[Knowledge and use of different support programs in the context of early prevention in relation to family-related psychosocial burden]

[Postpartum Care by Midwives: Socioeconomic Status has a Strong Influence on the Amount of Care Received An Analysis with Routine Data from BARMER Health Insurance]

BACKGROUND

Socio-economic situation is associated with inequalities in access to health care and health-related resources. This also applies to pregnancy, birth and the postpartum period. Compared to other European countries, Germany has very good care options for the postpartum period. It has an unique system of postpartum care, which comprises home visits by midwives for 12 weeks after birth and beyond in problem cases and thus has structurally good care options. So far, however, there are hardly any studies based on routine data that show which mothers receive homevisits in postpartum care and to what extent.

METHOD

The study population comprised 199,978 women insured with BARMER who gave birth to at least one child in the years 2017-2020. Some women were pregnant several times in this period of time. The services billed by freelance midwives for outreach midwifery care in the puerperium were considered for 227,088 births, taking into account the socioeconomic situation of the mothers.

RESULTS

According to the definition of the German Institute for Economic Research, 26% of the mothers belonged to a low income group, 46% to a medium income group and 29% to a high income group. Similar to what was shown for midwifery care during pregnancy, large differences were also found with regard to postpartum care: While 90.5% of the women with a high income received home visits, only 83.5% of women with a medium income did so, and only 67.9% of women with a low income. The groups did not differ with regard to other characteristics such as rate of caesarean section, preterm births, twins, age or concomitant diseases to an extent that could explain the differences in care. Women who had received midwifery services in pregnancy were much more likely to receive home visits by a midwife in the postpartum period. Furthermore, there was a correlation with the density of midwives in the respective region.

CONCLUSIONS

The results suggest that access to home-based postpartum care by freelance midwives is significantly limited for low-income women. In contrast to antenatal care, women in the postpartum period cannot switch to other service providers, as outreach postpartum care is a reserved activity of midwives. Women with low incomes thus receive less midwifery care, although they have a higher need for support (Eickhorst et al. 2016).

[Adverse Childhood Experiences in Mothers and Intergenerational Family Violence]

For children, own adverse experiences, as well as their exposure to intimate partner violence poses a severe risk for health and development. In order to answer the question of intergenerational transmission of family violence, adverse childhood experiences in mothers are considered to be a significant risk factor for the occurrence of child maltreatment and intimate partner violence in families, which, however, has been little studied in Germany. Therefore, this paper uses cross-sectional data of 5.646 mothers that was taken fromthe representative study "Kinder in Deutschland - KiD 0-3". Multiple binary-logical regression models were calculated in order to examine the influence ofmaternal adverse childhood experiences on various forms of family violence. As a result, 823 mothers (9,3 %) reported adverse childhood experiences; 157 (2,8 %) admitted that their child had already been exposed to physical harm or harsh punishment, and 168 (3,0%) reported intimate partner violence since the birth of their child, respectively 493 (8,7 %) since any past relationship. Taking demographic and socioeconomic factors into account, the occurrence of all three forms of violence becamemore likely inmothers with adverse childhood experiences: physical harm of the child (OR = 2,78, p ≤ 0,001), current intimate partner violence of themother (OR = 3,76, p ≤ 0,001), as well as her lifetime experiences in general (OR = 3,67, p ≤ 0,001). Therefore, the support and guidance of families (e.g., by early childhood interventions) should take into account the connection between negative maternal childhood experiences, as well as familial forms of violence, and, if applicable, make generous preventative offers. In case of signs for familial violence, additional protective steps should be applied.

Improving working relationships with families in German early childhood interventions home visitors: a quasi-experimental training study

BACKGROUND

Home visitation services within German Early Childhood Interventions (ECI) for families with a child aged 0-3 are mainly provided by frontline pediatric nurses and family midwifes. Home visitors are often challenged by difficult interactions with families. Mentalizing, the ability to understand mental states of oneself and others, is a key skill for building effective working relationships, which in turn positively affect intervention outcomes. The aim of this study was to investigate if a mentalizing skills training offered to home visitors active in German ECI contributes to continued professional development. We investigated, whether the training positively affected the quality of the working relationships with families as well as home visitors' empathy, self-efficacy, and mentalizing.

