Kinderschutz und Frühe Hilfen aus Sicht der Kinder- und Jugendmedizin

Demands for prevention in the areas of child protection, child development and early education are increasingly being discussed in the health care system, social services and the educational and school system. Concepts in health care include health promotion, risk assessment and primary and secondary prevention. Child protection promotes strategies such as early social support services and at-risk screening and educational systems advocate early intervention and concepts to enhance child development. The complexity of children's developmental needs and their living environments require a comprehensive approach of all three systems and integration of services and interventions. Each child's needs must be individually analysed and services tailored appropriately. A case vignette demonstrates and analyses typical problems of interacting systems. A systemic view of systems of care allows planning of efficient and sustainable social and health care policies.     

Familienhebammen im System Früher Hilfen

Background

During the last 10 years, family midwives have become increasingly integrated into the Early Intervention System in Germany. As representatives of the health care professions and based on a trusting relationship with vulnerable families, they use several strategies to promote positive health behavior and health conditions.

Objectives

The aim of the study was to obtain insight into subjective theories of family midwives, which influence their dealings with families and taking a guiding role for the families.

Methods

Following a qualitative research approach, 13 family midwives were interviewed. The interviews were interpreted according to methods recommendations by Witzel.

Results

Structural circumstances influence family midwives’ subjective theories of good quality. In spite of disclaiming controlling function, family midwives who work directly with representatives of child welfare services, by trend follow the aims of child welfare services. Family midwives working in conjunction with a private agency emphasize their strategies of health promotion.

Conclusion

Family midwives can be supported in their strategies of health promotion. Association with a private agency seems to be helpful for maintaining the salutogenetic perspective of midwives.

     

Förderung der kindlichen Entwicklung durch Frühe Hilfen?

Background

A primary goal of early childhood interventions is to enhance child development through fostering parental competencies in socially disadvantaged mothers.

Method

The preliminary effects of the home visiting program “Pro Kind” were analyzed using a longitudinal randomized control group design. By the end of 2009, 755 high-risk primiparae had been enrolled. Self-rated maternal competencies as well as the cognitive development of the children assessed with the Bayley Scales of Infant Development (BSID)-II were analyzed.

Results

Interim analyses showed first positive treatment effects on self-rated maternal competen­cies as well as on cognitive development in children under 3 years old. However, higher self-ratings of maternal competencies did not explain the better cognitive development of the child.

Conclusion

“Pro Kind” as an early childhood intervention seems to contribute positively to children’s cognitive development in socially disadvantaged families. Clinical and research implications of biased maternal self-perceptions are discussed.     

Soziale Netzwerkanalyse interdisziplinärer Kooperation und Vernetzung in den Frühen Hilfen

Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.     

Frühe Hilfen aus der Distanz – Chancen und Herausforderungen bei der Unterstützung psychosozial belasteter Familien in der COVID-19-Pandemie

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Kontaktbeschränkende Maßnahmen waren zur Eindämmung des SARS-CoV-2-Infektionsgeschehens ab Frühjahr 2020 in...     

Strukturen und Qualität in Projekten der Frühen Hilfen

Background

Activities connected to early interventions support young parents who experience challenging personal or social circumstances during the family foundation phase and therefore contribute to better health in children in the first few years of their life. Based on this concept, Welcoming Programmes in four Berlin boroughs include the provision of family vouchers to young parents. These vouchers can be used to participate in health promoting and preventative services related to early interventions at reduced cost or free of charge.

Methods

In a formative evaluation, these voucher projects were examined through an analysis of documents. In addition, expert interviews were conducted focussing on prevention approaches, project structures and the utilisation of the vouchers. The research used the criteria for good practice in health promotion addressing social determinants developed by the German cooperation network Equity in Health (2015) as a theoretical reference.

Results

There are limitations in comparability as the project structures are heterogenic, including both universal and selective prevention approaches. In addition, three of the four projects are financed based on an annual allocation procedure, leading to planning insecurity and discontinuity in the further development of the project concepts. However, a high level of engagement motivation can be found among and between the different actors involved on all organizational levels. This is positive and must be considered an important general resource.

Conclusion

A number of recommendations to optimise the projects can be drawn from the results. Arguably the most import of these is the need to develop a systematic, joint quality management system that stimulates a general improvement of the projects.

     

Frührehabilitation und Rehabilitation im Krankenhaus

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die Finanzierung und damit das Angebot intensiver frührehabilitativer Maßnahmen im Krankenhaus gestalten sich im...     

Implementierung Früher Hilfen für Familien mit und ohne Migrationshintergrund

Background

Early childhood interventions may contribute to a reduction of social and health inequalities in families with an immigrant background. The present article describes access to and practical issues concerning home visitation in immigrant and nonimmigrant families in the German pilot project ??Pro Kind??.

Method

Standardized interviews with participants, home visitors?? documentations and counseling experiences accompanying clinical work are considered in cross-sectional as well as longitudinal analysis in the immigrant compared to the non-immigrant target group.

Results

The home visiting program ??Pro Kind?? successfully reaches financially and socially disadvantaged women with an immigrant background early in pregnancy, although the representativeness of the sample is restricted. Results from implementation research and home visitors?? documentations reveal culture-specific intervention topics and challenges, demanding a culturally sensitive and appreciative approach.

Conclusion

Early access to young women with an immigrant background can be optimized. A possible solution may be the improved cooperation with established partners working in this field. Further challenges are involving the women??s partners, overcoming cultural and language barriers, and adapting intervention materials to better meet the special needs of this target group as well as providing culturally sensitive counseling accompanying the home visitor??s work.     

Gesundheit der Ökonomie und Ökonomie der Gesundheit

Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association between poverty and ill-health reflects causality running in both directions. Building on accordant evidence, the report on “Macroeconomics and Health” detects several key findings: A worldwide scaling up of health interventions for the low-income countries of $30 to $40 per person will require approximately $27 billion per year in donor grants by 2007, compared with around $6 billion per year that is currently provided. These investments would save eight million lives and they would translate into hundreds of billions of dollars per year of increased income in low-income countries. To benefit from this situation, the report generates a two-part strategy: “Donor finance will be needed to close the financing gap, in conjunction with reform efforts by the recipient countries themselves” and it calls for a “National Commission on Macroeconomics and Health” to formulate a so-called “Poverty Reduction Strategy Paper”. Although many questions are answered, e.g. How was donor spending calculated? Who pays how much? Which reforms are needed? - the report is silent on a few key points, e.g. How is donor spending collected? How is the utility of donor spending and reform activities evaluated? What is the function of the WHO and other international organisations in that context?     

Sexuelle Gesundheit und Medizin im WIR – Walk In Ruhr: Vorstellung des Zentrums und Ergebnisse der Evaluation

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Ein ganzheitliches Konzept sexueller Gesundheit und Medizin berücksichtigt die Diversität von Lebenswelten, um...