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Samenvatting Orthopedagogische Doelgroepen En Werkvelden 2

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Orthopedagogische Doelgroepen En Werkvelden 2

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Hogeschool Gent (HoGent)

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Type Summary

odw2
drughulpverlening
internering
ggz
adhd
ass
dcd
leerstoornissen
verontrusting
diagnostiek

Institution
Hogeschool Gent (HoGent)
Education
Orthopedagogie
Course
Orthopedagogische Doelgroepen En Werkvelden 2

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ORTHOPEDAGOGISCHE
DOELGROEPEN EN
WERKVELDEN 2
Hogeschool Gent, academiejaar 20-21

Merel Vanhove

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 0

,INHOUDSOPGAVE
THEMA 1: CLASSIFICATIE & DIAGNOSTIEK ...................................................................................................... 12
Classificatie ........................................................................................................................................................ 12
klinisch-psychiatrisch classificatiesysteem .................................................................................................... 12
empirisch-statistische classificatiesystemen ................................................................................................. 14
diagnostiek ........................................................................................................................................................ 15
diagnostiek in engere en ruimere zin ............................................................................................................ 15
3 verschillende ‘soorten’ diagnostiek ........................................................................................................... 16
voor- en nadelen voor het stellen van een diagnose .................................................................................... 17
THEMA 2: KINDEREN, JONGEREN EN VOLWASSENEN MET GEDRAGSPROBLEMEN OF GEDRAGSSTOORNISSEN
....................................................................................................................................................................... 18
inleiding ............................................................................................................................................................. 18
terminologie en definiëring............................................................................................................................... 18
terminologie: gedragsproblemen versus gedragstoornissen ........................................................................ 18
aandachtspunten bij de definiëring .............................................................................................................. 19
definitie van gedragsproblemen ................................................................................................................... 20
DSM-criteria .................................................................................................................................................. 21
Oppositioneel-opstandige stoornis (ODD) ................................................................................................ 22
Normoverschrijdende gedragsstoornis (CD) ............................................................................................. 23
prevalentie ........................................................................................................................................................ 24
etiologie ............................................................................................................................................................ 25
monocausale verklaringsmodellen ............................................................................................................... 25
Biologische verklaringsmodellen ............................................................................................................... 25
Psychoanalyse – psychodynamisch model ................................................................................................ 26
Leertheorie ................................................................................................................................................ 26
Cognitief-behavioristische theorie ............................................................................................................ 26
Systeemtheorie ......................................................................................................................................... 27
Orthopedagogiek ...................................................................................................................................... 27
multicausale modellen .................................................................................................................................. 27
diagnostiek ........................................................................................................................................................ 28
behandeling van gedragsproblemen ................................................................................................................. 28
THEMA 3: GEZINNEN MET MEERVOUDIGE EN COMPLEXE PROBLEMEN ......................................................... 29
multiprobleemgezinnen .................................................................................................................................... 29
inleiding ......................................................................................................................................................... 29
historiek en definitie ..................................................................................................................................... 29
inhoudelijke typeringen van de term ‘multiprobleemgezin’ ........................................................................ 30
kenmerken van de problemen van het gezin ............................................................................................ 30

