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MODULE 2

MULTIDISCIPLINARY ANAMNESIS AND DIAGNOSIS

Unit 1: Understanding, complete and use an anamnesis rapport, initial and long term.

● Demonstrate what is and what purpose an anamnesis report serves, in general – DEFINITION

The term anamnesis (ανα + μνήμη= memorisation), derived from the Greek word recollection, essentially
describes the reminiscence in our memory of events that have taken place in the past. An anamnesis
report is a report which contains information about a person over time. The term is connected with the
field of medicine and psychology, but it is also found in the social sciences and on the field as a means of
collecting information relating to a person's life.

The information extracted and recorded in a report constitute an important tool for the social worker
(but not only) because it provides him with a general, and usually complete, picture of the person in
front of him, with whom he has to work with or for. The report or history of a person is essential to
develop the diagnosis and the prognosis that follows, and to make the overall evaluation concerning that
individual. The specialist, doctor, psychologist or social worker has, in a succinct manner, access to the
data that can help him in his work in the present and in the future.

Doing a anamnesis report is not solely the prerogative of the specialized personnel (doctor, psychologist,
social worker, pedagogist) of an institution. It basically consists of interviewing a person, in an institution
for minors for instance, where information is collected by asking questions, and is then recorded. Any
worker can do this job, as long as the person in question has received the adequate preparation and
training for it.

However, anamnesis is not limited to the first contact with the minor. As complete it is, the initial
anamnesis report is a great help for the continuous assessment of the minor and for the prognosis of
possible crises situation but it is not enough. The assessment of the minor is a daily process that follows
both, development (cognitive, emotional, physical) and social contacts and activities. So we have also an
everyday life anamnesis carried out by carers and the scientific staff of the shelter. Those information are
added to the minor’s file.

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● Explain what kind of information content should an anamnesis report have usually for one
single YP 13/18

The initial report does not have a standardized form. We distinguish medical from psychological reports
as they collect different types of specialized information for the needs of each professional, and we also
distinguish social reports. Reports also differ from institution to institution, from professional to
professional. There is however a common ground and common elements between all reports:

Demographic data : Name, age, sex, place of birth, religion, place of residence
Family situation : Parents, siblings, order in the family, other relatives (grand-parents, uncles/aunts,
responsible person, tutor(s) etc.)
Family relations/links : Parents, together or separated, orphan from one or both parents etc.
Education : Class, performances, preferences/difficulties in which subjects
Medical history : Health situation, operations, medication, problems faced in the past
Amical relations : Friends’ age, which kind of groups considered as friends
Behavior : With family and friends, at school, alone or in a group (agressive, passive, etc.)
Use of substances : In the past and in the present (and type of substances used)
Activities : Hobbies, occupations
Reasons that led to placement in the Prosecutor’s decision, judicial social report, minor’s personal opinion
institution :

The report may include: information from the family and friendly environment when it exists, medical
diagnoses and hospital reports, educational reports (from school, teachers, speech therapists), and the
psychological/psychiatric profile of the person. All this information is added and enhances the elements
recorder during the personal interview.

During the stay of the minor in the institution, a set of information are collected daily by staff and
complete the initial information: changes, improvements, problems that occur during the life of the child
in the shelter.

● Demonstrate the functioning of the RYCH; the use of the anamnesis report in its own
institution as well as in cooperation/partner institutions
In Greek Legislation, Article 1532 of the Civil Code, concerning relations of minors with their parents
states that, if it is established that the custody of a minor is not exercised to the benefit of the minor, is
not exercised at all, or is exercised abusively by the parents, then custody can be removed on the Court’s
order and the care of the child is awarded by judicial decree to a third person. Thus, it settles the
placement of the child in an institution when the conditions do not allow for the minor to stay with his
family or relatives.

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According to article 1607 of the above Code, when the condition of the minor, mental and physical, or
his mental state, requires his placement in a “special institution”, a series of appraisals are also required
by the Court to confirm the placement. The prosecutor's social report should always be taken into
consideration - report, medical and psychiatric examinations, and psychological advice coming from
public hospitals. By “special institution” we mean psychiatric clinics for minors and institutions treating
different pathologies (such as mental retardation, various forms of disability, etc.). By “special premises”
we mean juvenile detention centers meant for minors who have committed crimes and are over 15 years
of age (article 126, penal code).

With this capacity, the institution has custody of the minor and can therefore have access and can
process the personal data of the minor.

The Greek legislation in all juvenile matters follows European directives. It will be interest to see how the
others states-members of EE trait those questions.

