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Volledige samenvatting Orthopedagogische doelgroepen en werkvelden 2
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samenvattingORTHOPEDAGOGISCHE DOELGROEPEN EN
WERKVELDEN 2
Orthopedagogie - HoGent Campus Schoonmeersen
Schooljaar: 2020-2021 - MT1 – SEM2
Docent: M. Gesquiere, J. Lesseliers, A. Standaert, N. Dirkx
Margot De Weirdt
,2
,Inhoudsopgave
1. Classificatie en diagnostiek.................................................................................................................9
1.1. Classificatie..................................................................................................................................9
1.1.1. Klinisch-psychiatrisch classificatiesystemen.........................................................................9
1.1.2. Empirisch-statische classificatiesystemen...........................................................................10
1.1.3. Overzicht.............................................................................................................................12
1.2. Diagnostiek................................................................................................................................12
1.2.1. Diagnostiek in engere en ruimere zin.................................................................................12
1.2.2. Verschillende ‘soorten’ diagnostiek....................................................................................13
1.2.3. Voor- en nadelen van het stellen van een diagnose...........................................................13
1.2.4. Conclusie.............................................................................................................................13
2. Kinderen, jongeren en volwassenen met gedragsproblemen en gedragsstoornissen (GES)............14
2.1. Terminologie en definiëring.......................................................................................................14
2.1.1. Terminologie: gedragsproblemen versus gedragsstoornissen............................................14
2.1.2. Aandachtspunten bij definiëring.........................................................................................14
2.1.3. Definitie van gedragsproblemen.........................................................................................14
2.1.4. DSM-criteria........................................................................................................................15
2.2. Prevalentie.................................................................................................................................17
2.3. Etiologie.....................................................................................................................................18
2.3.1. Monocausale verklaringsmodellen.....................................................................................18
2.3.2. Multi causale modellen.......................................................................................................20
2.4. Diagnostiek................................................................................................................................20
2.5. Behandeling...............................................................................................................................20
3. Kansarmoede en multiprobleemgezinnen (MPG).............................................................................21
3.1. Multiprobleemgezinnen............................................................................................................21
3.1.1. Historiek en definitie...........................................................................................................21
3.1.2. Inhoudelijke typering van de term ‘multiprobleemgezin’...................................................21
3.1.3. Hoe kijken multiprobleemgezinnen en hulpverleners naar elkaar?....................................22
3.1.4. Hulpverlening: 6 principes..................................................................................................22
3.2. Kansarmoede.............................................................................................................................22
3.2.1. Definitie..............................................................................................................................22
3.2.2. Kansarmoede = multidimensioneel....................................................................................23
3.2.3. Hoeveel gezinnen in kansarmoede?...................................................................................23
3.2.4. Kenmerken (Van Regenmortel)..........................................................................................23
3.2.5. Benadering vanuit multiperspectiviteit...............................................................................24
3
, 3.2.6. Gevolgen voor latere ontwikkeling.....................................................................................24
4. Kindermishandeling: situaties van verontrusting..............................................................................25
4.1. Definitie en vormen...................................................................................................................25
4.1.1. Lichamelijke/fysieke mishandeling.....................................................................................25
4.1.2. Emotionele mishandeling...................................................................................................25
4.1.3. Seksueel misbruik...............................................................................................................26
4.1.4. Verwaarlozing.....................................................................................................................26
4.1.5. Nog enkele andere vormen................................................................................................26
4.2. Prevalentie.................................................................................................................................26
4.3. Gevolgen....................................................................................................................................27
4.3.1. Gevolgen op korte termijn..................................................................................................27
4.3.2. Gevolgen op lange termijn..................................................................................................27
4.4. Verklaringen..............................................................................................................................27
4.5. Preventie...................................................................................................................................28
4.6. Vermoeden van kindermishandeling.........................................................................................28
4.6.1. Waar kan je terecht?..........................................................................................................29
5. Hechting...........................................................................................................................................31
5.1. Enkele pioniers..........................................................................................................................31
5.2. Definitie.....................................................................................................................................31
5.3. Ontwikkeling van hechting........................................................................................................31
5.3.1. Summiere beschrijving van de identiteitsontwikkeling.......................................................31
5.3.2. Psychodynamische benadering van hechting.....................................................................32
5.4. Onderzoek naar de kwaliteit van hechting................................................................................32
5.5. Klinisch-psychiatrische classificatie van hechtingsstoornissen..................................................33
5.6. Etiologie.....................................................................................................................................34
