[Stressful Living Conditions in Nuclear, Single Parent and Stepfamilies and Use of Prevention Services. Findings of Two Representative German Studies]. / Belastungslagen von Alleinerziehenden-, Stief- und Kernfamilien Inanspruchnahme von Unterstützungsangeboten. Befunde aus zwei repräsentativen deutschen Studien.

AIM OF THE STUDY: Comparison of (stressful) living conditions and use of universal, selective and indicated prevention services in nuclear, single parent and stepfamilies with young children. METHODS: Using two representative German surveys of mothers with children aged 0-3 years (KiD 0-3 2015, n=6,671, and AID:A 2019, n=1,501), mothers' reported burden and the use of various prevention services in different family types were examined descriptively and with Chi²-tests. RESULTS: Overall, single parent families and, to some extent, stepfamilies showed increased socioeconomic stress compared to nuclear families (e. g., young motherhood, higher poverty risk). In particular, universal prevention services (e. g., prenatal classes, parent-child courses) were used less frequently by single parent families, while selective and indicated services such as family or child guidance counselling services and offers of youth welfare agencies were used more frequently. CONCLUSION: Increased socioeconomic stress suggests a higher need for support among single parents compared to nuclear families. Universal group offers are possibly not sufficient to meet these needs, whereas selective individual counselling offers such as pregnancy and child guidance counseling are used more frequently by single parent families and stepfamilies compared to nuclear families. There seems to be a lack of (group) offers tailored to single parent families - particularly in the first developmental phase of a child's life.

Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life.

Purpose: For the past three years, the German longitudinal COPSY (COVID-19 and PSYchological Health) study has monitored changes in health-related quality of life (HRQoL) and the mental health of children and adolescents during the COVID-19 pandemic. Methods: A nationwide, population-based survey was conducted in May-June 2020 (W1), December 2020-January 2021 (W2), September-October 2021 (W3), February 2022 (W4), and September-October 2022 (W5). In total, n = 2,471 children and adolescents aged 7-17 years (n = 1,673 aged 11-17 years with self-reports) were assessed using internationally established and validated measures of HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2), psychosomatic complaints (HBSC-SCL), and fear about the future (DFS-K). Findings were compared to prepandemic population-based data. Results: While the prevalence of low HRQoL increased from 15% prepandemic to 48% at W2, it improved to 27% at W5. Similarly, overall mental health problems rose from 18% prepandemic to W1 through W2 (30-31%), and since then slowly declined (W3: 27%, W4: 29%, W5: 23%). Anxiety doubled from 15% prepandemic to 30% in W2 and declined to 25% (W5) since then. Depressive symptoms increased from 15%/10% (CES-DC/PHQ-2) prepandemic to 24%/15% in W2, and slowly decreased to 14%/9% in W5. Psychosomatic complaints are across all waves still on the rise. 32-44% of the youth expressed fears related to other current crises. Conclusion: Mental health of the youth improved in year 3 of the pandemic, but is still lower than before the pandemic.

Resolving relationship dissolution-What predicts emotional adjustment after breakup?

Relationship dissolution is a critical life event individuals have to cope with. Factors like relationship duration and relationship quality or having a new partner are likely to affect how people recover emotionally from a separation, which is linked to long-term adjustment. However, prospective evidence on the role of these factors is scarce. Hence, this study aims to investigate predictors of emotional recovery following relationship dissolution. Pooled data of the German Family Panel pairfam on 3734 separation events of 2709 individuals aged 18 to 48 were used, applying a statistical model called seemingly unrelated regressions to predict emotional outcomes (relief, anger, guilt, and sadness) and the general emotional state regarding separation. Sociodemographic and relationship characteristics, indicators of relationship quality, conditions of the separation, and features of the current situation were considered as potential predictors. Regression analyses evidence strong links of initiator status, having a new partner, time since separation, and satisfaction with the social network to less negative emotional outcomes following separation. Relationship quality or serious problems before the separation only affected some of the investigated emotional outcomes. Interestingly, the predictors investigated were less powerful in explaining respondents' feelings of guilt compared to the other emotions. Overall, these findings provide deeper insight into short-term adjustment to separation. Understanding these processes may help to assess risk factors for negative coping mechanisms and improve tailored counseling strategies.

[Family stressors on young children's emotional development]. / Familiale Belastungsfaktoren für die emotionale Entwicklung junger Kinder.