METHODS

To test the effects of a single day mentalizing skills training on the working relationship in N = 73 ECI home visitors, we used a quasi-experimental design with repeated measures (T0, T1, T2, T3) across seven weeks in order to assess immediate change from baseline (T0) after the training (T2) and stability of changes at follow up (T3). A literature-based intervention was implemented before the training to estimate possible repeated measurement and expectational effects (T1). Primary outcome was the quality of the working relationship experienced by the home visitors. Secondary outcome criteria were empathy, work-related self-efficacy, self-reported and observer-rated mentalizing.

RESULTS

Significant positive change in the working relationship quality was observed at T2 and at T3. Results on the secondary outcomes were less consistent, with data indicating improvement in empathy and increase on some but not all components of mentalizing.

CONCLUSIONS

This study provides preliminary evidence that brief mentalizing skills trainings may be an effective method for continuous professional qualification in frontline ECI home visitors who afterwards, experience better working relationships with families. Thus, training participation may positively impact efficacy and implementation of home visitations in ECI.

„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.

Cognitive Profiles of Children with Low Motor Performance: A Contribution to the Validation of the WPPSI-IV

(1) Background: Developmental Coordination Disorder (DCD) is a common developmental disorder of preschool age. Children often show cognitive deficits in addition to motor problems. Various studies point in particular to problems in visual perception, working memory and processing speed. In this context, it is investigated whether the Wechsler Preschool and Primary Scale-IV (WPPSI-IV) is a suitable instrument for mapping these deficits in a valid and economical way. (2) Methods: The WPPSI-IV profiles of children with DCD (n = 12), below-average motor performance (n = 22) and a control group (n = 32) were compared. (3) Results: Children with DCD achieved significantly poorer test performance in the primary indices Verbal Comprehension, Visual Spatial, Processing Speed and Full Scale compared to a control group. Children with below-average motor skills, on the other hand, do not differ from the children in the control group. (4) Conclusions: The WPPSI-IV is a suitable instrument for diagnosing cognitive deficits in the context of DCD. The Fluid Reasoning and Verbal Comprehension indices should be used as a supplement to assess cognitive performance levels.

Evaluation of a cross-sectoral care intervention for families with psychosocial burden: a study protocol of a controlled trial

Background

Family risk factors, e.g. low socioeconomic status or parental mental health disorders, can affect children’s health and development. Thus, targeted preventive services for families with psychosocial burden are crucial. The German Early Childhood Intervention (ECI) program is a preventive approach that aims to strengthen parent’s resources by supportive services. However, research has revealed that only a proportion of the families considered to have substantial risk factors access the ECI program. To increase pediatricians’ skills in identifying risk factors, and to improve the cross-sectoral collaboration between relevant professionals and the referral of families to supportive services, the PATH-intervention (Pediatric Attention To Help) was developed. The PATH-intervention includes interprofessional quality circles and a one-day training program for the pediatricians. This study aims to evaluate this complex cross-sectoral care intervention for families with psychosocial burden.

Methods

Using a prospective quasi-experimental, controlled (matched-pair), longitudinal mixed-method design, we will compare families under treatment of pediatricians trained in the PATH-intervention with families under treatment of a control group of pediatricians. Participating families are asked to complete online-surveys. As a primary outcome, we will examine the use of supportive services of the ECI by burdened families. Secondary outcomes are the proportion of correctly identified families with psychosocial burden by the pediatricians, as well as information provision and motivation of the families to use the supportive services. Additionally, the cost-effectiveness ratio will be investigated. In the process evaluation, we will qualitatively explore the acceptance of the PATH-intervention of all involved stakeholders and the treatment fidelity of the trained pediatricians.

Discussion

This study will determine whether the PATH-intervention enables the pediatricians to identify and recommend supportive services to burdened families, as well as the families’ use of the supportive services of the ECI. Qualitative data will give insight into the acceptance of the intervention from the perspective of all stakeholders and the treatment fidelity. Results of this study could be the starting point for the broader implementation of the PATH-intervention as standard care.

Trial registration

German Clinical Trials Register (DRKS): DRKS00023461 (3rd December 2020); WHO UTN: U1111- 260-6575.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07787-9.