5.7. Prognose....................................................................................................................................35
6. ADHD................................................................................................................................................36
6.1. Wat is ADHD?............................................................................................................................36
6.1.1. Terminologie en definiëring................................................................................................36
6.1.2. Ontwikkelingsverloop.........................................................................................................36
6.1.3. Gedragskenmerken.............................................................................................................37
6.2. Diagnostiek................................................................................................................................37
6.2.1. Gedragsdiagnose................................................................................................................37
6.2.2. DSM-criteria........................................................................................................................37
6.2.3. Het diagnostisch proces......................................................................................................39
6.3. Etiologie.....................................................................................................................................39
4
, 6.4. Prevalentie en co-morbiditeit....................................................................................................40
6.5. Prognose....................................................................................................................................41
6.6. Ondersteuning...........................................................................................................................41
6.6.1. Ondersteuning van het kind...............................................................................................41
6.6.2. Ondersteuning in de omgeving...........................................................................................42
7. Situaties van verontrusting (jeugdhulp)............................................................................................43
7.1. Historiek....................................................................................................................................44
7.1.1. De evolutie van de wetgeving inzake jeugdbescherming...................................................45
7.2. Organisatie & aanbod................................................................................................................47
7.3. Terugblik en blik op toekomst...................................................................................................50
8. Integrale jeugdhulp...........................................................................................................................51
8.1. Historiek....................................................................................................................................51
8.2. Huidig beleid & organisatie........................................................................................................53
8.2.1. Doelstellingen.....................................................................................................................53
8.2.2. De organisatiestructuur......................................................................................................53
8.3. Uitdagingen & kritieken.............................................................................................................55
8.4. Praktijk.......................................................................................................................................55
8.5. Wat is actueel?..........................................................................................................................55
9. Leerstoornissen................................................................................................................................56
9.1. Geschiedenis..............................................................................................................................56
9.2. Begrippen..................................................................................................................................56
9.2.1. Wanneer is er sprake van een leerstoornis?.......................................................................56
9.2.2. Etiologie..............................................................................................................................57
9.2.3. Dyslexie...............................................................................................................................57
9.2.4. Dyscalculie..........................................................................................................................58
9.2.5. Prevalentie en co-morbiditeit.............................................................................................58
9.2.6. Handelsgericht diagnostisch traject....................................................................................58
9.3. Beeldvorming.............................................................................................................................59
9.4. Orthopedagogische ondersteuning...........................................................................................59
9.4.1. Het zorgcontinuüm.............................................................................................................59
9.4.2. Aantal specifieke ondersteuningsvormen...........................................................................60
10. Coördinatieontwikkelingsstoornis (DCD)........................................................................................61
10.1. Wat is een coördinatieontwikkelingsstoornis?........................................................................61
10.1.1. Terminologie en definitie..................................................................................................61
10.1.2. Primaire kenmerken.........................................................................................................61
10.1.3. Verloop.............................................................................................................................61
5
, 10.2. Prevalentie en co-morbiditeit..................................................................................................62
10.3. Etiologie...................................................................................................................................62
10.4. Prognose..................................................................................................................................62
10.5. Secundaire kenmerken DCD....................................................................................................62
10.6. Diagnostiek..............................................................................................................................63
10.7. Ondersteuning.........................................................................................................................63
11. Geestelijke gezondheidszorg (GGZ)................................................................................................64
11.1. Historiek..................................................................................................................................64
11.2. Organisatie...............................................................................................................................65
11.2.1. Klassieke aanbod..............................................................................................................65
11.2.2. Het niet-klassieke aanbod en zorgvernieuwende projecten.............................................66
11.2.3. Uitbouw zorgcircuits en zorgnetwerken...........................................................................67
11.2.4. Gespecialiseerde zorg.......................................................................................................68
