儿童保护中的行为问题:从复杂创伤的概念出发的理解与干预

IF 1 4区 医学 Q4 NEUROSCIENCES
Sandrine Bonneton, Aziz Essadek
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引用次数: 0

摘要

儿童保护服务(CPS)支持的青少年代表了一个暴露于反复关系创伤的人群,这显著增加了发展以多形症状为特征的复杂创伤的风险。采用CPS治疗的青少年表现出的行为问题可能符合这一病种学框架。他们可能导致在适应环境方面遇到重大困难,特别是当多重受害的轨迹明显时。不幸的是,专业人士未能认识到这一诊断仍然很常见。因此,机构的反应往往不能很好地适应有关青少年的需要,促进了对其行为表现的过度精神化,而牺牲了基于其创伤历史的全面和整体的办法。方法:本研究对CPS支持下青少年通过行为问题表达的复杂创伤进行理论-临床反思。它是基于最近主要的临床和科学贡献,特别是与综合和系统方法有关的研究。结果:理论和临床数据强调了在CPS支持的青少年中识别复杂创伤表现的重要性和困难,特别是当他们出现行为问题时。分析强调了临床支持系统和创伤知情实践在构建机构反应中的贡献。这些做法,特别是依恋、情感调节、能力(ARC)模式,通过促进对行为症状的发展和关系理解,为在CPS内实施青少年教育支持提供了一个结构化框架,超越了危机管理逻辑,并在必要时能够有效地使用特定的护理模式。讨论:认识到往往以多重受害为特征的创伤历史,似乎对充分满足有关青少年的需要至关重要。虽然综合和系统的方法代表了转变CPS专业实践的有希望的杠杆,但它们的实施在法国仍然处于边缘地位。讨论了反思和研究的途径,以促进机构具体采用这些模型,特别是在培训,团队支持和机构之间的结构连接方面,目的是建立更好协调的教育和治疗干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Behavioral problems in child protection: Understanding and intervening from the concept of complex trauma].

Introduction: Adolescents supported by child protection services (CPS) represent a population exposed to repeated relational trauma that significantly increases the risk of developing complex trauma characterized by polymorphic symptomatology. The behavioral problems presented by adolescents followed by CPS may fit within this nosographic framework. They can lead to major difficulties in adapting to their environment, especially when the trajectory of polyvictimization is pronounced. Unfortunately, the failure of professionals to recognize this diagnosis remains frequent. As a result, institutional responses are often poorly adapted to the needs of the adolescents concerned, promoting an excessive psychiatrisation of their behavioral manifestations at the expense of a comprehensive and holistic approach rooted in their traumatic history.

Method: This work offers a theoretical-clinical reflection on complex trauma expressed through behavioral problems among adolescents supported by CPS. It is based on the main recent clinical and scientific contributions, particularly research related to integrative and systemic approaches.

Results: Theoretical and clinical data highlight both the importance and the difficulties of identifying manifestations of complex trauma among adolescents supported by CPS, especially when they present behavioral problems. The analysis emphasizes the contributions of clinical support systems and trauma-informed practices in structuring institutional responses. These practices, particularly the Attachment, Regulation of Affect, Competence (ARC) model, by promoting a developmental and relational understanding of behavioral symptoms, provide a structured framework for operationalizing the educational support of adolescents within CPS, moving beyond crisis management logic and enabling the effective use of specific care modalities when necessary.

Discussion: Recognizing traumatic history, often marked by polyvictimization, appears essential to adequately meet the needs of the adolescents concerned. While integrative and systemic approaches represent promising levers for transforming professional practices within CPS, their implementation remains marginal in France. Avenues for reflection and research are discussed to promote the concrete adoption of these models by institutions, particularly in terms of training, team support, and structuring connections between institutions, with the aim of building better-coordinated educational and therapeutic interventions.

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来源期刊
CiteScore
4.60
自引率
7.40%
发文量
162
审稿时长
6-12 weeks
期刊介绍: Une revue française de renommée internationale. - Un comite de rédaction représentant tous les aspects de la prise en charge psychiatrique du patient. - Une sélection rigoureuse d''articles faisant l''objet de plusieurs expertises. - Des travaux d''auteurs et de chercheurs de renommée internationale. - Des indexations dans les grandes bases de données (Current Contents, Excerpta Medica, etc.). - Un facteur d''impact qui témoigne de la grande notoriété de la revue. La tribune des publications originales de haut niveau. - Une très grande diversité des sujets traités, rigoureusement sélectionnés à travers des sommaires dynamiques : - des éditoriaux de médecins référents, - une revue de presse sur les actualités internationales, - des articles originaux pour approfondir vos connaissances, - des mises au point et des cas cliniques pour engager votre réflexion sur les indications et choix possibles au travers de mises en situation clinique, - des dossiers thématiques pour faire le tour d''une question. - L''actualité de l''AFPB : L''Encéphale publie régulièrement des comptes rendus de l''Association française de psychiatrie clinique.
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