Is the Level of Motor Development at School Entry Related to the Use of Municipal Exercise Programs? A Social-Differential Analysis

Children’s motor development is socially unevenly distributed despite many municipal exercise programs (EXP). It has not been sufficiently investigated whether and how they appeal to children from different social backgrounds. This study investigates the use of municipal EXP in preschool age and the association between participation and motor development considering social circumstances. In school entry health examinations, parents were asked about participating in various EXP (response = 65.5%; n = 6480). Motor development, i.e., body coordination and visual-motor coordination, were assessed by a social pediatric development screening, and social circumstances by migration background (MB) and parental education (PE). Poisson regression estimated adjusted Incidence Rate Ratios (IRR; 95% confidence interval, 95%—CI) for relationships between social circumstances and participation in programs and participation and body coordination/visual-motor coordination. Children with MB (IRR 0.73; 95%—CI 0.71–0.75) and low PE (IRR 0.45; 95%—CI 0.40–0.50) used EXP less often. Children participating less often have a finding in body- (IRR 0.76; 95%-CI 0.63–0.90) and visual-motor coordination (IRR 0.47; 95%—CI 0.35–0.62). Significant effects were found for children with and without MB and higher PE. Municipalities should make EXP more attractive for families with MB and low PE.

Inanspruchnahme von Unterstützungsangeboten in Familien mit einem psychisch belasteten Elternteil

Hintergrund

Kinder psychisch erkrankter Eltern sind vielfach mit familialen Belastungen konfrontiert und haben ein erhöhtes Risiko, selbst an einer psychischen Störung zu erkranken. Präventionsangebote auf Eltern- und Kindebene haben entsprechend hohe Relevanz. Wenig Beachtung in der Forschung fand bislang die Frage, inwieweit therapeutische und beratende Unterstützungsangebote für psychisch belastete Eltern auch der gesundheitlichen Versorgung ihrer Kinder zugutekommen.

Fragestellung

Die vorliegende Studie untersucht eltern- und kindbezogene Prädiktoren der Inanspruchnahme von therapeutischen und familienbezogenen Unterstützungsangeboten bei Eltern mit selbstberichteter psychischer Belastung. Zusammenhänge zur Inanspruchnahme von Kinder- und Jugendtherapie, auch in Abhängigkeit von der kindlichen psychischen Gesundheit, werden geprüft.

Material und Methode

Ausgehend von 844 Eltern mit 1146 Kindern im Alter von 7 bis 16 Jahren, die in den Wellen 11 und 12 des pairfam-Panels befragt wurden, umfasst die Stichprobe der Hauptanalysen 161 Kinder, deren Elternteil über Depressionssymptome oder eine psychische Erkrankung berichtete. Angaben zur Inanspruchnahme von Therapie und weiteren Angeboten stammen von dem Elternteil, Angaben zur psychischen Gesundheit der Kinder von diesen selbst.

Ergebnisse

Etwa ein Drittel der Eltern mit selbstberichteter psychischer Belastung nimmt eine Therapie in Anspruch. Hierbei werden häufiger auch weitere Angebote für Familien und Kinder genutzt. Selbstberichtete Verhaltensauffälligkeiten der Kinder haben jedoch keinen weiteren Effekt auf ihre Versorgungslage.

Schlussfolgerung

Die Befunde sprechen für eine unzureichende Versorgungslage von auffälligen Kindern psychisch belasteter Eltern, auch dann, wenn die Eltern selbst in Behandlung sind.

Assessment of the quality of woman-centred midwifery care from the mothers' perspective: A structural analysis of cross-sectional survey data

OBJECTIVE

Development and psychometric evaluation of a multidimensional model and assessment scales measuring core aspects of the quality of woman-centred midwifery care processes in Germany.

DESIGN & PARTICIPANTS

201 women, who received midwifery care during their pregnancy in 2018, were enrolled 6 to 18 months after birth. Data were assessed in a retrospective cross-sectional survey in Germany.

MEASUREMENTS

Established scales that are used in health care were adapted to the context of woman-centred midwifery care: Shared Decision-Making (SDM-Q-9-M), Empathy (CARE-M), Internal Team Participation (TEAM-M) and Professional Competence (PC-M). Confirmatory factor analyses were adapted to prove (a) the homogeneity of the single scales and (b) the multidimensional structure of the entire item pool.