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 0

, inhoud van de problemen van het gezin ................................................................................................... 30
hoe kijken multiprobleemgezinnen en hulpverleners naar elkaar? .............................................................. 32
ouders naar hulpverleners ........................................................................................................................ 32
hulpverleners naar ouders ........................................................................................................................ 32
hulpverlening aan multiprobleemgezinnen: 6 principes .............................................................................. 33
tegemoetkomende hulp............................................................................................................................ 33
gezinsgerichte hulp ................................................................................................................................... 33
emancipatorische hulp .............................................................................................................................. 33
integrale hulp ............................................................................................................................................ 33
samenwerking en coördinatie ................................................................................................................... 33
supervisie .................................................................................................................................................. 33
kansarmoede..................................................................................................................................................... 34
definitie ......................................................................................................................................................... 34
kansarmoede = multidimenioneel/ multi-aspectueel ................................................................................... 34
hoeveel gezinnen leven in kansarmoede? .................................................................................................... 34
kenmerken van kansarmoede ....................................................................................................................... 36
multicomplexe problematiek .................................................................................................................... 36
gevoelens van machteloosheid ................................................................................................................. 36
gevoelens van wantrouwen ...................................................................................................................... 36
gestoorde communicatie .......................................................................................................................... 36
benadering van kansarmoede vanuit multiperspectiviteit ........................................................................... 37
gevolgen voor de latere ontwikkeling ........................................................................................................... 38
THEMA 4: KINDERMISHANDELING: SITUATIES VAN VERONTRUSTING ........................................................... 39
inleiding ............................................................................................................................................................. 39
definitie en vormen van kindermishandeling ................................................................................................... 39
fysieke/lichamelijke mishandeling ................................................................................................................ 39
(WHiplash) Shaken Infant-syndrome (SIS) ................................................................................................ 39
Münchausen (by proxy) syndrome ........................................................................................................... 40
verwaarlozing ................................................................................................................................................ 40
lichamelijke verwaarlozing ........................................................................................................................ 40
emotionele verwaarlozing......................................................................................................................... 40
psychogene dwerggroei ............................................................................................................................ 40
seksueel misbruik .......................................................................................................................................... 40
emotionele mishandeling.............................................................................................................................. 40
sibling mishandeling ...................................................................................................................................... 41
ritueel misbruik ............................................................................................................................................. 41
prevalentie ........................................................................................................................................................ 41

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 1

, gevolgen van kindermishandeling..................................................................................................................... 41
gevolgen op korte termijn ............................................................................................................................. 41
gevolgen op lange termijn ............................................................................................................................ 41
verklaringen voor het ontstaan van kindermishandeling ................................................................................. 42
preventie van kindermishandeling .................................................................................................................... 43
vermoeden van kindermishandeling ................................................................................................................. 44
waar kan je terecht ........................................................................................................................................... 45
THEMA 5: HECHTING ...................................................................................................................................... 46
pioniers in de wetenschap over hechting ......................................................................................................... 46
definitie ............................................................................................................................................................. 46
ontwikkeling van hechting ................................................................................................................................ 46
een summiere beschrijving van de identiteitsontwikkeling .......................................................................... 46
psychonamische benadering van hechting ................................................................................................... 47
onderzoek naar de kwaliteit van hechting ........................................................................................................ 49
klinisch-psychiatrische classificatie van hechtingsstoornissen ......................................................................... 51
etiologie van hechtingsstoornissen ................................................................................................................... 52
prognose ........................................................................................................................................................... 53
THEMA 6: KINDEREN, JONGEREN EN VOLWASSENEN MET AANDACHTSDEFICIËNTIE-
HYPERACTIVITEITSSTOORNIS (ADHD) ............................................................................................................. 55
inleiding ............................................................................................................................................................. 55
wat is ADHD? ..................................................................................................................................................... 55
terminologie en definiëring........................................................................................................................... 55
gederagskenmerken ...................................................................................................................................... 56
primaire gedragskenmerken – 3 kenmerken, 2 dimensies ....................................................................... 56
dimensie 1: Aandachtsdeficiëntie/onoplettendheid ............................................................................ 56
dimensie 2: Hyperactiviteit-impulsiviteit .............................................................................................. 57
ontwikkelingsverloop ............................................................................................................................ 58
secundaire gedragskenmeken .................................................................................................................. 59
diagnostiek ........................................................................................................................................................ 59
gedragsdiagnose ........................................................................................................................................... 59
DSM-criteria .................................................................................................................................................. 60
overzicht DSM-Criteria .............................................................................................................................. 61
het diagnostisch proces ................................................................................................................................ 62
etiologie ............................................................................................................................................................ 63
prevalentie en co-morbiditeit ........................................................................................................................... 64
prognose ........................................................................................................................................................... 65
positieve noot ................................................................................................................................................... 66