11.3. Recente evoluties....................................................................................................................68
12. Internering......................................................................................................................................70
12.1. Justitiële en maatschappelijk context van internering.............................................................70
12.1.1. De interneringswet (Wetgeving).......................................................................................70
12.1.2. Differentiatie met ‘gedwongen opname’..........................................................................70
12.1.3. Masterplan Internering.....................................................................................................71
12.2. Internering in de justitiële praktijk...........................................................................................71
12.2.1. Voorwaarden voor internering.........................................................................................71
12.2.2. Interneringsprocedure......................................................................................................71
12.2.3. Opvolging van de KBM......................................................................................................72
12.3. Internering in de klinisch-agogische praktijk............................................................................73
12.3.1. Schets van de doelgroep...................................................................................................73
12.3.2. Waar zijn de geïnterneerde personen?.............................................................................73
12.3.3. Onderverdelingen in het werkveld...................................................................................73
12.3.4. Methoden en werkmodellen............................................................................................74
13. Drughulpverlening..........................................................................................................................76
13.1. Geschiedenis............................................................................................................................76
13.1.1. Situatie in Vlaanderen.......................................................................................................76
13.2. Terminologie............................................................................................................................76
13.2.1. DSM-criteria......................................................................................................................76
13.3. Drugs........................................................................................................................................77
13.4. Maatschappelijke reacties.......................................................................................................78
13.5. Psychologische inzichten.........................................................................................................78
6
, 13.5.1. Mens-middel-milieu..........................................................................................................78
13.5.2. Fasen van het afhankelijkheidsproces..............................................................................79
13.5.3. De vicieuze cirkels van Van Dijck.......................................................................................79
13.5.4. Stadia van verandering.....................................................................................................79
13.5.5. Dubbeldiagnose................................................................................................................80
13.6. Orthopedagogiek.....................................................................................................................80
13.6.1. Therapeutische gemeenschap..........................................................................................80
13.6.2. Casemanagement.............................................................................................................80
13.6.3. Opvoedingssituatie van kinderen van drugsverslaafde ouders.........................................81
14. Niet Begeleide Buitenlandse Minderjarigen...................................................................................82
14.1. Aspecten die emotioneel welzijn beïnvloeden........................................................................82
14.2. Dagelijkse stressoren...............................................................................................................82
14.3. Procedure van asielaanvraag...................................................................................................82
14.4. Voorzieningen voor Jongerenwelzijn versus asielcentra..........................................................82
14.5. Hoe beter omgaan met jonge vluchtelingen?..........................................................................83
15. Neurocognitieve stoornissen (dementie).......................................................................................84
15.1. Situering & prevalentie............................................................................................................84
15.2. Terminologie............................................................................................................................85
15.3. DSM-criteria.............................................................................................................................85
15.4. Symptomen.............................................................................................................................86
15.4.1. Primaire symptomen/kernsymptomen.............................................................................86
15.4.2. Secundaire symptomen....................................................................................................86
15.5. Oorzaken.................................................................................................................................86
15.6. Risicofactoren & beschermingsfactoren..................................................................................87
15.7. Verloop (belevingsfasen).........................................................................................................87
15.7.1. Het bedreigde en verwarde bestaan................................................................................87
15.7.2. Het verdwaalde bestaan...................................................................................................87
15.7.3. Het verzonken bestaan.....................................................................................................87
15.8. Ondersteuning.........................................................................................................................88
15.8.1. Realiteitsoriënterende houding (ROH)..............................................................................88
15.8.2. Reminiscentie...................................................................................................................88
15.8.3. Zintuigprikkeling...............................................................................................................88
15.8.4. Validation (Naomi Feil).....................................................................................................88
15.8.5. Geïntegreerde belevingsgerichte begeleiding..................................................................89
15.8.6. Warme zorg......................................................................................................................89
15.9. Mantelzorg..............................................................................................................................89
7
,8
, 1. Classificatie en diagnostiek
Van alle tijden, maar veranderd voortdurend CHAOZ
1.1. Classificatie
= het systematisch ordenen en groeperen van problemen op basis van gelijke
eigenschappen en onderlinge relaties
!! NOODZAKELEIJK door de grote verscheidenheid aan ‘problemen’
Communicatie en gemeenschappelijke taal = belangrijk
Verstaan we hetzelfde?
