Simsek Zeynep, Erol Nese, Oztop Didem, Münir Kerim
Harran University, School of Medicine, Department of Public Health, Sanlıurfa, Turkey.
Ankara University, School of Medicine, Department of Child Psychiatry, Ankara, Turkey.
Child Youth Serv Rev. 2007 Jul;29(7):883-899. doi: 10.1016/j.childyouth.2007.01.004.
We examined the prevalence of emotional and behavioral problems and associated risk and protective factors among children and adolescents ages 6 to 18 years reared in orphanages in Turkey ( = 461, 87.9% of all eligible subjects) compared with a nationally representative community sample of similarly-aged youngsters brought up by their own families ( = 2280). Using the 90th percentile as the cut-off criterion, it was found that the Teacher's Report Form (TRF) score was higher for children and adolescents in orphanage care than in the community (23.2%, orphanage v. 11%, community). Multiple regression models explained 73% of the total variance of TRF Total Problems score for children and adolescents in orphanages. Regular contact with parents or relatives, between classroom teachers and orphanage staff, appropriate task involvement, perceived social support and competency were significant protective factors against emotional and behavioral problems. Younger age at first admission, being small for age, and feelings of stigmatization were associated with higher TRF Problem Scores (<.05). Parental psychiatric disorder was unrelated to emotional and behavioral problems in children reflecting that psychosocial adversity and parenting problems in of themselves lead to institutionalization, irrespective of identifiable parental mental disorder. The findings are interpreted in the light of an urgent need for development of early intervention programs that promote community care of children by preventing separation from families, provision of support services for families in need, and development of counseling programs to prevent abandonment, abuse and neglect. Finding ways for child welfare professionals to collaborate more closely with early intervention programs would also increase the viable opportunities and rights of children and adolescents currently cared for in the system. Finally, alternative cost-effective care models need to be promoted including foster care or adoption systems and family based homes in the community.
我们调查了土耳其孤儿院中6至18岁儿童和青少年（n = 461，占所有符合条件受试者的87.9%）的情绪和行为问题患病率以及相关风险和保护因素，并与全国具有代表性的由自己家庭抚养的同龄青少年社区样本（n = 2280）进行了比较。以第90百分位数作为截断标准，发现孤儿院照料的儿童和青少年的教师报告表（TRF）得分高于社区儿童和青少年（23.2%，孤儿院vs. 11%，社区）。多元回归模型解释了孤儿院中儿童和青少年TRF总问题得分总方差的73%。与父母或亲属定期联系、课堂教师与孤儿院工作人员之间的联系、适当的任务参与、感知到的社会支持和能力是预防情绪和行为问题的重要保护因素。首次入院时年龄较小、身材低于同龄人以及受歧视感与较高的TRF问题得分相关（P <.05）。父母的精神疾病与儿童的情绪和行为问题无关，这表明心理社会逆境和养育问题本身会导致儿童被送进孤儿院，而与可识别的父母精神疾病无关。鉴于迫切需要制定早期干预计划，通过防止儿童与家庭分离、为有需要的家庭提供支持服务以及制定咨询计划以防止遗弃、虐待和忽视来促进儿童的社区照料，对这些研究结果进行了解释。找到儿童福利专业人员与早期干预计划更密切合作的方法，也将增加目前在该系统中得到照料的儿童和青少年的可行机会和权利。最后，需要推广具有成本效益的替代照料模式，包括寄养或收养系统以及社区中的家庭式住所。
