children )ur profession has nothing to do with pupils who are in hospital for an verage period of under a week, for example following a surgical operation; espite varying requirements in the federalism of our education system, all lderal states quantify the publicly regulated authorisation tor attendance S a Uprojec ted hospital stay of a minimum of four weeks". This is rarely chieve d nowadays, even in the orthopaedic depar tm ent which was origially the germ cell for the development of the education of sick children. owadays, our area of operation is confined to a few specialised somatic ards including oncology, haematology, nephrology (dialys is) and convaScence wards . I will cover the new focal area of adolescent psychiatry lparately below. ,ildren and adolescents "undergoing inpatient treatment at regular ln -
These young patients however are suffering trom severe , frequently extremely pa inful and longer-term illnesses, Chronic illnesses cut deeper into the individual concept of li fe than a scalpel in case of appendicitis, deeper than the fraetures treated in the orthopaedic ward, after which it is expected that patients will subsequently be able to walk again. Patients who qualify for the SfK [school for sick children] are as a rule either HI tor 10ng periods or suffer from chronic disea ses. "Chronic and psychosomatic iIInesses chiefly dominate in the medical histories of children and adolescents in industrialised nations" (Schindler-Ma rlow in the Rheinische Ärzteblatt, 2007, Vol, 4, p.l l ). "For this reason, hospital educators observe a high level of stress and fatigue in ward patients. We should however not ove rlook the fact that this can conceal struggles taking place: struggles of resistance." Social climate Child ren with chronie illnesses and the;r parents are not only rebelJing against life-shortening prognoses; they are also battling against the threatening loss of social indusion and participation. Although the perniciousness originates from their illness, affeeted patients frequently feel their personality assauJted by lt, not out of invidiousness, but due to a feeling of powerlessness. Schooling in hospital takes place against the background of these types of intra- and jnter~psychologica l processes. I should like to extend this topie by examining the sodal-psychological context. The social climate in industrialised count ries at the beginning of the new millennium expects individuals to be successful and demands that pupils receive extra encouragement (cf. "gene ration barometer" 2009, Allensbach Institute for Demoscopy). "Failure and illness are not part of the picture. Within the employment seetor, this is for example borne out by statistical surveys on the low rate of iIIness . IIIness jeopardises sodal participation. In the world of education, the boom in the es tablishment of private schools and private tuition centres documents the aspiration for the best possible school qualifications. Fail'ure to ga in these qualifications can be compared with a socia l death sentence. This results in outbreaks of iIIness being either countered by over-dramatisa tion or min imisation,
e in most cases suffering from conditions such as diabetes, rheumatism, ergies, cystic fibrosis and renal diseases, In recent times, individual lrds at paediatric clinics - also within a day-clinic setting - have begun focus on these types of perennial patients with chronic di seases. (cf, che!s, 1996 tor the statistical increase in this patient group).
At the beginning of the new school yea r in 2005 in which numerous federal states had reduee d the length of the grammar school career up to Abitur fGerman university entrance qualiflcation] to 12 years, the weekly maga zine "Eltern" IParent sJ ran a title page dep icting a ch ild sta rting primary school with a flag waving out of his satchel reading uAbi 017" lequivalent: 'A' levels in 2017]. Longe r absences from school or repeating a cl ass are simply not included in these calculations and are either ignored or are to be prevented at alt costs with the aid of specialis ts and medication.
is introduces a second term: the chronically ill. These patients do not perience the temporary and episodic nature of illness and in fa c t exrie nce the exact opposite. Permanently ilI patients will have to adapt !mse!ves to the long~ term irreversible status of their suffering, Should )ir ailment be accompanied by life -shortening features, they are also :>\'10 as terminally ilI. Chronic ilIness but without the threat of a lifeeatening condition is a term located within the intersection of iIlness j a handicap, ronic illnesses are disruptions to the concept of life
In this climate of expectation, teachers of siek children must resign themselves to be considered as the providers of aperfect repair system. Following discharge from hospital, everything shou ld resurne as previously without a break. The task of teachers in hospital is therefore frequently misunderstood as "private tuition on prescription", These wishes are legitimate and the provision of these teaching staff by the state originated to a great extent from this premise. I quote from a recommendation by the KMK conference in 1998: "Schooling (in hospita l) provides pupils with the opportunity to learn successfully despite theif illnes ses; this reduces
rva ls" (KMK, 1998) are hOlVever also laughl. The lolal number of days in >spital are added together to produce an annual figure. These children
