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Social-Emotional Competence in Young Children with Hearing, Visual or Intellectual Impairments - an Explorative Study with the ITSEA Early emotional and social competence is considered as an important requirement for social participation in family and child care settings. We report on a study exploring the usefulness of the competence scales as a part of the "Infant-Toddler Social and Emotional Assessment" (ITSEA) for one- to three-year old children in a sample of 253 toddlers with hearing, visual or intellectual impairments. Internal consistency of the six scales is good (alpha.86). An ANOVA reveals significant differences between the three groups and a correlation with additional disabilities. These explorative results support the development of a German standardization of the ITSEA.

In Bavarian psychiatric hospitals approximately 15,000 people with mental handicaps and mental illnesses were killed after the so-called Action T4. The Heil- und Pflegeanstalt (psychiatric hospital) Günzburg was a so-called Zwischenanstalt (interim institution). The aim of the study was to analyze its role in carrying out "regionalized euthanasia".Based on defined criteria the patient records of deceased patients at the Günzburg Psychiatric Hospital between July 1941 and December 1943 were analyzed to establish whether criteria for "regionalized euthanasia" were fulfilled.During the study period 45 patients at the Günzburg Psychiatric Hospital probably died following actions by direct or indirect intention to kill using malnutrition, neglect, medication overdose or a combination of these actions.The Günzburg Psychiatric Hospital was involved in "regionalized euthanasia".

The German federal law of equal treatment of disabled persons (Behindertengleichstellungsgesetz des Bundes, BGG) came into effect in 2002. An evaluation of this law was required by the national plan of action for the implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Project evaluation objectives were to estimate whether the needs of disabled persons were being met and whether the instruments proved to be adequate for fulfilling the aims of the law. Jurisprudential analyses in combination with surveys were used for this research. It was found that the BGG still lacks adequate publicity. Its impact, however, was assessed as positive. Results also indicate that there might be some shortcomings with regard to accessibility. For a closer examination, however, more data focusing on accessibility in the context of health care and rehabilitation is.Im Jahr 2002 trat das Behindertengleichstellungsgesetz des Bundes (BGG) in Kraft. Im Zuge des Nationalen Aktionsplans zur Umsetzung der UN-Behindertenrechtskonvention (UN-BRK) wurde es evaluiert. Es sollte untersucht werden, ob das Gesetz in seiner jetzigen Form die Belange aller Menschen mit Behinderung ausreichend berücksichtigt und sich die Instrumente des BGG bewährt haben. Die Evaluation umfasste rechtswissenschaftliche Analysen und sozialwissenschaftliche Erhebungen. Im Ergebnis wurde festgestellt, dass das BGG noch nicht hinreichend bekannt ist, jedoch andererseits überwiegend positiv eingeschätzt wird. Im Weiteren zeigt die Evaluation Verbesserungspotenziale zur Barrierefreiheit im Bereich der gesetzlichen Krankenkassen auf und weist darauf hin, dass insgesamt eine verbesserte Datenlage zur Barrierefreiheit im Gesundheitswesen und von Gesundheitsleistungen, ferner von Rehabilitationsdiensten und -einrichtungen notwendig ist.

This study intends to research experiences of employees of ambulatory and stationary residential facilities for people with mental and multiple disabilities and family members concerning the health care of the target group.A qualitative research design was applied. As a data collection tool expert interviews were used. Proxy-interviews of employees of ambulatory and stationary residential facilities for people with mental and multiple disabilities and of family members were carried out.In total, 21 interviews could be evaluated with the software program MAXQDA. In particular, the results show that interviewees experienced or perceived a lack of individual time, prescribed measurements, conducted interventions and measurements, etc in the health care field of independent physicians.Systematic, structural, qualification-related and financial limitations impede a high-quality care for the target group. Further studies are necessary to receive differentiated knowledge about the health situation of the target group and to optimize the health care provision.