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 2

, ondersteuning ................................................................................................................................................... 66
ondersteuning van het kind .......................................................................................................................... 66
farmacotherapie........................................................................................................................................ 66
functietraining ........................................................................................................................................... 67
vaardigheidstraining.................................................................................................................................. 67
psychosociale begeleiding ......................................................................................................................... 67
ondersteuning in de omgeving ..................................................................................................................... 68
gedragstherapeutische ouder- en leerkachtentraining ............................................................................ 68
redelijke aanpassingen .............................................................................................................................. 68
buitengewoon onderwijs en andere ondersteuningsvormen ................................................................... 68
beslissingsboom ondersteuning ................................................................................................................ 69
concrete tips...................................................................................................................................................... 69
THEMA 7: ONDERSTEUNING EN PLAATSING VAN KINDEREN EN JONGEREN IN SITUATIES VAN
VERONTRUSTING ........................................................................................................................................... 70
inleiding ............................................................................................................................................................. 70
historiek ............................................................................................................................................................ 71
de evolutie van de wetgeving inzake jeugdbescherming.............................................................................. 73
de kinderbeschermingswet van 1912 ....................................................................................................... 73
de wet betreffende de jeugdbescherming van 1965 ................................................................................ 73
de staatshervormingen en gecoördineerde decreten van 1990 ............................................................... 74
5 belangrijkste principes van de gecoördineerde decreten BJB van 1990 ............................................ 74
de toegang tot de jeugdbijstand tot 2014............................................................................................. 75
de gewijzigde wet op de jeugdbescherming in 2006 ................................................................................ 76
nieuw decreet jeugddelinquentierecht 2019 ............................................................................................ 76
organisatie en aanbod van Jongerenwelzijn ..................................................................................................... 77
toeleiding tot de jeugdhulpverlening ............................................................................................................ 77
ontwikkelingen betreffende het aanbod en de organistie van de jeugdhulp: van erkenningscategorieën
naar een modulair kader ............................................................................................................................... 78
inleiding ..................................................................................................................................................... 78
indeling van private voorzieningen volgens erkenningscategorieën ........................................................ 78
categorie 1: Begeleidingstehuizen ........................................................................................................ 78
categorie 2: Genzinstehuizen ................................................................................................................ 78
categorie 3: Onthaal-, oriëntatie- en observatiecentra ........................................................................ 79
categorie 4: Dagcentra .......................................................................................................................... 79
categorie 5: Thuisbegeleidingsdiensten ................................................................................................ 79
categorie 6: Diensten voor begeleid zelfstandig wonen ....................................................................... 79
categorie 7: Diensten voor pleegzorg ................................................................................................... 79