FINDINGS

Appropriate to good model fit was confirmed for both the single assessments (CFI ≥ .96; SRMR ≤ .032) and the multidimensional model (CFI=.96; SRMR=.049). Minor model modifications reflecting local item dependencies had to be considered for the scales SDM-Q-9-M, TEAM-M, and PC-M. For the CARE-M scale, Participatory Communication proved to be a separate, second structural component.

CONCLUSIONS

Shared Decision-Making, Empathy, Internal Team Participation, and Professional Competence constitute core components of woman-centred midwifery care processes. A multi-dimensional assessment is now available measuring women's experiences with midwifery care. The assessment provides an essential component to master the complex challenge of measuring the quality of midwifery care inside and outside the hospital by means of a standardised and validated assessment.

Doctors as disseminators? Practicing physicians as multipliers for community-based prevention networks in a large city in western Germany

Aim

Practicing physicians have a special position as disseminators of community-based prevention for children. However, it is unclear to what extent physicians inform parents about programs. The study investigated: To what extent do physicians disseminate information about community-based prevention for children aged 0–7? Do differences exist along family’s socioeconomic position (SEP) and immigrant background?

Subject and methods

We conducted a retrospective cohort study in a German school entrance examination. Parents were invited to participate in a survey on community-based prevention with information about their awareness and information source. SEP was measured by parental education, immigrant background by country of birth. For nine services types, we counted how often parents named physicians and other professional groups as information sources. To estimate social differences, we calculated adjusted odds ratios (OR) with 95% confidence interval (CI).

Results

Survey participants included 6480 parents (response 65.49%). Compared to other information sources, physicians were mentioned less frequently. For example, regarding language therapy, 31.2% of parents were informed by healthcare/social services, and 4.4% by physicians. Lower educated parents were less frequently informed by physicians about counseling services (OR 0.58; 95% CI 0.46–0.73) compared to higher educated parents. Parents with immigrant background were informed less often about parenting skills courses (OR 0.79; 95% CI 0.70–0.90) compared to parents without immigrant background, but more often about language therapy (OR 1.47; 95% CI 1.13–1.91). No further social differences were observed.

Conclusion

The role of physicians as disseminators for community-based prevention is expandable. They should promote parenting skills courses in a socially sensitive way.

Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study

PURPOSE

The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood.

METHODS

As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months.

RESULTS

After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood.

CONCLUSIONS

Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services.

TRIAL REGISTRATION

The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).

[Differences in Use of Early Intervention by Adolescent Mother-Child Dyads Compared to Adult Mothers and their Children]

Adolescent mothers and their children represent a high-risk group for unfavorable developmental outcomes. There are early health and support services for this group. The aim of the current study was to investigate and compare the use of these interventions by adolescent mother-child dyads compared to adult mothers and their children. N=99 mothers (age of children: 5.3±1.0 months) were interviewed regarding early interventions, which were sorted into three groups ("interaction interventions", "child development" and "maternal support interventions") and pooled according to costs. Group differences in utilization and, exploratively, differences in allocation paths between adolescent and adult mothers were investigated. "Interaction interventions" were significantly more frequently used by adolescent mothers (U: 605.50, p<0.001). Interventions concerning "child development" (U: 633.50, p<0.001) and "maternal support" (U: 477.50, p<0.001) and interventions to be paid for (U: 582.00, p<0.001) by adult mothers. Social contacts (U: 817.00, p=0.003) and general practitioners (GP)/gynecologists (U: 879.00, p = 0.054) directed the adult mothers significantly more often to interventions, whereas adolescent mothers significantly more frequently were directed to other professional contacts (U: 877.50, p=0.01) and the youth welfare service (U: 962.50, p=0.021) as intermediaries. Early interventions for child and maternal health and interventions with costs were used significantly less frequently by adolescent mothers. Healthcare professionals such as GPs, gynecologists and pediatricians, should expand their counselling services on health interventions and support services in the high-risk group of adolescent mothers.

[Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]

After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.

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.

Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany

BACKGROUND

The KiD 0-3 national main study is a cross-sectional study on adversity in early childhood and parental access to support services, conducted as part of a long-term policy program for early intervention services in Germany.

OBJECTIVE

To identify risk factors for child abuse, neglect and exposure to intimate partner violence (IPV) and investigate if parental use of early intervention programs or contact to child welfare services was associated with reported child maltreatment.

PARTICIPANTS AND SETTING

8063 families with infants and toddlers participated in the survey. Parents answered a written questionnaire during mandatory health checks for the child. The sampling was based on a regionally clustered model of pediatricians' practices.