The paper reviews international research on sexual abuse prevention for individuals with mental retardation and programs implemented in Germany. Using Pubmed, PsycINFO, and various search engines, 263 studies and 128,080 search results for programs were retrieved, of which twelve international studies and six national programs met several inclusion criteria. Studies provided evidence for the effectiveness of prevention programs. Clinical significance, however, is restricted by methodological limitations. None of the programs found throughout Germany has yet been evaluated. Implications for future research in the field of sexual abuse prevention for children and adolescents with mental retardation are discussed.

No empirical data about the topic "Mental Disability and Dementia" in Germany exist. The aim of this survey was to obtain current data about mentally disabled people with dementia. Therefore, the following questions need to be clarified: how many mentally disabled people are affected with dementia, which difficulties occur regarding the diagnosis of dementia and what challenges have to be solved in upcoming years. In all, 45 organisations for the mentally disabled took part in the survey, showing that dementia amongst people with mental disabilities appeared largely starting at the age of 50. Standardized diagnostics are seldom used by these organisations. Instead, observation of behaviour by care attendants plays a central role, due to the fact that speaking and introspection are not possible for a majority of the patients. In general, institutions for people with mental disabilities do not have specific offers for people with dementia, occasionally there are offers regarding their living situation and free time activities.

«Euthanasia» was the cynical euphemism used by the Nazis to refer to the systematic murder of hundreds of thousands of mentally sick and handicapped people between 1939 and 1945, at least 6,000 of whom were children. Based on the example of Günter Nevermann, this paper provides insight into the complex acts of registering, selecting, and targeting children labelled as "inferior" and "unworthy to live." This case clearly shows that Nazi doctors were not necessarily enmeshed in some tragic conflict. Rather, apparently without any qualms, they sacrificed the sick children who had been entrusted to their care, for the ideal of obtaining a "racially healthy corpus," a term used without being questioned. Most of the perpetrators were never brought to justice, and not a few of them later held managerial positions in child and adolescent psychiatry in the two German states. Many of them were members or even honorary members of the "Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V." in its present or previous form. We feel it is necessary to inform the public effectively about this state of affairs, to discover what really happened and to determine who was responsible.Unter dem euphemistisch-zynischen Begriff der «Euthanasie» wurden zwischen 1939 und 1945 systematisch mehrere hunderttausend kranke und behinderte Menschen ermordet. Unter ihnen waren mindestens 6.000 Kinder und Jugendliche. Anhand des Einzelschicksals von Günter Nevermann aus Wismar wird das System der Erfassung, Aussonderung und Tötung eines als «lebensunwert» und somit für die Gemeinschaft nicht tragfähig erscheinenden Kindes nachgezeichnet. Sein Fall dokumentiert eindringlich, dass Ärzte, wie nach 1945 häufig behauptet, sich keineswegs in einer «tragischen Zwangslage» befanden. Scheinbar ohne moralische Skrupel opferten sie die ihnen anvertrauten jungen Patienten einem kaum hinterfragten Ideal, dessen Ziel die Vervollkommnung des «Volkskörpers» war. Nur sehr wenige der Täter wurden in beiden Teilen Deutschlands zur Verantwortung gezogen. Zumeist praktizierten sie weiter, hatten leitende Funktionen inne und waren Mitglieder oder sogar Ehrenmitglieder der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V. (DGKJP) bzw. derer Vorgängerorganisation. Hier gilt es künftig aufzuklären und aufzudecken.

People with learning and physical disabilities require special attention and nursing care during hospitalisation. A systematic literature research in the databases PUBMED, CINAHL and Cochrane Library (1990-2011) was conducted, 17 relevant publications could be found. The following problems were identified. The situation of people with learning disabilities in hospital is characterised by communication barriers between patients and health care professionals. Furthermore, the emotional situation of patients has to be emphasised. In the foreign environment of a hospital, they suffer from fear and uncertainty. Both phenomena interact with each other and are influenced by conditions such as time, continuity of care, professional competence, and attitudes towards disabled people. Family members are able to calm the patients. They take on the task of translating. Clinical Nurse Specialists are familiar with these problems. They improve the situation of learning disabled patients in the hospital. The studies show small samples and the results need further verification. Results out of Germany, Austria and Switzerland are not available. Therefore, in these countries further empirical research on this topic is strongly recommended. The results indicate the importance of obtaining comprehensive information about needs of disabled patients before their hospital stay. Family members should be involved in nursing care during a hospital stay.