Internal rules/ regulation:

Each institution has its own way of functioning and its own ethics (charte). In this way, the number of
hosted children, gender (where there is a distinction), age, and problems that the institution takes care
of or refers ex officio to other bodies or other institutions, are determined in advance.

There are institutions that accept only girls or only boys. Some those only accept unaccompanied minors.
Others which impose age restrictions, i.e. children under 13 years of age or children/adolescents over 13.
There are institutions which refuse minors approaching adulthood. There are also institutions that do not
accept minors with health, physical or psychiatric/psychological problems. Selection is based on the
capabilities of each institution to respond to the minor’s needs. These are determined both by the
institution’s regulations, and in the moment, depending on the group of children living in the institution.
The caregiver knows from the regulations which kind of group of minors he has to take care of.

The internal rules and regulations of an institution also define the premises’ functioning, their
maintenance and their administration. It also defines the scope of work of the employees, the
relationships between them, and the use of auxiliary tools. Taking and disposing of the record of a minor
is subject to the restrictions set by the institution’s regulations. There are for instance institutions that
keep the record in a “Personal File” for the hosted minor. Only the scientific team has access to that file.
Filling the record is done by the psychologist or the social worker depending on their availability, and
advisory access remains their prerogative. There is no separate psychological record.

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In other institutions, filling the report is the duty of the social worker. The record is kept in a “Personal
File” for each hosted minor and apart from the scientific team, the management and the president of the
institution can also access the file. The psychologist keeps a separate file with the psychological history
of the minor, which is accessible only by him/her, and is not included with the general record.

● Explain the legal frame that protects the minor’s intimate information

The anamnesis report is a written report containing details about the person, describing also his
personality through information about the person’s life. By this nature, the report is governed by a strict
legal framework. Article 16, §1, of the United Nations Convention on the Rights of the Child states that
"no child shall be subjected to arbitrary or unlawful interference with his privacy, his family, at his home
or in his correspondence, nor to unlawful attacks upon his honor and his reputation". In Greece, the
protection of personality is established by article 57 of the Civil Code and has received constitutional
guarantee in Article 2, §1, which provides that "respect and protection of human dignity are a primary
obligation of the state".

Law 2472/1997 (Greek legislation) for the "protection of individuals against the processing of personal
data", in line with the European Directive 95/46/EC on the protection of personal data, represents a
safety valve protecting information that is recorded and archived. The above law exempts through the
provisions stated in Article 5, §δ’ from treatment when it is necessary to carry out work of public interest
or work that falls in the exercise of public authority and is executed by a public authority or has been
assigned by it to the person responsible for processing it.

• realize an anamnesis report respecting the special conditions of a potential crisis situation
(initial and long term)

Report/interview making

Receiving report and collecting information through a personal interview requires certain conditions,
especially for the children and adolescents they lived traumatized events and their reactions may be
uncertain:

- Context: The place in which the interview is conducted is comfortable for the interviewee,
intimate and quiet. It ensures contact between the interviewee and interviewer.
- Duration: The time is short so as not to tire the interviewee. A long interview can bore or tire
the interviewee. The interview usually lasts as long as a therapeutic session, between 45-60
minutes with an interval breaks of 10 minutes.

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- Worker’s capacities: The interview/record is an act that takes place between two people. It is a
binary relation, which is however uneven considering the role of each person. The interviewer’s
aim is to gather information, thus to take, while the interviewee gives. It is therefore necessary
to ensure :
o trust and security
o confidentiality
o acceptance: the interviewee should not feel that he is being judged.
o self-determination: The interviewer does not give advice, does not comment.
o Empathy
o The interviewer needs to pay attention to his behavior (gestures and facial
expressions, hostile body language like folded arms, interrogatory and aggressive
eye contact).
- Way of asking and type of questions asked: the interview is structured in advance as a protocol
or in the form of open questions. The questions are not leading questions, but they leave space
and time for the minor to answer to them as he wishes and is able to.
- Only in the case where the child is confused or does not understand the question, can we ask a
directed/a leading question, so that the child better understands the question. If the minor
seems frighten, it is better to stop the interview and do it later.
- If a minor does not speak the language of the interviewer, the use of a translator is required. This
can be:
o Direct, with the physical presence of the interpreter.
o Indirect, using means of telecommunication (telephone, skype etc).

The translator is aware of the confidential nature of the interview, his role is thus specified to
him and he should not intervene. It is advised to use the services of a professional translator.

Recording information

The recording of information is frugal/simple. If the record contains a limited number of questions, the
interviewer can complement it. If it is not structured, the interviewer writes down his questions and
filling up the answers. In the end, it is a straightforward record of events, without any personal opinion
on the part of the interviewer, without aphorisms or criticism.