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 3

, categorie 8: Diensten voor herstelgerichte en constructieve afhandelingen (HCA) ............................. 79
categorie 9: Crisishulp aan huis ............................................................................................................. 79
nood aan flexibilisering van het jeugdaanbod: het MFC-proefproject ..................................................... 79
de ontwikkeling van het Experimenteel Modulair Kader (EMK) ............................................................... 80
het huidig (modulair) jeugdaanbod .............................................................................................................. 80
de private voorzieningen .......................................................................................................................... 81
organisaties voor Bijzondere Jeugdzorg (OVBJ) .................................................................................... 81
diensten voor pleegzorg ........................................................................................................................ 81
Centra voor Integrale Gezinszorg (CIG) ................................................................................................. 81
Diensten voor Crisishulp aan Huis (CaH) ............................................................................................... 81
Onthaal-, oriëntatie- en observatiecentra in een modulair kader (OOOC) ........................................... 81
Diensten voor Herstelgericht en Constructieve Afhandeling ................................................................ 81
(regulier erkende) projecten ..................................................................................................................... 82
columbus ............................................................................................................................................... 82
Youth at Risk.......................................................................................................................................... 82
time-out projecten of NAFT (naadloze flexibele trajecten) .................................................................. 82
ontheming ............................................................................................................................................. 82
de publieke jeugdinstellingen ................................................................................................................... 82
de gemeenschapsinstellingen ............................................................................................................... 82
de overige gesloten centra .................................................................................................................... 83
terugbblik en blik op de toekomst .................................................................................................................... 83
afkortingen ........................................................................................................................................................ 84
THEMA 8: NAAR EEN INTEGRALE JEUGDHULP IN VLAANDEREN ..................................................................... 85
inleiding ............................................................................................................................................................. 85
historiek ............................................................................................................................................................ 86
inleiding ......................................................................................................................................................... 86
kritieken op de organisatie van de jeugdhulpverlening ................................................................................ 86
integrale jeugdhulp: een werk van lange adem ............................................................................................ 87
fase 1: Het ontstaan van de Integrale Jeugdhulpverlening (1999-2004) .................................................. 87
Strategisch Plan Integrale Jeugdhulpverlening (2000) .......................................................................... 88
decreet betreffende de Integrale Jeugdhulp (2004) ............................................................................. 88
Decreet betreffende de rechtspositie van de minderjarige in de Integrale Jeugdhulp (2004) ............. 88
fase 2: Implementatie van de twee decreten (2005-2012)....................................................................... 89
Fase 3: Het nieuw decreet (2012 – heden) ............................................................................................... 89
voor wie en door wie is integrale jeugdhulp ................................................................................................. 89
huidig beleid en organisatie .............................................................................................................................. 90
vernieuw decreet betreffende de Integrale Jeugdhulp (3 juli 2013) ............................................................ 90

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 4

, principes .................................................................................................................................................... 90
contextgerichtheid ................................................................................................................................ 90
krachtenperspectief .............................................................................................................................. 90
vraagsturing........................................................................................................................................... 90
subsidiariteit .......................................................................................................................................... 90
instemming............................................................................................................................................ 90
diversiteit .............................................................................................................................................. 90
doelstellingen van de Intergrale Jeugdhulp .............................................................................................. 90
inzetten op vermaatschappelijking van de jeugdhulp .......................................................................... 91
tijdige toegang tot de jeugdhulpverlening organiseren ........................................................................ 91
waarborgen van continuïteit in de jeugdhulp ....................................................................................... 91
gepast omgaan met verontrusting ........................................................................................................ 91
het aanbieden van crisishulp................................................................................................................. 91
participatie aan de jeugdhulp ............................................................................................................... 92
huidige organisatiestructuren ....................................................................................................................... 92
de rechtstreeks toegankelijke hulp (RTH) ................................................................................................. 92
brede instap .......................................................................................................................................... 92
probleemgebonden hulp ....................................................................................................................... 93
multidisciplinaire teams (MDTs) ........................................................................................................... 93
de intersectorale toegangspoort (ITP) regelt de toegang tot de niet-rechtstreeks toegankelijke hulp
(NRTH) ....................................................................................................................................................... 93
aanmelden bij de intersectorale toegangspoort ................................................................................... 94
scheiding tussen indicatiestelling en jeugdhulpregie ............................................................................ 94
de gemandateerde voorzieningen ............................................................................................................ 95
de gerechtelijke toegang tot hulp ............................................................................................................. 96
terminologie dossiers ................................................................................................................................ 96
crisishulp, bemiddeling en cliëntoverleg ................................................................................................... 97
jeugdhulp buiten het toepassingsgebied van IJH ...................................................................................... 97
enkele voorbeelden van trajecten van de integrale Jeugdhulp ................................................................ 98
van brede instap naar NRTH (lijn 1) ...................................................................................................... 98
traject naar NRTH bij verontrustende situaties (lijn 2) ......................................................................... 98
traject naar NRTH via de JRB (lijn 2) ...................................................................................................... 99
lijn 3: ondersteuning van hulpverleners en cliënt: bemiddeling- cliënoverleg – crisijeugdhulp ........... 99
voornaamste vernieuwingen en uitdiagingen .................................................................................................. 99
innovatieve concepten .................................................................................................................................. 99
uitdagingen voor en kritieken ten aanzien van de IJH ................................................................................ 100
top-down verhaal .................................................................................................................................... 100