Severe constipation is a well recognized symptom amongst disabled or mentally ill patients. Characteristically, these patients live without bowel movements for days and present themselves with abdominal distension and fecal impaction. Inpatient treatment is necessary frequently. Due to intestinal obstruction, diagnostic approaches are often delayed because of lack of cooperation. Data of 94 disabled patients with severe obstipation are presented. 54 patients were admitted to inpatient treatment of constipation or bowel obstruction, 40 were treated for another diagnosis but had severe constipation which required intervention. Ileus or conservatively untreatable constipation led to 16 operations in 14 patients (polypectomy 2, rectopexy 1, cecostoma 5, left hemicolectomy 3, subtotal colectomy 5). Cecostomata are considered not to be effective as definite treatment whereas colonic resection resulted in daily bowel movements.

To bring the data from the Federal German Health report about work disability and pensioning into context with current knowledge about the course and etiology of depression.The report data about first-time recipients of a disability pension were analysed by year, illness and gender. Resulting data were interpreted and were compared with international publications.The percentage of applications for disability pensions due to psychiatric illnesses have been rising steadily for two decades. Among these, depression (31%) and neurotic disorders (23%) are most frequently responsible, while most other causes of disability have been declining. Current treatment of depressive disorders does not seem to have had any effect in terms of reducing the number of disabled persons per year.Although the risk factors associated with developing a depressive disorder have been extensively studied, data explaining the progression into disability is scarce but essential. More research in the psychodynamics of depression and work participation might be helpful.

Data on the prevalence of mental health disorders among children and youth with hearing disorders, blindness, physical handicaps or intellectual disabilities are reviewed. Problems in parent-child relations and issues in the development of social competence and social participation are discussed as risk factors for emotional social maladjustment. The differentiation between developmental problems resulting from the handicap and mental health problems is a challenging task in practice. Some conclusions for psychopathological assessment of handicapped children and youth are presented.

A lack of perseverance, attention and poor modulated behaviour are important criterions of handicapped children (Dilling et al. 1993). Therefore, instructions have to be repeated quite often, sometimes even by different family members. For this reason, good family coherence might reduce symptoms significantly (Döpfner and Lehmkuhl 1995). The handicapped child might cause less disagreement in families with good coherence, which improves family;s features (Saile et al. 1995). Families of 15 handicapped children were included for evaluation and compared with a matched, healthy control group. Parents were asked to complete a form assessing the family;s features ("Familienklima-Testsystem", Schneewind et al. 1985), "Erziehungspraktiken", (Schneewind et al. 1985). Group comparison was made by the Mann-Whitney-U-Test. Our results strongly suggest, that good coherence seems to have positive effects on family;s features, especially by handicapped children. So we think, that on the one hand good coherence might reduce symptomatology and that on the other hand family's features have protective effects on handicapped children.

The contraceptive management of the handicapped adolescent does not differ much from what is recommended for the non-disabled and healthy adolescent. However, one of the major differences is that education about sexual issues does not necessarily lead to self-regulation, especially in the mentally handicapped. The decision for a particular contraceptive should take into account the individual situation and the mental and physical capabilities of the adolescent. The ability of a disabled adolescent to give free and informed consent to different methods of contraception always has to be determined before a choice is made.

a) Does the psychiatric expertise confirm the claimed psychiatric diagnoses in patients applying for a disability pension due to a psychiatric (co)morbidity? b) Had the patients received adequate psychiatric treatment before being sent for the psychiatric disability expertise?Key data of 101 psychiatric expertises done in 2002 on behalf of the Swiss invalidity insurance/Basel were analysed.a) 17% did not have a psychiatric diagnosis affecting the ability to work. In 50%, the ability to work was reduced by max. 30%, i. e. the prerequisites of a pension were not met. b) Patients with a psychiatric diagnosis affecting the ability to work: 50% reported to take a specific psychotropic medication, but only in 40% of them (i. e. 20% of the patients with a psychiatric disorder) the blood level was within the therapeutic range; only 35 % reported to have "some form of psychotherapy"; only 15% had been previously hospitalized.Many of the 101 patients applying for a disability pension had not been sufficiently diagnosed and had not received adequate psychiatric/psychotherapeutic treatment before the expertise.