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● Explain his/her Responsibilities and field of action

By the term Team, we mean the specialized staff and the caregivers/special educators. Everyone comes
in contact with the hosted minors.

The information recorded are numerous and confidential. The purpose of communicating information is
to bring the attention of the team to specific characteristics of the minor which can potentially cause a
crisis, to facilitate the understanding of the minor’s behavior, and to initiate a collective action to address
it. In this way, it is not the entire record that is consulted but parts of it, sometimes only a specific one,
for instance the minor’s tendency to escape and older attempts at doing so, or suicidal tendencies, etc.
The professional staff and especially the psychologist and the social worker are the providers of that
information to the caregivers.

When it comes to other institutions or members of the specialized staff, the communication of the
record depends again on the regulations of the institution. Thus, some institutions make the entire
record of a minor available if needed be, in order to avoid repeated interviews that can be traumatic for
the minor. Others do not communicate the record to anyone, keeping it private.

External workers are not just workers working for the interest of the minor (doctors, teachers, etc.) but
they can also be contributors intervening voluntarily for the institution (volunteers, financial sponsors,
artists supporting actions of the institution), scientific bodies interested in research (universities,
research centers), state institutions (ministries), etc. The communication of minors’ records and their
archiving is prohibited in all circumstances, as we saw. If any information is provided, it is necessary to
have the minor’s consent and to inform him, if his age is over 15. In the others cases, the rensponsable of
the institution has the responsibility to decide.

● Realize and register an initial anamnesis report for one single YP 13/ 18 - communication
with the YP; complete an anamnesis report during the stay of one YP.

In order to record the minor’s history and do the interview, it is essential for the employee to understand
the minor’s situation:

- Be aware if there is, or not, an institutional protocol on how to record the history of a minor. If it
does not exist, he prepares all the questions.

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- Ask questions in a comprehensible manner that should be adapted to the age and needs,
psychological and pedagogical, of the minor.
- Ensure a specific context for the interview, in a designated area (quiet, uninterrupted by phones
and external factors).
- Present himself and explain why he needs this information.
- Show respect to the minor, without pushing him, judging him, or advising him.
- Stop the interview whenever he realizes that the minor does not pay attention anymore.

The interviewer recording the history can draft the reference of the report. He should use simple and
understandable wording. He should avoid jargon and tell the events as they happened.
During the stay of the minor in the shelter, information is collected all along his/her life in the shelter. By
the caregivers, the scientifical team, by the pedagogical team, the different experts they have contact
with the minor. The changes, growing up mentally, physically etc, are important information too. The
contacts with family or friends, the group of pairs. Behaviors, etc.

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Unit 2.2: Understanding and use a Diagnosis Report for one single YP 13/18

● Demonstrate what is and what purpose does a diagnosis report serve

The diagnosis is the result of a comparative analysis done by a doctor or a psychologist between the
patient’s history and an objective examination. It is the recognition of a disease from which the patient
suffers through nosological findings. Such are the nosological manifestations, clinical and laboratory
findings ( eg blood tests).

Clinical manifestations are divided in symptoms and signs. A symptom is the nosological manifestation
which is perceived by the patient either subjectively (i.e. pain), or objectively (i.e. appearance of rashes).
A sign or a natural sign is the nosological manifestation that the doctor finds during the physical
examination of the patient (i.e. heart size). The diagnosis can thus be different. It refers to the distinction
between diseases that show common clinical manifestations. Through the exclusion of some of those
diseases, the expert comes to a diagnosis that explains all the symptoms and signs felt by the patient.

The diagnosis is necessary for the assessment of the prognosis, in order to predict what will be the
natural course of the disease as it was recorded through the study. At the same time, the diagnosis
contributes to administrating the appropriate treatment in order to eradicate the disease. The term
diagnosis, hence, is also used in the social sciences. It refers to the assessment of the information that
the social scientist has, out of which he can make a prognosis concerning the evolution of a situation, in
order to prevent and lead to its dissolution, i.e. demonstration of violence.

● Explain what type of information, indicative for a crisis, he/she can find in a diagnosis
report – different disciplines

As a medical and psychological/psychiatric tool, the diagnosis, both the comparative and the final one,
always follows the history of the patient. Thus, beyond the disease that one reasonably expects to find in
a diagnostic report, there is also in the diagnosis report the history as it was recorded by the specialist,
which can differ from one specialist to another. The reason behind this difference is because for each
diagnosis, every specialist will investigate all the possible information that might explain the symptoms
and signs of the patient.