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 5

, complexe taal en instrumenten .............................................................................................................. 100
inspraak binnen de IJH? .......................................................................................................................... 100
inhoudelijke debat naar de achtergrond ................................................................................................ 100
besluit.............................................................................................................................................................. 100
hoe verloopt het in de praktijk? ...................................................................................................................... 100
hulpverleners .............................................................................................................................................. 100
de contactpersoon-aanmelder.................................................................................................................... 101
omgaan met verontrusting/ aanmelden bij de GV ..................................................................................... 101
samenwerking en gedeelde verantwoordelijkheid ..................................................................................... 101
contactpersoon- aanmelder ........................................................................................................................ 101
omgaan met verontrusting ......................................................................................................................... 101
grote frustraties .......................................................................................................................................... 101
de cliënten................................................................................................................................................... 101
jongeren en hun ouders .......................................................................................................................... 102
de organisaties ............................................................................................................................................ 102
wat is er actueel .............................................................................................................................................. 102
THEMA 9: KINDEREN, JONGEREN EN VOLWASSENEN MET LEERSTOORNISSEN ............................................ 103
inleiding ........................................................................................................................................................... 103
geschiedenis .................................................................................................................................................... 103
begrippen ........................................................................................................................................................ 104
wanneer spreken we over een leerstoornis? .............................................................................................. 104
etiologie ...................................................................................................................................................... 105
opportunity-Propensity model van Byrnes en Miller (2007) .................................................................. 106
dyslexie........................................................................................................................................................ 107
dyscalculie ................................................................................................................................................... 108
prevalentie en comorbiditeit ...................................................................................................................... 109
prevalentie .............................................................................................................................................. 109
comorbiditeit........................................................................................................................................... 109
een handelingsgericht diagnostisch proces ................................................................................................ 109
beeldvorming .................................................................................................................................................. 110
sterktes en kwetsbaarheden binnen het kind............................................................................................. 110
sterktes en kwetsbaarheden in de omgeving ............................................................................................. 111
eerste kennismaking met de orthopedagogische ondersteuning................................................................... 112
het zorgcontinuüm ...................................................................................................................................... 112
een aantal specifieke ondersteuningsvormen ............................................................................................ 112
THEMA 10: KINDEREN, JONGEREN EN VOLWASSENEN MET EEN COÖRDINATIEONTWIKKELINGSSTOORNIS
(DCD)............................................................................................................................................................ 114

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 6

, Wat is een coördinatieontwikkelingsstoornis ................................................................................................. 114
terminologie ................................................................................................................................................ 114
dsm-5 criteria .............................................................................................................................................. 114
primaire kenmerken .................................................................................................................................... 115
verloop ........................................................................................................................................................ 116
prevalentie en comorbiditeit .......................................................................................................................... 117
etiologie .......................................................................................................................................................... 117
prognose ......................................................................................................................................................... 117
secundaire kenmerken DCD ............................................................................................................................ 117
diagnostiek ...................................................................................................................................................... 118
ondersteuning ................................................................................................................................................. 119
functietraining ............................................................................................................................................. 119
vaardigheidstraining.................................................................................................................................... 119
psycho-sociale begeleiding ......................................................................................................................... 119
educatie....................................................................................................................................................... 119
beweging stumuleren ................................................................................................................................. 119
redelijke aanpassingen ................................................................................................................................ 120
buitengewoon onderwijs ............................................................................................................................ 120
THEMA 11: HISTORIEK EN ORGANISATIE VAN DE GEESTELIJKE GEZONDHEIDSZORG IN VLAANDEREN ......... 121
inleiding ........................................................................................................................................................... 121
historiek .......................................................................................................................................................... 122
ontstaan van de geestelijke gezondheidszorg in Vlaanderen ..................................................................... 123
uitbouw van de ‘moderne’ psychiatrie ....................................................................................................... 123
evoluties in de behandeling van personen met psychische problemen ................................................. 123
veranderingen in de zorginstantie .......................................................................................................... 124
organisatie....................................................................................................................................................... 125
het klassieke aanbod ................................................................................................................................... 125
overzicht GGZ-voorzieningen .................................................................................................................. 125
psychiatrische ziekenhuis (PZ)............................................................................................................. 125
psychiatrische afdelingen in algemene ziekenhuizen (PAAZ) ............................................................. 125
psychiatrische verzorgingstehuizen (pvt) ............................................................................................ 125
initiatieven Beschut Wonen (IBW) ...................................................................................................... 126
Centra voor geestelijke gezondheidszorg (CGG) ................................................................................. 126
revalidatiecentra ................................................................................................................................. 126
het niet-klassieke aanbod en zorgvernieuwende projecten ....................................................................... 126
gezinsverpleging ...................................................................................................................................... 126
psychiatrische zorg in de thuissituatie (PZT) ........................................................................................... 126