There are indications of a link between right-wing extremist orientation and attitudes towards people with mental illnesses. Social distance is used to investigate this.In 2002, a representative survey was conducted among the German adult population (n = 2089). Social distance was measured using a question from the European values surveys. Right-wing extremist attitudes were measured with a scale developed by Niedermayer and Faller.Only a marginal link between right-wing extremism and social distance towards people with mental illnesses was found which, moreover, showed an inconsistent pattern.It would be premature to conclude from this "negative" finding that a right-wing extremist orientation has no influence on the attitude towards people with mental illnesses, especially in the light of only one form of discrimination being investigated here.

This paper describes the procedures in planning support programmes for persons with long term psychiatric disabilities in the Region of Hannover (1.15 mill. inhabitants) and presents some results of a research project concerning process quality of all 570 planning procedures, which took place in the year 2001. The study covers the evaluation of the type and extent of recommended support programmes in the different catchment areas of this region in relation to the psycho-social risk of the patients. Following the presentation of the results deductions for the implementation of a systematic quality development process in community psychiatry are discussed.

Vocational rehabilitation is an important component of community-oriented mental health care. How is the situation of supply with vocational rehabilitation facilities in Germany offering their services to mentally challenged persons?Search of a Germany-wide rehabilitation database, supplemented by information from the Federal Working Groups on Vocational Rehabilitation. Cartographical classification of the identified facilities. Analysis of the results in a comparison of the situation in the 16 German States (Länder).The Länder of North Rhine Westphalia, Bavaria, Baden-Wuerttemberg and Lower Saxony offer the greatest number of vocational rehabilitation facilities to mentally challenged persons. In all East German and in some of the West German Länder vocational rehabilitation facilities are restricted to some areas and to certain vocational preconditions. Many of the facilities in these areas are structured as centres and situated in rural areas. Hence, they lack community-orientation. Only North-Rhine Westphalia offers country-wide community-oriented vocational rehabilitation facilities to mentally challenged persons, which are not restricted to certain vocational preconditions.The supply with vocational rehabilitation facilities for mentally challenged persons has improved during recent years. Nevertheless, the situation in many of the German Länder needs to be improved, particularly in respect of the availability of rehabilitation facilities for younger mentally challenged persons without prior working experience. The implementation of decentralised community-oriented facilities should be favoured in centres, especially in larger sparsely populated areas.

Visual acuity can be assessed by different strategies. The constant-stimulus-, the stair-case-, the Best-PEST-strategies, and the EN ISO 8596 are discussed. In cases of presumed psychogenic visual impairment and malingering it can be useful to modify these strategies striving for a determination of the (minimum) visual acuity based on statistical analysis rather than "clinical experience". The EN ISO 8596 defines visual acuity by a 60 % criterion, thus implying guesswork, if recognition of the optotypes is uncertain. Therefore, the forced-choice-procedure is mandatory. Objective psychophysical (preferential looking, induction or suppression of rhythmic eye movements) and electrophysiological methods (VEP) of visual acuity assessment can be useful in infants, in the mentally handicapped, and in patients with presumed psychogenical influence or malingering.

This article attempts to fertilize the concept of recognition by Axel Honneth for use with mentally handicapped persons. The "Concept of Recognition" offers a concept of fairness that is closely tied to the idea of an integrated life style. The development of self-confidence, self-respect and self-esteem--as differing levels of practical self-relation--are bound to the experience of inter-subjective acceptance. This represents the basic requirement on which the development of a person's identity depends. Refusal of recognition, and/or disregard, exclusion, or disgrace negatively effects the integrity of a person. The relevance of the concept of recognition in psychosocial practice is described, this allows mentally handicapped persons to be observed out of the perspective of "suffering" as well as out of the perspective of "acting". This necessarily requires a biographical and environmental approach. Biography oriented support approaches require continual evaluation of the institutional arrangements that possibly themselves are the source of indignities, disregard and restrictions of autonomy. This analysis however remains incomplete if the social conditions that are responsible for the violation of recognition criteria are not investigated as well.