Information found in diagnostic reports:

Psychiatric diagnosis
Assessment and evaluation of the psycho-mental state:
Face expressions, attitude, appearance, Body care/ alimentation,
Concentration, Attention/ focusing, Memory, Judgment and
perception, Emotion, Hospitalization in psychiatric clinic, Suicidal
ideation / Suicidal attempts, Self-harm, self-destructive behavior,

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Scarifications, Depression, Borderline disorder, Anxiety disorder,

Psychological diagnosis
Medical diagnosis
Subsidiary medical sciences
Aggressiveness/ use of violence, Other mental health disorder.
Recommendations and medical therapy - medication
Background information
Medical and development history, Family and social history, Previous
evaluations (if they are exists)
Behavior information
Observation, Behavior rating scales, interview
Testing:
standardized assessment targeted the domain of
• Cognitive-intellectual-executive functioning,
• attention/ concentration, memory,
• sensory-motor/perception processing,
• speech/language,
• academic achievement,
• emotional personality
Using
WEIS-III, CAS, Trial Making Test A and B, Stroop Color Word Interface,
MMIP-A, brown attention deficit scales, Wisc, CAT, house tree person
projective test, raven matrices, etc.
Using also PTSD Test, Depressions Scales (BDI), etc:
Recommendations
Explanations and recommendations for the evolutions and the areas
that may be targeted for intervention ex. Managing the depression and
anxiety symptoms, establishing structure and boundaries with school
teacher etc.
Family history, medical family history
Family diseases, psychiatric problems, heredity
Personal history
Birth history, Previous state of health, Psychomotor Development,
Vaccinations, Medications, (hobbies, pets, habits, exposition to
dangerous for the health environment)
Objective examination
general and special examination
Diagnosis
Recommendations
Speech therapist
Physiotherapist
Table 4.

Very important to this section is also social diagnosis. Approaching diagnosis from this integrated
perspective potentially provides a broader context for practitioners to understand extra-medical and
psychological factors, which in turn has consequences for patient care and health outcomes,
consequently, for the minors in institutions/shelters. Social diagnosis recognizes interplay between social
structures and illness manifestations/ symptoms.

● Defines the deontological and legal limits prohibit the information’s communication –
confidentiality

Health is constitutionally guaranteed in Greece in Article 5, §5 as a legal right and the right of a patient to
professional secrecy are guaranteed through Article 9. The only exception to the protection of personal
data is found in Article 7 § 1 of the 2472/1997 law, subparagraph δ’, when "treatment concerns health

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issues and is performed by a person who deals professionally with the health service and is subject to a
duty of confidentiality or related codes of conduct, provided that the elaboration is necessary for medical
prevention, diagnosis, care or for the management of health services.".

Diagnoses however medical procedures are and as such are subject to medical confidentiality. The
obligation of confidentiality in any medical act is imposed in the medical world by the medical code of
conduct in Article 23. Nationally (in Greece), medical secrecy is enshrined in Article 212 of the Criminal
Procedural Code which clearly states that "what was declared between doctor and patient during
medical practice" must remain secret. This is also indicated in article 371 of the Criminal Code. At the
European level, medical confidentiality is protected by Article 7 of the Principles of European Medical
Ethics (1987).

In the context of a shelter institution for minors, the diagnosis comes from two main sources : from the
medical world – we refer to all medical specialists ( pathologist, cardiologist, etc. ) - and the
psychological/psychiatric world, where the diagnosis is made by the psychiatrist and/or the psychologist.
In the medical world, we also take into account subsidiary sciences such as physiotherapy, speech
therapy, etc.

Diagnostic reports forms are an integral part of the hosted minor’s folder. Rarely will these documents
however come to light. The legal regime that protects them prohibits any access to them. Usually, the
only people who have access and can consult these documents are only the scientific team of each
institution (psychologist, social worker, doctor, nurse, management). Access to psychological reports can
be restricted to all but the psychologist.

● Analyze which diagnosis reports (medical, psychological, psychiatric, social) are needed for
single YP in the RYCH.

The identification of data that can potentially cause a crisis within the institution cannot be one-
dimensional and based exclusively on the diagnosis and history of the hosted minor. It is also the daily
observation and work with the minor that will help to indicate if and when a crisis situation will occur,
also depending on the history and diagnoses. Nonetheless, there are signs which may be indicative of
such a situation and are due to the fact that the child is far from his family environmen:

o Family history (domestic violence, absence or negligence from parents, way of birth)
o Family heredity (health problems, psychiatric problems)
o Abuse (physical/psychological, neglect)

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o learning disabilities, cognitive problems, developmental problems

o Sexual abuse, victimization of the minor
o trafficking and smuggling, modern slavery
o Pathology (psychiatric problems, medical problems concerning the family or the minor
himself)
o Delinquent behavior
The diagnosis reports they are important are all they contain such information.

