Peer-reviewed article
Exclusion From Childcare Centre Attendance in Toddler and Preschool Patients in a Psychiatric Day Clinic: Patterns From Comparison of a 2018/2019 and a 2023/2024 Cohort.
Bonnekoh LM, Friese L, Fellmeth RH, Sánchez Guerrero HA, Hansen S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined exclusion of toddlers and preschoolers with mental health disorders from childcare centres in a psychiatric day clinic, comparing two time periods. Exclusion rates increased from 8% in 2018/2019 to 25.5% in 2023/2024, with boys disproportionately affected in both cohorts. Male sex and membership in the later cohort predicted exclusion, while socioeconomic status, migration status, and parental psychiatric conditions did not. Among excluded children, 78% achieved partial or full reintegration into childcare during treatment.
Key points
- Exclusion from childcare centre attendance among children in psychiatric treatment rose significantly from 8.0% (2018/2019) to 25.5% (2023/2024)
- Boys were predominantly excluded, comprising 66.7% of excluded children in 2018/2019 and 92.3% in 2023/2024
- Male sex and cohort membership in 2023/2024 were significant predictors of exclusion, while socioeconomic status, migration status, and parental psychiatric conditions were not
- Approximately 78% of excluded children achieved partial reintegration or improvement in social integration during psychiatric day clinic treatment
- The study emphasises that ensuring inclusive access to early education should be an important therapeutic goal aligned with the UN Convention on the Rights of the Child
Limitations
The study is retrospective and limited to children attending a psychiatric day clinic, so results may not generalise to the broader population of young children with mental health disorders. The reasons for the increase in exclusion rates between cohorts are not explained, and the document does not detail specific mechanisms of reintegration or long-term follow-up outcomes.
Abstract
Background Childcare centres for toddlers and preschool-aged children serve as a setting crucial to mental development, as stable relationships with caregivers and peers outside the family form. Children with early mental health disorders, especially externalising behaviours, are at increased risk of being excluded from access to these institutional services. Methods The retrospective study investigates partial or full exclusion from childcare centre attendance among toddlers and preschoolers (N = 177) who received psychiatric day clinic treatment within two periods (2018/2019 and 2023/2024). We compared excluded and non-excluded children regarding clinical parameters in a binary logistic regression. Furthermore, treatment trajectories were examined to assess reintegration into childcare settings as a potential therapeutic outcome. Results Among the patients in the psychiatric day clinic for toddlers and preschoolers, the rate of exclusion from childcare centre attendance was 25.5% (2023/2024) and 8.0% (2018/2019), respectively. Boys were predominantly excluded from childcare centre attendance with 66.7% (2018/2019) and 92.3% (2023/2024). Overall for both cohorts, while male sex (p = 0.028) and cohort membership in the 2023/24 cohort (p = 0.009) predicted exclusion, other investigated variables (i.e., socioeconomic status, migration status, parental psychiatric condition) did not show an effect. In 78.1% of the excluded patients in the combined samples, (partial) reintegration or improvement of social integration was recorded or initiated during treatment. Conclusions In our study, exclusion from childcare attendance differed between 2018/2019 and 2023/2024 in toddler and preschool children, especially affecting boys. In line with the UN Convention on the Rights of the Child, 1989, ensuring inclusive access to early education regardless of physical or mental impairments should be an important therapeutic goal. Mental health professionals should pay special attention to and actively support prevention and reintegration regarding early life exclusion experiences from childcare centres.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Psychiatric day clinic treatment involving reintegration support and active efforts to facilitate return to or improved attendance at childcare centres
- Population
- Toddlers and preschool-aged children (N=177) with early mental health disorders attending a psychiatric day clinic across two cohorts (2018/2019 and 2023/2024)
Key finding
78.1% of excluded patients achieved partial or full reintegration into childcare or demonstrated improved social integration during treatment