Cedric Sachser

Evidence-based practices (EBPs) can support the delivery of high-quality, evidence-informed care for children and adolescents, yet are rarely implemented in German Child and Youth Welfare Service (CYWS) facilities. Although attitudes toward EBPs have been associated with EBP use, implementation is also shaped by organizational and individual factors. However, little is known about these relationships among child welfare workers (CWWs) in German CYWS facilities. This study therefore examined attitudes toward EBPs and their associations with perceived implementation climate and professional quality of life among CWWs. Baseline data of 161 child welfare workers in 37 German CYWS facilities from multi-center cluster-randomized controlled trial BETTER CARE were analyzed. Associations between the implementation climate (Implementation Climate Scale (ICS)) and the Professional Quality of Life (ProQOL) on attitude toward EBPs (Evidence-Based Practice Attitude Scale (EBPAS)) were examined using LASSO-based predictor selection followed by multiple linear regression analyses with cluster-robust standard errors. The ICS subscales recognition ( β = 0.22, p = .002), rewards ( β = -0.21, p = .004), and selection for openness ( β = 0.26, p = .002), as well as the ProQOL subscales burnout ( β = -0.60, p < .001) and compassion satisfaction ( β = 0.32, p = .022) were significant predictors of the attitudes toward EBPs among CWWs. Among CWWs in German CYWS facilities, attitudes toward EBPs were associated with selected dimensions of implementation climate and professional quality of life. The findings suggest that attitudes toward EBPs should be considered within their organizational and individual context.

1. Population-based studies demonstrate that a high number of children and adolescents experience one or more potential traumatic events (PTEs) during their lifetime (Landolt et al., 2013; McLaughl...

Background: Suicidality is a major public health concern worldwide. Evidence on the prevalence and risk factors of suicidality amongst unaccompanied young refugees (UYRs), a population already at risk for mental health disorders, is scarce. Methods: Given the complexity of individual risk factor constellations influencing suicidality, machine learning (ML) methods offer a statistical approach that can detect complex relations within the data. Four ML classifiers, (logistic regression (LR), random forest (RF), support vector machines (SVM), and extreme gradient boosting (XGB)) were trained on a dataset of n = 623 UYRs (M _age =16.77, SD = 1.34, range: 12–21), retrieved from the large-scale randomized controlled trial Better Care to predict suicidal ideation. Features used in the classifiers were age, gender, asylum status, having contact with the family, and whether parents are alive as well as clinically elevated post-traumatic stress symptoms (PTSS), depressive symptoms and past suicide attempts. The classifiers were then tested on the independent dataset of n = 94 UYRs (M _age =16.31, SD = 2.03, range: 5–21) retrieved from the screening tool porta project to examine their predictive performance. Results: The prevalence of past-week suicidal ideation in the combined sample of N = 717 was 18.13%. All classifiers yielded good predictive performance (accuracy 0.734–0.840, sensitivity 0.857, AUC 0.853–0.880). The most relevant features were past suicide attempts, PTSS and depressive symptoms as risk factors, and having a living mother as protective factor. Conclusions: Suicidal ideation is prevalent amongst UYRs, and using ML approaches, the classifiers were able to classify roughly 85% of the cases with suicidal ideation in the past week correctly as suicidal. Building on the findings of this study, screening for suicidality could be further improved by implementing ML classifiers in the assessment to highlight potential at risk cases early, and suitable interventions be developed.