• Recognize which elements of the diagnosis report give relevant/helpful information for
the work with YP in the RYCH and witch are missed.

The diagnostic reports are at the disposal of the scientific team. They have the responsibility
to filter the information and give it to all in order to understand the behavior and the
difficulties that a minor has. The scientific team is the one that stands out the important
information. They separate all the elements that show that the child may develop dangerous
and critical behaviors. The approach is holistic. The diagnosis must be holistic, in other
words, it must include as much information as possible originating from various specialists
to minimize the possibility of surprise. So we are looking for family problems, medical and
psychiatric problems, development problems, social relationships, social interactions.

We are loking not only for the information we have, but most for the “absent” information.

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Unit 3: Evaluate the anamnesis and diagnosis information and make the prognosis and plan of
intervention for future crisis situations in the RYCH

● Describe differences between normal puberty and derogations.

The history/report and diagnoses provide a complete profile of the minor, nonetheless, this profile
translates itself in daily life as a set of behaviors, and as a set of symptoms, resulting from possible
diseases, mental and physical. The institution’s staff knows about the specificities of adolescence, a
period considered special due to the rapid bodily changes and the new developments adolescents face,
both in their cognitive abilities and in their sexuality. It is an anxious search for an answer to the question
"Who am I”? ', or in other words, a search for identity.

Beginning/middle of adolescence End of adolescence/ beginning of

Childhood identity (experimental period in order to adulthood: adoption of a sense of
take final decisions) identity

Table5. Healthy/normal development according to E.H., Erikson, in Herbert, M.

The pathological development of a teenager in adolescence is characterized by various behaviors, which

are an evidence of a failure in the quest for identity:

• Imitation of a slave or submission to a

leader or a team
• Rebel, abandonning school, Early social maturity. Compulsion with
Defensive behavior/ delinquent behavior, criminal social relations (i.e. early marriage,
Tendencies to run away behavior, bullying early sexual relations)
• Drugs/alcohol, substances’ abuse

• Drugs/alcohol, substances’ abuse

• Confusion of identity, indifference Attempt/successful suicide
Dépression • Low self-esteem/feeling of
emptiness

Table4. Healthy/normal development according to E.H., Erikson, in Herbert, M.

Simultaneously, the institution’s staff is also able to recognize the defense mechanisms that minors use
during adolescence, mechanisms that help to smoothen stress and failures, and help in protecting the
integrity of the minor’s Ego.

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Defensive mechanism
Emotional isolation
Flight (refusal of reality)
Daydreaming
Rationalisation
Projection
Transfer/ transposition
Table 5. Healthy/normal development according to E.H., Erikson, in Herbert, M., Ψυχολογικά προβλήματα Εφηβικής
Distant attitude and cynicism in dealing with reality.
Avoiding to get involved with the reality, with the aim of avoiding stress
caused by facing reality.
Creating an imaginary world in order to escape from reality.
Using rational explanations to explain unacceptable behaviors or behaviors
leading to failure, i.e. an adolescent who considers himself very smart
explains that his failure at exams is due to the unfair and unreliable school
system.
Projection of feelings and thoughts to others in order to avoid internal
conflicts, i.e. an adolescent girl who says that her peer does not like her
and is mean to her, while in reality she is the one feeling jealousy and
dislike for her peer.
Transposition of feelings or predesigned actions from a person to which
they were originally intended for, to another person, i.e. An adolescent
who hit and tortures his peers while he actually intends this behavior to his
violent father.
Ηλικίας (ed. Καλαντζή-Αζίζι), Athens, 1994

Besides common behaviors of adolescence, pathological or not, the institution’s staff also know that a
violent incident (abuse, sexual abuse, violent loss of parents, etc. ) can cause a set of symptoms resulting
from the psychological trauma.