Is it necessary to understand your vis a vis or is it enough to meet, to get in touch? Awareness of the different perception of reality is important. INTERINDIVIDUELL: Defined as basic requirements for getting in touch, mutual modelling and interchange were "Knowing your own world", "Being curious about the world of the other", candour and tolerance. Time makes the essential framework.Are the interindividuell parameters also practicable for groups/organizations?In the psychosocial context the subjective perception of the world is cause and cure at the same time. The basic requirements enable people, by getting in touch, to reorganize themselves.

The article focuses on the results of vocational integration over the last two decades and on actual results from client-surveys as presented by the Arbeitsgemeinschaft Deutscher Berufsförderungswerke (ADB) (working group of the German vocational retraining centres) and the Berufsförderungswerk Heidelberg (BFW Heidelberg, the vocational retraining centre in Heidelberg). Process quality of vocational rehabilitation can be indicated by data like the number of persons dropping out of their training - the ratio to be found in the vocational retraining centres is on a lower level than in other institutions of vocational training. Clients have changed: during the last decade the average age of the clients in the BFW Heidelberg has increased by 3 years, there is a higher proportion of women, but there also are more clients with psychological disorders. A new group of clients is growing - non-handicapped persons who pay for their training themselves. Process quality has improved, with graduates of the BFW Heidelberg saying significantly more often that they can use much or very much of the training courses' contents within their later occupational activities -- the proportion increases with the level of training they had undergone. Additionally the proportion of those is growing who see themselves in an -- according to their training -- adequate occupational situation. These are certainly positive results referring to the indicators of process quality. Concerning outcome quality one has to take the levels of occupational integration into account. Compared with the results of German vocational retraining centres overall, graduates of the Heidelberg centre constantly had a higher level of vocational integration over the last 20 years, one of the reasons being that the vocational training offered in Heidelberg reaches up to the level of degree of a university of applied sciences. The situation on the job market strongly influences occupational integration: it is evident that a high rate of unemployment will extend the time span necessary for placement. But in the long run occupational integration proves to be amazingly high. Variables that influence the results are: level of disability, sex, age and marital status. The level of vocational qualification is a characteristic with high evidence: integration of graduates at the level of "Fachschule" (highly skilled technician or the like) is 10 % higher and that of graduates at the level of "Fachhochschule" (university of applied sciences) another 10 %. Participation in vocational rehabilitation generally is highly estimated -- estimation as given two years after the training increases with the level of qualification. In the Heidelberg centre progress is seen in expanding the proportions of special target groups (which of course is politically aimed at): women now account for some 30 %, there are more elderly clients and for example also more clients with psychological disorders. The vocational integration of these various groups has to be regarded under different aspects. For example, the situation of severely disabled clients is quite ambivalent: their proportion is falling and their rate of occupational integration is relatively low -- yet there are effects that may compensate. So the importance of the disability decreases with a rising level of vocational training. The data presented may permit the conclusion that vocational rehabilitation at the Heidelberg centre has become more successful over the last decade.

The author describes the development in German law regarding the protection of sexual self-determination of disabled persons. Her analysis encompasses the last twenty years, starting from the "cripple-tribunal 1981", where disabled women first raised the subject in German public. As the main legal reforms for disabled persons in Germany, the author analysis the Thirty-First-Criminal-Law-Change-Act and the Sixth-Act-To-Reform-Criminal-Law of 1997/98 as well as the Ninth-Social-Law-Code of 2001. The author welcomes these legislative reforms but points to the fact that the judiciary has yet failed to implement particularly the criminal law reform. In addition she shows that the new criminal law does not fill all former protection gaps. She demands further reforms in other areas of law. Finally she emphasizes that comprehensive information and education for all those who are concerned by the subject are necessary.