The construct of epistemic trust has garnered significant attention, both conceptually in relation to societal shifts in trust in communicated knowledge and social learning, and empirically in relation to psychopathology. Recently, the ETMCQ, a self-report tool, was developed to assess individual differences in epistemic stance (ES). This paper reports on the validation of a German version of the ETMCQ. Using a representative sample of 2,519 participants older than 16 years of age, the primary aim was to test the factorial validity of the instrument, while also examining associations with age, gender, and education level. A secondary aim explored associations between the three ETMCQ dimensions (trust, mistrust, and credulity) and retrospectively reported childhood maltreatment and other adversity, as well as other psychological factors, including psychopathology. Exploratory and confirmatory factor analyses revealed three correlated but distinct factors—Trust, Mistrust, and Credulity—largely in line with the original validation, resulting in a 12-item version for the German adaptation. Our findings support previous theoretical links between epistemic stance and psychological functioning, particularly the association between epistemic disruption (high mistrust and/or credulity) and increased symptomatology. Additionally, both Mistrust and Credulity were linked to childhood maltreatment, attachment avoidance, attachment anxiety, and fearful attachment. Key results suggest associations between ETMCQ factors and developmental psychopathology constructs, with these factors partially mediating the relationship between early adversity and current mental health symptoms. In terms of discriminant validity, we provide ES cut-offs in relation to widely used psychopathology screening tools. Differences in ES were also observed between individuals from the former East and West Germany, as well as in relation to income, gender, and education, suggesting cultural and socio-economic influences on the construct. In light of these findings, the ETMCQ can be seen as a brief and easy-to-administer tool that holds promise for enhancing clinical and theoretical understanding of interpersonal knowledge transfer.

Background: Digital (mental) health interventions have the potential to address barriers in mental health care. However, attitudes towards these interventions are a crucial factor to their successful implementation. Therefore, this study aims to assess those in a representative sample of the German adult population. Method: A total of N = 2,519 participants took part in the survey as part of a larger study. Following a structured face-to-face interview, participants completed a self-administered questionnaire under the supervision of the interviewer. The questionnaire was based on the E-Therapy Attitudes Measure (ETAM) and the Attitudes towards Psychological Interventions Questionnaire (APOI). Results were analyzed by means of Pearson's product moment correlation coefficients and Spearman's ρ statistics. Supplementary open-ended questions explored participants' utilization of digital health interventions for specific conditions, the conditions they perceived as suitable for those, and the perceived barriers to their adoption. Replies on open-ended questions are summarized descriptively. Results: While a majority of participants (34.0%–41.5%) indicated partial agreement with the potential usefulness and advantages of digital health interventions (Items 1-3), a substantial proportion (45.8%, 95% CI [43.8%, 47.7%]) expressed an entire refusal to use them for future psychological problems (Item 4). Older individuals and those with lower educational status expressed particular critical views. Key barriers identified by participants comprised the absence of personal contact, technical issues, and concerns related to data privacy and security. Conclusion: The results of this study indicate that while participants acknowledge the potential benefits of digital health interventions, the observed limited acceptance rates and identified barriers are to be addressed, in order to fully harness their potential.

Traumatic experiences profoundly impact mental and physical health, alongside an individual’s trust in their social environment. Disruptions in epistemic trust – the ability to evaluate and trust socially communicated information – are theorized to increase vulnerability to psychopathology by impairing social learning. This cross-sectional study investigated associations between trauma characteristics and epistemic stance using self-report data from a representative German sample ( N = 2519). We examined relationships among trauma type, age at trauma, epistemic stance, PTSD and cPTSD. Neither trauma type nor timing alone predicted epistemic stance. However, their interaction revealed that early relational trauma demonstrated the strongest association with epistemic disruption. Within epistemic stance, heightened credulity mediated associations between trauma and both PTSD and cPTSD. Findings align with the hypothesis that early relational trauma disrupts epistemic trust, increasing susceptibility to psychopathology. Clarifying how trauma type and timing interact to shape epistemic stance can advance trauma-informed interventions and therapeutic approaches.