CIM-10 describes psychological trauma as a transformation of one’s personality, which is the

consequence of a catastrophic experience. The conversion is accompanied by the installation of a series
of symptoms and complex behaviors:

- Suspicion and hostile attitude towards the world and people

- Social alienation, isolation
- Feelings of "emptiness" and absence of hope
- The person feels he is constantly at risk and threatened.
- Severance from the social network, feeling that "nothing touches me, nothing interests me"

The catastrophic experience has such an important form and intensity that it does not leave space for us
to talk about a vulnerable person and a sensitive personality. The changes are permanent and last for
more than two years. Delinquent behavior, problems with society and social exclusion are the result of
psychological trauma and they primarily reach populations that have already faced medical and
psychological problems and social, economic and legal issues. Personality change is generally preceded
by PTSD, a reaction usually caused by a violent and unexpected incident, limited in time and course
(Trauma type 1 according to Terr):

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PTSD (Post Traumatic Stress Disorder)

It manifests itself after a long period of time, usually several months after the incident
Intrusions The adolescent has the impression that he is reliving the same trauma or parts of it.
Αvoiding Avoiding stimuli reminding him of the trauma, develops fears.
Neuro-vegetative Hyperactivity, insomnia, tachycardia, sweating, anger towards others and one’s self
Troubles through violent act/behavior.
Intrusion syndrom The adolescent relives the trauma through thoughts, images, physical sensations
and nightmares They repeat themselves and occupy the toughst and the life of the
victim.
Symptoms related to the Stress, use of medication and alcohol, drugs, depression, suicidal tendencies,
trauma psychosomatic problems.
Table 6.

The duration and intensity of the trauma plays an important role in the appearance of symptoms.

Single Psychological Trauma
Manifestation of PTSD
Repetition of psychological trauma over a longer period of time (repeated
sexual abuse, torture, daily abuse, war and detention) – this is trauma
type ΙI according to Terr
Explosion of anger and rage as a defensive mechanism and a way to respond
to the stress caused by the trauma ; nutritional problems (bolimia,
anorexia) ; Suicidal Tendencies ; Passage à l’acte ; Delinquent behaviors
(stealing etc) ; Use of alcohol and other drugs ; Self-harming (cuts, wounds,
etc.) ; hyper-sexualized behavior with constant change of partners when
there has been sexual abuse ; various forms of prostitution with adult charm
being an important element, also offering in exchange/as a reward the use
of one’s body; physical pain and medical problems (headaches,
stomachaches, etc.).
On the other hand,
Behavior of absolute passivity, maintaining a relationship of dependency
with the perpetrator (strong willingness to be with him and to obey to him) ;
Lack of autonomy and initiative.
Table 7

Characteristic of these psychological traumas is the fact that children avoid speaking about themselves,
what they felt and about the attack(s) they endured. They keep it a secret for a long time, often forever,
applying the "law of silence ". In these cases, we do not face avoidance anymore but total denial of the
event(s) that happened, accompanied by mental inhibition, emotional easing, severance and/or
reduction of interests, from participating to other activities.

Bullying constitutes an important social phenomenon; it is the use of physical and/or psychological
violence against one or more minors from one or several minors. It must be distinguished from common
fighting as the victim cannot defend himself because he is in a weaker position, and he usually hides this
phenomenon as he experiences it as something extremely humiliating. This occurs mainly in the school
environment but it is not uncommon to observe this towards a newcomer in a shelter institution.

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● Explain the responsibilities and fields of action of relevant persons/organizations with

regard to YP

Each team meets with its members to discuss the current problems that each minor faces separately.
Within the scientific team, the social worker creates the minor’s life schedule within the institution and
monitors its implementation and evolution. The psychologists monitor the minor’s mental state and
prescribe treatments when needed. The doctor oversees the therapeutic trajectory where needed. The
teacher/educator oversees the minor’s performance at school and identifies potential weaknesses. The
group discussion concerns the progress of the child as a whole, his integration in the institution, his
educational trajectory and his achievements, and the course of his medical therapy.

The team of caregivers has the duty to take care of the minors and to prepare the activities compatible
for each minor. Any specific behavior, difficulties, mental condition, symptoms of a pathology (whether
medical or psychosocial) are firstly perceived by them. Addressing the problems and finding solutions to
those is part of their work. The cooperation between the two groups (scientific and caregivers) is thus
essential, through meetings. Caregivers inform the scientific team on the activities they carry out and
about the problems that arise. The scientific team evaluates the information and prognosticates,
meaning that they try to predict the eruption of possible crisis situations. The shelter institution and its
regulations define when and how often the groups meet, usually weekly. Extraordinary meetings are
planned depending on the needs.

All members and partners have a piece of information expressed as behavior, emotion, act,
choice, etc…, and all those pieces contribute to create the anamnesis report. Both reports
therefore depend on all the information that partners and employees collect and give. It is
important to keep that a report not stop generated throughout the stay of the minor in the
hostel. Instead, it can evolve, be compared with the past and present, and gives the workers to
have a complete file on the minor who outlining its weaknesses and enables employees to
develop methods and troubleshooting strategies.