Classificatie ≠ diagnostiek
1.1.1. Klinisch-psychiatrisch classificatiesystemen
Psychiatrische stoornissen ->> onafhankelijke en duidelijk afgelijnde ziekte-entiteiten
Criteria ->> kernsymptomen, duur, aanvang en mate
Diagnostische criteria: criteria waarbij individu positief scoort
Differentiaal diagnostische criteria: uitsluiten criteria van andere stoornissen
Pas als men aan bepaalde nodig criteria voldoet -> ‘STOORNIS’
Categoriaal: men heeft een stoornis of men heeft ze niet
DSM systeem om problematieken van individuen te beschrijven en te classificeren in
‘stoorniscategorieën’
Sluit aan bij paradigma 3, het medische model
Problemen worden onderverdeeld in duidelijk omschreven ‘stoornis’-categorieën
DSM-5
• Drie delen
DEEL 1: uitleg indeling en uitgangspunten
DEEL 2: 22 hoofdcategorieën
DEEL 3: classificaties die nog niet zijn openomen
• Nieuwe namen
• Meer dimensioneel gepresenteerd
Hoofdcategorieën DSM-5 -> Te kennen
1. Neurobiologische ontwikkelingsstoornissen (o.a. verstandelijke beperking, autismespectrumstoornis,
ADHD, leerstoornissen, tic-stoornissen….)
9
, 2. Schizofreniespectrum en andere psychotische stoornissen
3. Bipolaire-stemmingsstoornissen
4. Depressieve-stemmingsstoornissen
5. Angststoornissen
6. Obsessieve-Compulsieve en verwante stoornissen
7. Trauma-en stressor-gerelateerde stoornissen (met o.a. reactieve hechtingsstoornis, posttraumatische
stressstoornis…)
8. Dissociatieve stoornissen
9. Somatisch Symptoomstoornis en verwante stoornissen
10. Voedings-en eetstoornissen
11. Stoornissen in de zindelijkheid (o.a. enuresis & encopresis)
12. Slaap-Waak Stoornissen
13. Seksuele disfuncties
14. Genderdysforie
15. Disruptieve, lmpulsbeheersings-en andere gedragstoornissen (oppositioneel opstandige stoornis,
periodiek explosieve stoornis, normoverschrijdend-gedragsstoornis…)
16. Middelgerelateerde en verslavingsstoornissen
17. Neurocognitieve Stoornissen (o.a. Alzheimer, delirium…)
18. Persoonlijkheidsstoornissen (o.a. borderline, paranoïde, antisociale PS)
19. Parafiele stoornissen (o.a. exhibitionisme, pedofilie…)
20. Overige psychische stoornissen
21. Bewegingsstoornissen en andere bijwerkingen van medicatie
22. Andere problemen die een reden voor zorg kunnen zijn.
1.1.2. Empirisch-statische classificatiesystemen
Psychometrische invalshoek
‘Classificeren’, probleemgedrag inventariseren en beoordelen a.d.h.v. gedragsvragenlijsten
ASEBA
CBCL ->> ingevuld door ouders
TRF ->> ingevuld door leerkracht
10
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