METHODS

An automatic variable selection process was used to test risk factors and logistic regression models were employed for each outcome.

RESULTS

Significant risk factors (p < 0.05) for child abuse (1.91 %) were child age, IPV and parental stress. Neglect (0.83 %) was associated with couple distress, adverse childhood experiences, young maternal age, cramped housing, and migration history. IPV (2.98 %) was associated with child age, couple distress, depression/anxiety, harsh punishment, adverse childhood experiences, young maternal age, and poverty. Parents were more likely to use selective prevention programs in cases of child abuse and exposure to IPV.

CONCLUSION

Child abuse is mainly associated with proximal risk factors and neglect with distal factors. Exposure to IPV violence is associated with child abuse as well as with an accumulation of adversities. The association between service use and child maltreatment is discussed.

Wie viele Familien in Deutschland sind in welchem Ausmaß psychosozial belastet?

Zusammenfassung. Die Kumulation von Risikofaktoren ist ein gängiges Kriterium zur Indikation eines frühen Hilfebedarfs. Über die Anzahl und das Ausmaß der psychosozial belasteten Familien in Deutschland ist bislang nur wenig bekannt. Mit Daten von N=7 549 Familien der Studie Kinder in Deutschland – KiD 0 – 3 und einem Inventar aus 25 Risikofaktoren wurde die Klassifizierung der Familien in Risikogruppen anhand einfacher Summenindizes mit den Ergebnissen einer Latenten Klassenanalyse (LCA) verglichen. Während einfache Summenindizes 24 – 30 % der Familien als belastet identifizierten, erzeugte die inhaltlich überlegene LCA eine Vier-Klassen-Lösung mit 59 % unbelasteten und 5 % hochbelasteten Familien. Im mittleren Belastungsbereich unterscheidet sich die Gruppe der sozioökonomisch belasteten Familien (19 %) von Familien mit hohem elterlichem Stress und Konfliktpotenzial (17 %). Die Ergebnisse liefern wichtige Hinweise für die Versorgungsforschung zu Frühen Hilfen.

How effective is the early support program Babylotse-Plus for psychosocially burdened mothers and their infants? A comparative intervention study

Objectives

Our aim was to examine the effects of an early perinatal prevention program offered to mothers and families suffering from significant psychosocial burden.

Methods

All mothers giving birth in a Berlin university hospital during Jan-Aug 2013 were screened with a standardized 27-item questionnaire by trained staff. Mothers with a screening-score ≥ 3, who were not enrolled in other public support programs, were defined as psychosocially burdened. They received a detailed needs assessment and were followed up with counseling. When necessary, affected mothers were voluntarily guided through to specialized ‘early support’ institutions during the 12-month-intervention period. The historical control group (care-as-usual) consisted of children born at the same hospital the year before.

At 12 months postnatally, we interviewed mothers in both groups to assess their stress burden and coping skills by Parenting Stress Index and assessed the current childcare condition. Differences between the groups were compared by multivariable logistic regression analyses adjusting for potential confounders.

Results

The intervention group and the control group included 225 and 157 families, respectively. After 12-months, mothers in the ‘early support’ intervention group had significantly less often depression (adjusted odds ratio 0.25, 95%-confidence interval 0.07–0.94), less often a disturbed relationship with the parenting partner (0.34, 0.10–1.14) and reported reduced stress due to the child’s demands (0.40, 0.15–1.10) compared to the control group. Childcare indicators did not differ between the 2 groups.

Conclusions

In mothers at high psychosocial risk, the ‘early support’ intervention program Babylotse-Plus seemed to reduce the occurrence of depression and several stress indicators in the first postnatal year.

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

BACKGROUND

Early childhood interventions are locally and regionally organized support services for families from pregnancy until the end of the third year of life. The interventions promote diverse measures to enhance parental skills in order to improve developmental and living circumstances. One crucial element of early childhood intervention in Germany are prevention networks at municipal level. The collaboration of healthcare professionals and child and youth welfare professionals in these networks aims to provide nonstigmatizing access to early childhood intervention for families with psychosocial burdens. From the point of view of the healthcare sector, the research program Together for Families (ZuFa Monitoring) of the National Centre on Early Prevention (NZFH) at the Federal Centre for Health Education (BZgA) has collected representative data at the interfaces of gynecology, obstetrics, pediatrics, and early childhood intervention since 2017.