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● Display recommendations that protect and help a YP, the other minors, the residential
personnel and the institution

The caregiver addresses the problem in the field. He finds himself alone with the minor. The assessment
of a situation requires quick reflexes and sometimes direct intervention, both individually and
collectively, when more caregivers are needed (i.e. in the case of a fight).

The prognosis made thanks to the history, the diagnoses and the direct observation allows for the
prediction of a behavior. In this way, each caregiver is able to apply the instructions of the scientific team
and ask for their assistance when it is necessary.

In the case of minors who have experienced one or more traumatic events, the staff is faced with more
sensitive situations that they have to deal with:

o Personification of the welcome and meetings with the minor: any act which may enhance a
sense of identity is good. The goal is to create a bond not only with the worker but also with
humanity itself.
o Strengthen confidence, reconnection: The minors have experienced incidents of isolation, with
the feeling of "not belonging" in their family and community being intense. The traumatic event
isolated them both in time and space, and in their own life. The institution and the staff are
there to recreate a bond between the period "before" and "after» of the traumatic event. Thus,
being available, adapting to the minor’s needs and paying attention to him are necessary to
allow the minor to reposition himself in time and space, for him to make contact again with
reality.
o Ensuring care: victims are in need of a safe environment which is positive, which ensures respect,
good will, and gives them the possibility to reconnect with their family whenever possible.
o Ensuring protection from the external environment : As a mediator between the minor and the
external environment (police, courts, perpetrators, family), the shelter institution acts as a
protective shield and filter, which explains and reassures the minor concerning the following
steps.

The employed caregivers know all the partners to which they can turn to in order to solve a
problem/crisis situation involving minors. They are also aware of the hierarchy and the degree of
responsibility of each member of staff in the team. Therefore, depending on the case, on its complexity
or its rarity, he addresses the case to:

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o The whole team of caregivers and the scientific team

o The director responsible for the institution
o The supervisor : an external partner, usually a psychiatrist or a psychologist, who supervises
the scientific and the educational team.

The caregiver may consult :

o The parents, or family

o The minor’s school, the teachers
o Friends
o External partners

However, when there is a problem that surpasses not only the capacities of the institution as defined by
its rule of conduct, but also the skills of the staff dealing with the issue, then the caregiver will know to
which actor to appeal to, always depending on the problem at hand.

● synthesize and analyze all the information of anamnesis and diagnosis

The information collected through the history/report and diagnosis are assessed as a whole by the
scientific team and are combined with the information collected from the daily contact with the minor
within the institution. The caregivers who are in daily contact with the minors care for their needs and
observe their behavior. The educators have the duty to evaluate the history and the diagnosis of the
minors, and do the prognosis of the minor’s trajectory. The educators/caregivers have the duty to take
care of the daily care of minors, and to communicate any information to the scientific personnel,
whether it is an observation or a confession/discussion with the minor. The addition of this information
to the theoretical knowledge can help to estimate if a crisis situation is about to occur.

● Recognize the information (symptoms, behaviors)as relevant for a future crisis situation,
in a team and alone

Any information is important, however, some information and behaviors are particularly indicative and
should be considered critical:

- The period of arrival at the institution : the first days are tough
- The minor’s behavior:
o Non-verbal (introverted, unwilling to communicate with the surrounding environment )
o Aggressive (unwilling to cooperate and in opposition)

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o Destructive (destroying objects and other things)

o Dangerous (self-harming , harming others)
o suicidal or homicidal (suicidal ideas, murderous tendencies directed against other people
or animals)
- Abuse of the child, physical and/or sexual
- Aggressive/violent family environment
- Low educational level of parents
- Poor performance at school/ low IQ
- Maintaining relations with dangerous friendly environment
- Arrests for minor infringements (i.e. thefts) and/or attacks, aggressive behavior
- Suicide attempt(s)
- Diseases requiring long-term treatment
- Previous use of illicit psychoactive substances
- Victim of trafficking (trafficking and smuggling, modern slavery)
- Special cultural environment, speaking a different language from the usual:
o Unaccompanied minors
o Roma
o Minors coming from rural areas with a strong local dialect

• Use the information of anamnesis and diagnosis reports as a means to develop a team and
a single plan of intervention in case of a crisis situation to avoid/ minimize crisis situations
and distinguish the role of each member.

Each crisis is resolved in a specific way. Being in possession of all the relevant elements, the scientific
team develops a way to address the crisis and communicates it to the caregivers. The caregivers
have the explanation for the minor’s behavior and they can deal with it through :
o Discussions: the caregiver discusses with the child, tries to understand the reasons behind his
behavior and tries to calm down his stress. He tries to help the minor understand what the
problem is and to accept it.
o Encouragement: the caregiver encourages the minor to take the initiative to participate in the
institution’s daily activities and to express his feelings.

