Germany’s welfare system treats abused children for the symptoms of their traumas and often sends them through a maze of referrals and insufficient treatment avenues. Claus Gollmann has created an inpatient diagnostic institution—Kind in Düsseldorf—that enables doctors, social pedagogues, therapists, families, and caretakers to build their treatment on a proper assessment of root causes and to work hand in hand with one another. KiD has developed into a knowledge center for all relevant stakeholders in a field seeking creative and practical solutions.
Die neue Idee
During Claus’ 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 knew that the solution to a child’s trauma needs to go beyond physical health and be anchored in multidisciplinary social solutions. In order to buy time to decide the best next steps for children in crisis, Claus and his team 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 who spend their days with the kids. Based on these combined insights, he opened an inpatient diagnostic center, Kind in Düsseldorf (KiD—Child in Dusseldorf), where children may stay up to six months and live together with therapists, social and child care workers, as well as psychologists. This setting and regimen for care brings together several disciplines that were previously separate: It enables them to both delve deeper into the complex psychodynamics of the families and understand the root causes of the trauma.
In addition to its diagnostic function, KiD has developed into a center that reaches out to all players working with abused children. Youth welfare officers, sometimes unclear about where to place children, now feel relieved to have the possibility to send them to KiD because of the deeper diagnoses it ensures. 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. Begun in Dusseldorf in 1994, 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 more expensive than “normal” referrals, 50 youth welfare offices actively refer children to KiD and follow their recommendations for treatment in a majority of cases. 400 children have been diagnosed by KiD so far. Claus is also training welfare officers in intense three-day workshops on how to work with traumatized children, giving speeches at conferences for doctors on this topic as well as training a wide range of other groups, including police officers, lawyers, and child care workers.
In 2008 with the help of a foundation, Claus replicated his work in Hannover using a mix of social franchise and open source management and plans to start two more facilities in Berlin and Hamburg within the upcoming year. He 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. Claus 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.
Statistics indicate that every 10th child in Germany is exposed to severe physical, sexual, or psychological violence at least once during his/her lifetime. The German welfare system takes this problem seriously and sponsors a variety of outpatient and inpatient programs to support these children. For example, the youth welfare office (Jugendamt) in Düsseldorf (population 500,000), deals with 2,500 cases of children severely neglected and/or suffering from physical, sexual, and psychological violence. For these children, the city spends between €50 and €70 million (US$92 million) a year. However, more than 30 percent of children treated in these programs drop out, which results in children being passed on to five to ten 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 suffered from abuse in their childhood. If only the symptoms are treated, there is a higher likelihood these victims will become 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 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 often are not inclusive or interdisciplinary. For example, many children that Claus treats suffer from bedwetting. The current course of treatment for bedwetting in Germany involves a couple of medical examinations in the attempt to detect a physical problem as well as behavioral training to change the condition. Trauma research indicates, however, that the cognitive connection between brain and bladder is disrupted as a result of trauma: Bedwetting is in this case not a physical or behavioral problem. The understanding of a trauma is critical to overcome this misunderstanding and to prevent damage to a child’s self-esteem, yet it is not incorporated into current treatment. As another example, Claus often finds a way to include even the molesting father during therapy, allowing the children to have supervised contact. Considered outrageous a decade ago, this has been proven crucial to help children understand and accept that a person they love has harmed them and thus resolve the feeling of guilt they have internalized.
In Germany, generally 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. Long-term child care often does not require professional diagnostics and short-term psychiatric diagnosis lacks sufficient time to develop an adequate psycho-dynamic understanding of the children’s history and environment. Instead, 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, realizing its prevention potential.
Claus’ approach combines the children, parents, medical professionals and social welfare system to build a holistic diagnosis and treatment regimen for abused children. KiD’s inpatient diagnostic facility houses children 4- to 12-years-old for a six-month diagnostic period. A team of professionals (including social pedagogues, psychologists, and therapists) live and work closely with the children and collaborate to better understand the psycho-dynamics of the child’s trauma. This process ensures individualized care for children. Anecdotal evidence shows that children and their families are more hopeful than they have ever been about their future due to KiD’s influence.