Two research projects "Because Everything Concerning Violence Hurts--Sexual Exploitation of Girls and Women with Disabilities (Zemp and Pircher 1996) and "Sexualized Violence in the Daily Life of People with Disabilities" (Zemp et al. 1997) will be introduced. The following study examined women and men with disabilities who live in a residential institution due to their physical, mental and/or psychological disability. Sexual exploitation starts where a person is used by another in order to satisfy certain needs without being informed or giving consent. Sexual exploitation is an expression of a power relationship. People with disabilities are underprivileged concerning resources, articulation and information, position in society and degree of organisation. We worked with questionnaires and semi-structured interviews. It was important to us not to exclude anybody from the study due to the severity of the disability. In cases where participants were incapable of verbal communication, we used "yes/no-conversation" and "anatomical dolls". 130 men and 130 women between aged between 18 and 78 participated in this study. All women received prophylactic contraception in order to avoid the product of rape. Both male and female participants showed diminished knowledge of sexual education. Approximately 64% of female and 50% of male participants indicate that they have been exploited sexually. Disabled room mates were the predominant group of perpetrators for the male and the third important for the female participants. Sexualized violence in residential institutions is directly linked to structural violence. This can only be fought effectively by a change in paradigms from controlled to self-determined life.

The present article gives inside in research work in progress. Habermas (1973) pointed out the interdependency of economical motivational and other personal interests and the scientific results in research. Starting research on (sexual) self determination in institutions for mentally retarded people we were confronted with quite a number of conflicts of interests. The present article tries to clarify these conflicts from different perspectives e.g. the perspective of the management of the institutions, the perspective of the concerned inhabitants and the perspective of the caregivers. Describing the areas and hindrances we try to find out what sort of fascilitators are needed to improve the participation of mentally handicapped persons in this research process. From a methodological point of view we chose a qualitative approach to generate prototypes and controlled this approach by an expert committee. One of the main results is that a policy against sexual abuse in these institutions has to be part of the general quality discussion.

This report is based upon a model project financially assisted by a grant from the German Federal Ministry for Families, Senior Citizens, Women and Youth, starting in 1999 and ending at the end of 2003. In cooperation with two disability care residential institutions, a conceptual approach and method to the questions of sexual self-determination and sexualized violence is being developed. Through qualitative methods of research e.g. focus groups, professional helpers of all hierarchies of the institution, including management, and the residents themselves, all had the chance to contribute their own opinions and experiences to the research topic. Specifically, to ensure their voice was heard, the people with mental retardation had an important impact on the questionnaire themselves. All aspects of sexuality were discussed--with notable difficulty arising in particular over the subject of sexual violence. It turned out that nonverbal communication and the interaction between the group members in the residents group were most indicative of their concerns. The staff at the nursing and living areas discussed the following topics: distance and closeness in the interaction between staff and residents, standards, reflections of their own professional attitudes, questions of legality as well as the tense topic of individual needs and tasks of the group. How those questioned described their solutions and ways of coping, and the impressions of the researchers forms the starting point for the compiled work. The initial ideas for the topics and the design of the concept are now laid out.

16 children with spastic cerebral palsy and 25 mentally retarded children were assessed via the scales "Self-Care" and "Mobility" of the Pediatric Evaluation of Disability Inventory (PEDI). Age-adjusted PEDI scores were compared with the classification according to the three levels of the German statutory nursing insurance. Good correlations and highly significant dependence were found in children with spastic cerebral palsy but no dependence was seen in mentally retarded children. Apparently, assessment guidelines of the German statutory nursing insurance do not guarantee a valid assessment in all disabled children. In conclusion, future assessments of nursing needs in children should employ standardised assessment methods.

A large number of disabled or mentally retarded children were killed in the so-called "Children's Special Departments" of the "Third Reich". Such children were also misused in scientific research. Ambitious physicians in the "Children's Special Departments" experimented on them in co-operation with other institutions. This happened, for example, in research on the tuberculosis vaccine. The effectiveness of the BCG-vaccine was primarily tested at the Children's University Hospital of Vienna. Disabled children were first given the BCG-vaccine and then deliberately contaminated with tuberculosis bacteria. Subsequently they were transferred to Vienna's "Children's Special Department" in order to be killed there. The efficacy of vaccination was supposed to be demonstrable in their autopsies. Vaccine experiments were also carried out in the "Children's Special Departments" of Berlin and Kaufbeuren. There were likewise co-operations with other institutions.