GOAL

The background and goals, as well as design and methods of the ZuFa Monitoring studies are described. For obstetrics clinics and resident pediatricians, sample descriptions, including data on representativeness and early data regarding collaboration quality, are given.

EARLY RESULTS

The samples are representative for the population of obstetric clinics and resident pediatricians in Germany. At least two-thirds of the respondents indicate that the proportion of families with psychosocial burdens has increased. Care for psychosocially burdened families is regarded as challenging due to a lack of time, limited financial compensation, and aggravating conditions, such as language barriers. Respondents expect early childhood intervention to alleviate their daily work.

DISCUSSION

ZuFa Monitoring collects data regarding the care for families with psychosocial burdens at the interface of the health and the child and youth welfare sector. The research program generates information on inhibitory as well as promoting factors, thereby informing the further development and expansion of prevention networks at the municipal level, and heightening the quality of care for families in the health sector.

Is the Brief Child Abuse Potential Inventory (BCAPI) a valid measure of child abuse potential among mothers and fathers of young children in Germany?

BACKGROUND

In order to prevent child abuse, instruments measuring child abuse potential (CAP) need to be appropriate, reliable and valid.

OBJECTIVE

This study aimed to confirm the 6-factor structure of the Brief Child Abuse Potential Inventory (BCAPI) in a German sample of mothers and fathers, and to examine longitudinal predictors of CAP.

PARTICIPANTS AND SETTING

Two waves of data were collected from 197 mothers and 191 fathers of children aged 10-21 months for the "Kinder in Deutschland - KiD 0-3" in-depth study. Families were stratified based on prior self-report data for screening purposes.

METHODS

138 fathers and 147 mothers were included in the analysis (invalid: 25% mothers, 30% fathers). First, validity of reporting was examined. Second, confirmatory factor analysis (CFA) was employed to assess factor structure. Third, internal reliability and criterion validity were examined. Finally, multivariate poisson regressions investigated longitudinal predictors of CAP in mothers.

RESULTS

A previously established six-factor structure was confirmed for mothers but not fathers. CFA failed for fathers due to large numbers of variables with zero variance. For mothers, internal consistency and criterion validity were good. BCAPI score at follow-up was associated with baseline BCAPI score (β = 00.08), stress (β = 0.06), education (β=-0.19) and alcohol use (β = .58).

CONCLUSIONS

Findings confirm the six-factor structure of the BCAPI among German mothers. The clinical use of the BCAPI in fathers is not recommended as it might produce data that are hard to interpret. Further research with fathers is needed to establish if this is due to limitations with this dataset or with the questionnaire.

[Midwives and Nurses in Early Childhood Intervention: The Benefit of Additional Qualification]

Midwives and Nurses in Early Childhood Intervention: The Benefit of Additional Qualification Abstract.

BACKGROUND

Early childhood interventions are locally and regionally organized support services for families from pregnancy until the end of the third year of life. The interventions promote diverse measures to enhance parental skills in order to improve developmental and living circumstances. Midwives and nurses with additional qualification support burdened families in early childhood intervention.

METHOD

Within a retrospective survey (standardized interviews, CAPI) mothers' (N = 298) perspective of the benefit of the home visiting support is assessed. Data from two groups were compared: (1) mothers in the care of a midwife or nurse with additional qualification (Gruppe_{GFK + Quali}) and (2) mothers cared for by a midwife or nurse without additional qualification (Gruppe_GFK).

RESULTS

(1) Families with weighted levels of psychosocial burdens reported an enhanced need for help. (2) Midwives and nurses with additional qualification support more frequently families with high levels of psychosocial burdens. (3) Mothers with care of midwives and nurses with additional qualification reported this support as more useful in relation to every day demands than mothers with regular care after birth (questionnaire for evaluation of the received support: Gruppe_{GFK + Quali}: mean = 2.57; Gruppe_GFK : mean = 1.97; t (121) = 2.799, p = .003).

CONCLUSION

The study complements results of national and international studies showing that families with high levels of psychosocial burdens accept home visiting support. Furthermore, this support seems to be useful. An increase of the offer and the additional qualification is recommended for improving the developmental and living conditions of families with psychosocial burdens.