KiD reaches out and trains all stakeholders working in the field—from police officers to kindergarten teachers. Claus and his team put participants in practical cases at the center of their training. Knowing the relevant stakeholders in the region, KiD gives practical advice on next steps or recommends institutions that could support specific cases. Thus, each training leads not only to higher competencies in dealing with children, but also concretely eases the participants’ work.
The children are referred to KiD by the welfare offices in Düsseldorf and the surrounding regions, which pay a fixed sum per day for each referred child. In addition, there are indirect referrals by courts, but also kindergarten teachers, outpatient centers or care workers, who may ask the youth welfare office to place a child into Claus’ diagnostic center. As this does not cover the entire costs for KiD, it is supported by foundations and private donors. During the six-month diagnostics, the KiD team meets up to three times with the responsible social welfare officer to discuss the case as well as future options. In a best case scenario, the child returns to the family, often with additional therapy or family support. If a return to the family is not advisable, the KiD team reaches out to suitable institutions in the area and if the youth welfare officer follows their recommendation—transfers the child with in-depth information about their background, the underlying causes of their trauma, and their observations. KiD has become a referral point for questions or problems even after a child is transferred.
A scientific study on KiD delivered some striking results about the effectiveness of this form of diagnosis. For example, of the 86 cases that were referred to KiD without the suspicion of sexual abuse, KiD uncovered sexual abuse in 26 cases, affecting the referrals and the children’s future treatment. On the other hand, of 113 cases sent to KiD with suspected sexual abuse, KiD found that 12 cases were not related to sexual abuse. This ensures that children can return to their families in some cases when appropriate.
Claus has adapted his expansion concept based on the fact that Düsseldorf has developed into a knowledge hub in the field and that modern brain and trauma research has been able to create theoretical results in practice. Through his network, Claus is identifying organizations with a relevant network that are able to work according to KiD’s mindset and are ready to take on the upfront investments. For a fee, he conducts in-depth training and supervision for the staff of these organizations. A contract then enables organizations to begin Kind in Diagnostik (Child in Diagnostic), which is an adapted name and essentially a franchise of KiD. The organization is allowed to use the name and brand only for as long as they abide to strict quality standards agreed with and safeguarded by Claus. So far, KiD is already up and running in Hannover and negotiations are currently taking place in Hamburg and Berlin. Additionally, Claus closely collaborates with experts from the Düsseldorf youth welfare office to establish national quality standards for welfare offices and institutions working with traumatized children. A newly founded body would then train experts to certify the compliance with these standards.
Claus describes himself as having led a double life during his teenage years. On the one hand, he was very engaged in Catholic youth groups and reconciliation work between German and Eastern European youth. His aunt was the founder of a famous private development foundation and was one of the early advocates for empowerment and self-help in development aid.
On the other hand, Claus’ early years were also replete with mischief and a stubborn adolescent mindset: He was thrown out of schools for disobedience and had some friends who took drugs. Many of his friends grew up in broken families and had troubled upbringings. At 16, he realized that he wanted to make a change and get his life on track to avoid going further down the path some of his friends were following. Claus finished school and studied social pedagogy. Throughout his studies, he worked closely with difficult youth and he felt the need to influence the system. Claus found his first job after completing his studies in the psychiatric ward for children and youth near Wuppertal.
Deeply influenced by his first supervisor and mentor, Dr. Jungjohann, also a persevering innovator, Claus was pushed to think outside the box and advocate for his views. In his day to day work, he realized the need to create a safe environment to encourage children to open up and feel comfortable so that a thorough diagnosis can be achieved. Claus is adamantly working to change a system that currently expends resources ineffectively on the treatment of abused youth.