Background: The large-scale Russian invasion of Ukraine in early 2022 resulted in a humanitarian crisis with hundreds of thousands of children exposed to traumatic events. To date, trauma-focused evidence-based treatments (EBTs) for children and youth have not been systematically evaluated and implemented in Ukraine. This study aims at evaluating 1) the feasibility of a training program for Ukrainian therapists on Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and 2) the feasibility and effectiveness of the treatment for children, youth, and their families in and from Ukraine during the ongoing war. Methods: The project “TF-CBT Ukraine” was implemented between March 2022 and May 2024, in close collaboration with local and international partners. Therapists completed questionnaires before/after the training, and patients were asked to complete a measure on PTSD before and after treatment. Results: Altogether 138 therapists started the training program and 44.9% were certified as TF-CBT therapists. The program completers reported overall high satisfaction with the training program, a positive change in their attitude towards EBTs and trauma-related knowledge gain. The patients (age 3–21, 37% male) reported significant improvement in symptoms of PTSD at the end of treatment with large pre-post effect sizes for DSM-5 PTSD (d_selfreport = 2.36; d_{caregiverreport} = 2.27), ICD-11 PTSD (d_selfreport = 1.97; d_{caregiverreport} = 1.77), ICD-11 CPTSD (d_selfreport = 2.04; d_{caregiverreport} = 1.99), and DSM-5 pre-school PTSD (d_{caregiverreport} = 3.14). Conclusions: The results of this study are promising in regard to the general implementation of trauma-focused EBTs in active conflict areas. Future studies need to replicate these findings in a randomized controlled study design.

Background: Unaccompanied young refugees (UYRs) are exposed to numerous potentially traumatizing events and post-migration stressors before, during, and after migration. These adverse experiences may affect their mental health and their quality of life. Consequently, this study aimed to focus on the quality of life of UYRs and identify factors that may influence it. Methods: Potentially traumatic events (PTEs) and posttraumatic stress symptoms (CATS-2), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), as well as post-migration stressors (DSSYR) and quality of life (WHOQOL-BREF) were assessed in N = 158 UYRs (M _Age = 16.92, SD _Age = 1.41, 84.2% male) residing in different child welfare facilities in Germany. Serial mediation models were used to examine the influence of the above-mentioned factors on quality of life. Results: UYRs reported a mean of 6.18 (SD = 3.27) PTEs and 9.72 (SD = 4.49) post-migration stressors. The average quality of life ranged between M = 57.72 (SD = 16.46) for environmental quality of life to M = 66.39 (SD = 20.71) for social quality of life. PTEs significantly reduced the reported physical (b = -1.78, p <.001), psychological (b = -1.15, p =.025), and social quality of life (b = -1.98, p <.001) of UYRs. However, these direct effects were mediated by post-migration stressors alone and in series with mental distress. Conclusions: The quality of life of UYRs was not only associated with traumatic experiences but also with post-migration stressors and mental distress. Quality of life captures additional aspects of well-being and therefore, psychosocial care should not only address mental distress but also consider quality of life to achieve a sustainable improvement in the well-being of UYRs. Changes at the political-structural level, aiming to reduce post-migration stressors, could potentially improve the quality of life of UYRs. Trial registration: German Clinical Trials Register DRKS00017453. Registered on December 11, 2019.

Background: Unaccompanied young refugees (UYRs) exhibit elevated levels of mental distress, including posttraumatic stress symptoms (PTSS), depression and anxiety. Despite the considerable psychological burden, UYRs frequently lack access to mental health care (MHC). The factors that contribute to higher rates of treatment utilization among UYR remain poorly understood. Untreated PTSS can result in chronic impairment, underscoring the importance of identifying these factors. The aim of this study is to investigate factors associated with the intention and actual utilization of MHC of UYRs living in child and youth welfare facilities in Germany. Method: This study is part of the multi-site project BETTER CARE which aims to implement a stepped and collaborative care approach. A sample of N = 139 UYRs who had received a treatment recommendation for trauma-focused cognitive behavioral therapy (TF-CBT) was analyzed. Binomial logistic regression was performed to identify factors predicting the likelihood of intention to seek MHC. In addition, the association between intention to seek MHC and actual utilization was determined using a chi square test. Results: The results demonstrated a significant correlation between age (η = 0.25, p <.01), length of stay in Germany (η = 0.28, p <.01), and severity of PTSD symptoms (η = 0.26, p <.01) with intention to use MHC. In the logistic regression analysis, PTSD emerged as a significant predictor of intended use (B = 2.66, p <.05). The utilization of MHC was found to be closely associated with the initial intention to use (χ²(1) = 88.846, p <.001). Conclusions: The findings contribute to an expanding body of literature on the mental health requirements and service utilization patterns among UYRs, offering insights for policymakers, mental health professionals, and child welfare services striving to enhance care for this vulnerable population.