Hintere Außenansicht des D2 Gebäudes

The Complexity of Care for Children and Adolescents

For some years now, specialists working with children and adolescents have been saying that difficult complex case histories or so-called multi-problem cases are increasing significantly.

This was the starting point for a survey among long-time employees of nonprofit organisations (NPOs) working in child and youth care or therapy. The aim of the study was to find out to what extent the complexity of child and youth care has changed over the last 20 years. The Competence Center for Nonprofit Organisations and Social Entrepreneurship was commissioned by Caritas Vienna, Diakonie Austria, SOS Kinderdorf, VKKJ and Vorarlberger Kinderdorf at the beginning of 2019 with the methodological implementation of this study.

Previous studies have shed little light on the perspective of professionals who treat or care for children and adolescents. The report now available closes this gap to a certain extent and shows which developments and challenges exist with regard to the complexity of care and from the perspective of professionals working in the field. In this context, a special concept of care complexity was developed which served as the basis for the survey. Methodologically, a quantitative retrospective survey was conducted among professionals with many years of experience in the field of child and youth care and therapy for the years 1999, 2009 and 2019. The overall presentation of the subjectively perceived complexity of care and the associated stress was implemented by calculating a so-called "frequency and stress intensity index (FSI-I)".


The study shows that the complexity of care increased significantly between 1999 and 2019. While the FSI-I was still at 0.21 in 1999, it rose to 0.30 in 2009 and to 0.41 by 2019. An analysis of the associated burdens in various main and sub-dimensions clearly identified issues where there is a need for action and where the social space planning or management of the organisations can take action.

In summary, findings show that children and young people per se are themselves the least problem in terms of care complexity. With sufficient time resources for the caring or treating professionals, difficult complex care situations can be managed well.

The main points where pressure is currently coming into the system have a lot to do with increased time expenditure apart from the direct work with the children and adolescents. This includes, for example, increasing networking, a greatly increased effort in the area of content related parental work and communication with the system of origin, a lack of care services and the resulting search effort for external care or treatment as well as a challenging handling of new digital worlds. The following statement by one interviewee expresses this again in simple terms: "Often, the work involved is more strenuous than the actual job entails".

Further results and implications can be found directly in the study (currently only available in German).

Study presentation on 28 Jan 2020

On 28 January 2020, Christian Grünhaus and Julia Wögerbauer presented the results of the study on the complexity of care for disadvantaged children and adolescents at a specialist event at the Vienna University of Economics and Business Administration.

Afterwards, experts held the panel discussion "Increasing Complexity until the System Tips Over. What are the possible solutions" and discussed challenges that professionals working with children and adolescents are currently facing and derived solutions for the future.

The following experts took part in the panel discussion:

  • Thomas Buchner, research assistant, SOS Children's Village

  • Dunja Gharwal, Child and Youth Advocate, Vienna

  • Beate Huter, psychologist, Vorarlberg Children's Village

  • Klaus Vavrik, Medical Director of the Sonnwendviertel Outpatient Clinic of the VKKJ

  • Heinz Wieser, Managing Director, Diakonie Zentrum Spattstraße

  • Julia Wögerbauer, NPO Competence Center

  • Moderation: Christian Grünhaus, NPO Competence Center

Videos of our Facebook live stream are available on the German version of this site, just click on "Deutsch" on the very top of this page.


Mag.Dr.rer.soc.oec. Christian Grünhaus

Christian Grünhaus

Academic Director, Senior Researcher (prev. Schober)
Responsibilities: Work and research focus: Evaluation, SROI analyzes, financing, donation behavior, job satisfaction and motivation, care for the elderly, care for the disabled and accessibility