[The health sector and early childhood intervention: intersectoral collaboration in research]

Evaluation of a Child-centred Psychosocial Healthcare Intervention (KIDPROTEKT) - Results of a Cluster Randomized Controlled Trial in Paediatric and Gynaecologic Practices

KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.

„So unter Druck gesetzt zu werden, das hab‘ ich nicht gedacht.“ Fördernde und hemmende Einflüsse auf Zugangswege zu den Frühen Hilfen aus Sicht der Eltern

Hintergrund Frühe Hilfen bieten präventive Angebote an und sind offen für alle Familien mit Kindern bis 3 Jahren, besonders jedoch für Familien mit Belastungen, welche zu Unterstützungsbedarf führen. Im Vergleich zu Familien mit geringen Belastungen finden psychosozial stark belastete Familien weniger häufig einen Zugang zu den Frühen Hilfen.

Ziel der Studie Untersucht werden fördernde und hemmende Einflüsse auf Zugangswege zu den Frühen Hilfen.

Material und Methoden Es wurden teilstrukturierte, leitfadengestützte Einzelinterviews (N=17) mit Familien (N=13) geführt. Die Eltern hatten an einem Beratungsgespräch teilgenommen, in welchem eine Fachkraft Unterstützungsbedarf festgestellt und Frühe Hilfen-Angebote empfohlen hatte. Die Interviews wurden mittels qualitativer Inhaltsanalyse, angelehnt an Mayring, ausgewertet.

Ergebnisse und Diskussion Als förderlich für den Zugang zu Angeboten der Frühen Hilfen bewerten die Eltern eine vertrauensvolle, klare Kommunikation in den Beratungsgesprächen. Eine Barriere entsteht, wenn sie sich unter Druck gesetzt fühlen oder selbst keinen Bedarf an Unterstützung empfinden. Beratungsgespräche sollten zu unterschiedlichen Zeitpunkten (z. B. Schwangerschaft, Wochenbett) angeboten werden.

Schlussfolgerung Feinfühligkeit, wertfreie und vertrauensvolle Kommunikation auf Augenhöhe und ein Befähigungsansatz im Umgang mit Eltern sind in Beratungssituationen erfolgsversprechend.

Characteristics and patterns of health and social service use by families with babies and toddlers in Germany

OBJECTIVES

In the field of family health, cross-sectoral collaboration is promoted to reach vulnerable groups and overcome the prevention dilemma. To understand the extent to which these measures counteract the effects of social inequality with respect to health and social service uptake, we aim to identify socio-economic, health-related and psychosocial characteristics and patterns that are associated with the (non-)use of services.

STUDY DESIGN

This was a German representative cross-sectional study of 6860 mothers with a child younger than 48 months who answered the written questionnaire during child developmental examinations at paediatric practices in 2015.

METHODS

Associations were measured using logistic regression, and characteristics of user patterns were analysed using latent class analysis.

RESULTS

Mothers using universal services were less likely to report psychosocial stress and had more likely more socio-economic resources than mothers who did not use these services. The selective services pregnancy counselling (18.2%) were predominantly used by mothers who considered abortion during pregnancy (Odds Ratio [OR] = 3.9), mothers who received social welfare benefits (OR = 2.4), single parents (OR = 1.6) and mothers without social support (OR = 1.5). Four patterns of service use were identified: multi-service users (5.6%), low-service users (22.5%), medical service users (30.5%) and medical and social service users (41.6%). Families with less socio-economic resources were found in both the low-service group and the multi-service group; multi-users were more likely to have children with adverse perinatal characteristics and parenting stress.

CONCLUSION

We discuss whether low-service users are hard to reach, whereas multi-users are difficult to supply. Overall, there is a need to strengthen early psychosocial support.

„An manchen Tagen ein Drahtseilakt“

Hintergrund

Eine gelingende Unterstützung von Familien mit einem psychisch erkrankten Elternteil bedarf eines vertieften Verständnisses darüber, wie eine psychische Erkrankung die Ausübung der Elternrolle beeinflussen kann. Hierfür werden diese Familien aus zwei Perspektiven betrachtet: aus der Perspektive von psychisch erkrankten Müttern und aus der Perspektive von Kinderärztinnen und -ärzten.

Datengrundlage

Datenbasis für die Müttersicht ist die „Erreichbarkeitsstudie“ des Nationalen Zentrums Frühe Hilfen (NZFH), die 123 Tiefeninterviews mit Müttern zum Familienalltag und zu Unterstützungsbedarfen umfasst. Für die Ärztesicht werden Daten aus dem „ZuFa-Monitoring“ des NZFH ausgewertet, in der bundesweit repräsentativ 815 niedergelassene Kinderärztinnen und -ärzte zur Versorgung psychosozial belasteter Familien befragt wurden.

Ergebnisse

Eltern mit Anzeichen einer psychischen Erkrankung zeigen übereinstimmend aus Mütter- und Ärztesicht erhöhte elterliche Belastungen und Einschränkungen in den Bereichen Elternkompetenzen, Wahrnehmung der kindlichen Bedürfnisse und Impulsivität, die sich nachteilig auf die kindliche Entwicklung auswirken können.

Schlussfolgerung

Aus den Erkenntnissen werden Implikationen für die Praxis abgeleitet. Das Wissen um spezifische elterliche Belastungen kann von Fachkräften Früher Hilfen genutzt werden, um psychisch erkrankte Eltern passgenau bei der Ausübung ihrer Elternrolle zu unterstützen. In der psychotherapeutischen und psychiatrischen Praxis kann das Wissen helfen, betroffene Eltern zur Annahme geeigneter familienunterstützender Angebote zu motivieren.

Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study

OBJECTIVES

To investigate mothers' knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation.

DESIGN

Cross-sectional study.

SETTING

Prospective birth cohort in Regensburg, Eastern Bavaria, Germany.

PARTICIPANTS

2455 mothers after delivery.

OUTCOME MEASURES

Participants' knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants' use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no).

RESULTS

The vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered.

CONCLUSIONS

Overall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.

[Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention]

Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention In Germany, networks and measures of early childhood intervention (ECI) have been implemented nationwide. By specifically targeting families with multiple psychosocial challenges, ECI contributes to the enhancement of families' parenting skills, in order to promote equal opportunities for all children to grow up healthy and safe. In many families supported by ECI measures at least one parent shows symptoms of a mental health disorder, which poses a major challenge to ECI practitioners. Nevertheless, there is a lack of valid scientific knowledge about the proportion of young families living with symptoms of mental disorders, the degree to which parents' psychic burdens affect care in ECI measures and about the cooperation of different care providing systems. The National Center for Early Prevention (NCEP) monitors and evaluates the scaling up of ECI networks and measures in Germany. The present article compiles results of different NCEP studies focusing on parents with mental illness in Early Childhood Intervention. Results are discussed with regard to their relevance for further improving the care systems.