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o Isolation: when the minor becomes dangerous for himself and others (anger, rage, fights,
destroying material, etc.).
o Reward - deprivation : the caregiver rewards the minor with privileges when he respects his
obligations within the institution (use of telephone, computer, outings, etc.) or denies them
when his behavior goes against his obligations (forbidden to go out, to use a computing , to take
part in activities, etc.).
o Handling and solving conflicts – mediating : The caregiver has the capacity to be a mediator
between two or more people. Through his intervention, he reduces the tensions by talking to all
parties involved and he tries to find a common ground in their differences.
o Studying and learning the specific cultural characteristics of the minor (different country,
religion, language, clothing habits, eating habits, social habits before his placement in the
institution, i.e. work) in order to explain the differences both to the minor and to the other
hosted minors.
o Psychotherapy: with the institution’s psychologist or an external partner, when this is necessary.
o Psychiatric therapy: when the symptoms cannot be dealt with psychologically.
o Medical therapy: when the minor presents serious physical symptoms.
o Teachers' help: when the minor shows difficulties in his obligations for school.

When the minor speaks a different language than that of the caregiver, then a translator is
necessary.

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BIBLIOGRAPHY

• Bricaud, J. (2012). Accueillir les Jeunes Migrants, Lyon, Chroniques Sociales.

• Giotakos, O., Prekate, V. (dir). (2006). Sexual Abuse. Athens, Ellinika Grammata.
• Herbert, M., Ψυχολογικά προβλήματα Εφηβικής Ηλικίας, επιμέλεια Καλαντζή-Αζίζι) Αθήνα, 1994
• Jehel, L., Lopez, G. (dir). Psycho-traumatologie, Dunod, Paris, 2006
• Lopez, G., Tzitzis, S. (dir). (2007). Dictionnaire des sciences criminelles, Paris, Dalloz.
• Tsiantis, G., Manolopoulos, S. (1994). Contemporary children psychiatry. Athens, Kastaniotis
editions.
• Civil Code (2013). Thessaloniki, Sakoulas editions.
• Penal Procedural Code. (2013). Thessaloniki, Sakoulas editions
• Pénal Code (2013). Thessaloniki, Sakoulas editions
• American Psychiatric Association. (2004). Diagnostic and statistical manual of mental
disorders,IV-TR, (fr. Traduction), Paris, Masson.
• OMS (2000). Classification internationale des troubles mentaux et des troubles du
comportement. Paris, Masson,

Sites :

• www.eur-lex.europa.eu
• www.dpa.gr
• www.synigoros.gr
• www.0-18.gr
• www.psychiatry.org
• www. apa. Org

Annexes:

• Annex 1 : http://eur-lex.europa.eu/legal-content/EN-EL-DE/TXT/?uri=URISERV:l14012&from=EN
• Annex 2: http://fr.slideshare.net/debrajean333/full-psychological-reportsample

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Annex 3 :

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Annex 4:

http://ptsdusa.org/what-is-ptsd/get-help/

Re-experiencing Symptoms: Memories and images of the traumatic events may

intrude into the minds of those with PTSD. They occur suddenly without obvious
cause. They are often accompanied by intense emotions, such as grief, guilt, fear, or
anger. Sometimes they can be so vivid a person believes the trauma is actually
reoccurring.

Nightmares, Night Terrors

Sleepwalking, Sleep Fighting

Unwanted Daytime Memories, Images, Thoughts, Daydreams

Flashbacks, Feeling Like You're Reliving the Traumatic Event

Somatic Flashbacks (Physical Pain / Medical Condition Linked to the Feeling or

Bodily States Associated with the Traumatic Event)

Fixated on War Experience, Living the Past

Spontaneous Psychotic Episodes (the World Vanishes and you're Suddenly

Somewhere Else, Experiencing Some Sort of Trauma)

Panic Attacks, Undefined Dread or Fear

Phobias

Avoidance Symptoms: Traumatized individuals attempt to avoid situations, people

or events that remind them of their trauma. They feel numb, emotionless, withdrawing
into themselves trying to shut out the painful memories and feelings. Friends and
family feel rejected by them, as they are unable to show appropriate affection and
emotion.

Avoiding anyone or anything that reminds you of the traumatic event

Physical/emotional reaction to things that remind you of the traumatic event

Self-isolating, dread or social interaction

Anxiety in crowds, traffic

Despair, depression, sadness, emptiness, loneliness

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Annex 5:

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Annex 6:

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Annex 7

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