In the controversy about severely chronic mental patients, who still reside in the psychiatric hospital after decades of deinstitutionalization, their quality of life (QoL) has become a main topic. On the basis of a critique of the dominant, mere standardized approach to QoL this method is compared with a qualitative approach in such a schizophrenic "residual" patient group (n = 144). While in the standardized approach a high level of subjective QoL could be found that correlated positively with the duration of hospitalisation, the open interviews yielded specific experiences of deficiencies. The appraisal of the quality of life especially of chronic or hospitalized patients is reconsidered.

Theoretical background and first results of a vocational rehabilitation program for unemployed persons with chronic psychiatric disabilities will be presented. The aim of the program is job-placement in the regular labour market.After a 3-month preparatory period the participants were given the possibility of "training on-the-job" in the areas of social services, catering, and care taking activities in 12-months' rehabilitation reintegration courses in co-operation with a social service centre. In addition, a 6-months aftercare period will be included.More than one third of 34 participants (38 %) were placed in a regular employment.The results support the importance of vocational rehabilitation programs as a supplementary component of the care system of chronic mentally ill patients.

Starting from race hygienic and eugenic ideas at the end of 19th and at the beginning of the 20th century the development and the execution of the "euthanasia of children" by the Nazis is described. Particularly the carrying out of the killing action is so-called "special children's departments" is dealt with in detail by the use of available investigations. Finally questions about the perpetrator profile and regarding the significance of ethical principles in child and adolescent psychiatry are raised.

During the period of National Socialism in Germany, many "asocial", mentally retarded or disabled minors were persecuted. Several measures had been discussed theoretically before, but the National Socialists put the theoretical proposals into practice. As a result children and adolescents were separated, sterilized or killed. In concentration camps so-called "depraved" minors were selected to get special education. The object of this effort was to adapt minors to the ideology of national socialism. After passing the law to sterilize patients with "hereditary diseases" in 1933 about 375.000 people were sterilized unvoluntarily. In 1939 sterilizations came to an end except for adolescents at "high risk of reproduction". During the second world war more than 160.000 adult psychiatric patients were murdered. In addition to that, also a large number of disabled and mentally retarded minors were killed. This campaign was called child "euthanasia". Physicians tried to determine children's "value of life" by economic criteria. Children with negative ratings (i.e. inability to work or insufficient mental maturing) were killed by fasting "cures" or by barbiturates. Beyond that children were also used as research subjects. Their death was an accepted consequence. Physicians were also very interested in brain research. Finally, the relation to German child and adolescent psychiatry will be analysed. In the special political and social context of the Third Reich the German child and adolescent psychiatry became more significant. As a result of this the German association of child and adolescent psychiatry and allied professions was founded 1940 in Vienna. On this conference, some speakers suggested to persecute "asocial" minors. This suggestion was realized consequently. Up to now, the role of the German child and adolescent psychiatry has not been thoroughly discussed.

Social vulnerability and social isolation as to different, light and severe grades of chronically ill psychiatric patients were evaluated. A social vulnerability index, composed out of marital status, income, health, living conditions, occupation, and risk factors in childhood was used. The vulnerability of 64 severely chronically ill patients and of 84 chronically ill patients was assessed. According to their vulnerability, the patients were divided into a group of highly vulnerable and a group of less vulnerable patients. The social isolation of the two groups (severely chronically und chronically ill patients) was compared and assessed. We used objective criteria (such as living alone, no friends, no contact to family members) and subjective criteria (feeling isolated). Social Vulnerability and social isolation are higher in severely chronically ill patients compared to chronically ill patients. The severely sick group is significantly more affected by objective and/or by subjective isolation than the less sick group. In both groups patients have more difficulties in social relationships than non-isolated patients. There is no significant correlation between objective isolation and subjective isolation.