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 7

, activering ................................................................................................................................................. 127
domein ‘arbeid en vorming’ ................................................................................................................ 127
domein ‘vrije tijd en ontmoeting’ ....................................................................................................... 127
multidisciplinair overleg rond mensen met psychiatrische stoornissen ................................................. 127
outreach initiatieven en mobiele equipes .............................................................................................. 127
patiënten- en familieverenigingen .......................................................................................................... 128
de veranderende organisatie van de zorg: uitbouw van zorgcircuits en zorgnetwerken ........................... 128
zorgcircuits en netwerken voor volwassenen ......................................................................................... 128
gespecialiseerde zorg voor specifieke groepen .......................................................................................... 129
de K-diensten .......................................................................................................................................... 129
ondersteuning voor volwassenen met een verstandelijke beperking en bijkomende psychische en/of
gedragproblemen .................................................................................................................................... 129
recente evoluties............................................................................................................................................. 130
THEMA 12: INTERNERING ............................................................................................................................. 131
de zorg voor geïnterneerde personen binnen het algemeen forensische welzijnswerk ................................ 131
justitiële en maatschappelijke context van internering .................................................................................. 131
de actuele interneringswet ......................................................................................................................... 132
de wettelijke definitie van internering -belgisch staatsblad ................................................................... 132
krachtlijnen van de actuele interneringswet .......................................................................................... 132
differentiatie met een gedwongen opname ........................................................................................... 133
masterplan internering ............................................................................................................................... 134
internering in de justitiële praktijk .................................................................................................................. 134
interneringsvoorwaarden ........................................................................................................................... 134
interneringsprocedure ................................................................................................................................ 135
het psychiatrisch deskundigenonderzoek ................................................................................................... 136
de Kamer ter Bescherming van de Maatschappij (KBM) ............................................................................ 136
wat is het mandaat van de KBM ............................................................................................................. 136
wie is er op een KBM-zitting aanwezig.................................................................................................... 137
internering in de klinisch-agogische praktijk................................................................................................... 137
schets van de doelgroep ............................................................................................................................. 137
waar zijn de geïnterneerde personen? ....................................................................................................... 137
hoeveel geïnterneerde personen verblijven er momenteel in de gevangenis ....................................... 137
hoeveel geïnterneerde personen verblijven er momenteel buiten de gevangenis ................................ 137
onderverdelingen in het werkveld: risico en categorisering ....................................................................... 138
3 B’s: beveiliging, behandeling, bejegening ................................................................................................ 138
de vigerende theoretische kaders rond de zorg voor geïnterneerden ....................................................... 139
Risk-Need-Responsivity Model (RNR) ..................................................................................................... 139

Orthopedagogische doelgroepen en werkvelden 2 M.Vanhove 8

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