BACKGROUND: Adverse childhood experiences (ACE) have been pointed out as risk factors for physical and mental health, with consequences extending from childhood into adulthood. Based on research regarding the effects of selected ACE as well as the accumulation of ACE, this article investigates how different types of family stressors are linked to children's negative emotionality in infancy and early childhood. METHODS: Data are from the KiD 0-3 study (N = 5583) and the follow-up of a subsample after 2 years (n = 681). Based on 14 stress factors, we distinguish families with no/little stressors, socioeconomic stressors, parenting stressors, and multiple stressors. RESULTS: Children in multiply stressed families have the highest risk of high negative emotionality (compared to unstressed families: Odds Ratios [OR] ranging from 13.00 to 6.81), controlling for demographic characteristics, child-related stress factors (e.g., excessive crying), and caregiver childhood stress. Children in families primarily characterized by parenting stress also showed a significantly increased risk of high negative emotionality (OR ranging from 8.31 to 6.95), whereas this did not hold for children from socioeconomically stressed families (without parenting stress) compared to those from unstressed families. Longitudinal analyses of the follow-up subsample showed that changes in the number of stressors were also associated with parallel changes in children's negative emotionality. DISCUSSION: These results confirm findings from international research on ACE in Germany and for early childhood. They underline the importance of a well-developed early intervention system.

[Education and education deficits in day care centers and schools during the coronavirus pandemic]. / Bildung und Bildungsdefizite in Kita und Schule im Rahmen der Coronapandemie.

The contact restrictions during the coronavirus disease 2019 (COVID-19) pandemic massively limited the educational participation of children and adolescents, both in day care centers and in schools. During phases of lockdown, contact with friends and early child care was often severed, especially for young children. The quality of interactions between staff and children as well as among the children themselves, suffered from the many protective measures, the high fluctuation of children present and the shortage of staff. Pandemic-related group closures in day care centers more severely affected facilities with a high proportion of children from socially disadvantaged households, and the proportion of children with higher support needs increased. Schools and families were also confronted with the challenges of insufficient digitalization. Remote and digital lessons more often reached older and higher performing students from more socially advantaged families. Learning time in distance learning was at times on average halved and decreased especially when there was only little contact with teachers and for low-performing students. National as well as international trend data point to substantial learning gaps, especially among children from socially disadvantaged families with low cultural capital and from immigrant families, with the often less favorable learning conditions and limited support options in these families being the decisive factor. In addition, options for extracurricular activities outside of schools were absent in the lockdown. In the post-COVID education strategy greater emphasis should be placed on the integrated well-being of children and adolescents in order to rectify the constraints and stresses they experienced.

[Emotional Problems of Children and Adolescents in the COVID-19-Pandemic: Patterns of Change and Predictors]. / Emotionale Probleme von Kindern und Jugendlichen in der COVID-19-Pandemie: Veränderungsmuster und Prädiktoren.

The COVID-19-pandemic showed largely negative, but heterogeneous effects on the psychological well-being of children and adolescents.The present study aimed to (1) identify differential trajectories of emotional problems as young people entered the pandemic, (2) compare pre-pandemic trends to changes one year after its onset, and (3) analyze sociodemographic and social predictors of trajectories. 555 children and adolescents, aged 7 - 14 years at T1 (M = 10.53 years, 46.5 % female), were interviewed in three waves of the German family panel pairfam. Latent class growth analysis (LCGA) revealed four distinct trajectories of emotional problems: an increase after the onset of COVID-19 ("Mean increasing"), a decrease ("Mean decreasing"), no change at low level ("Low stable") or at high level ("Chronic high"), each after a stable trajectory before the pandemic.Multinomial logistic regressions showed that females and youth experiencing an increase in financial deprivation were at higher risk of increasing or chronically high level of emotional problems, while sociability proved protective. Migration background and rejection by peers showed mixed effects. The results emphasize the importance of a differential perspective on how the COVID-19-pandemic affected children's and adolescents' well-being. Besides negative consequences for vulnerable groups, also beneficial aspects of the pandemic should be considered.

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample-The mediating role of social isolation and bonding difficulties.

Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent-child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants' excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems.

[Families with Increased Parenting Stress and Conflict Potential: a Target Group for Psychosocial Support Services?] / Familien mit erhöhtem elterlichen Stress und Konfliktpotential: Eine Zielgruppe für psychosoziale Unterstützungsangebote?

STUDY AIM: Psychosocial stress can complicate the first phase of life for young families. One group that has received little attention so far are families with increased parental stress and conflict potential. This paper aims to 1) classify knowledge and use of support services for families with increased parental stress and conflict potential and 2) describe the psychosocial characteristics and parenting behaviours of these families. METHODS: For this purpose, data from a representative cross-sectional study in 2015 with n=7 549 families as well as the follow-up study with n=905 families were analyzed. Parents who took their child to a pediatrician's office for a screening examination (U3-U7a) completed a written questionnaire. Knowledge and use of services were assessed using four pre-defined stress groups (unstressed, socioeconomically stressed, with parental stress and conflict potential, and highly burdened). RESULTS: Families with increased parental stress and conflict potential are less likely to receive support offers. Despite high knowledge of selective prevention services, they use these offers less frequently than socioeconomically or highly stressed families. They are more likely to report dysfunctional parenting behaviors. CONCLUSION: This raises the question of whether families with increased parental stress and conflict potential receive too little support because they have no clearly visible need for help or whether they are adequately provided for due to the high socioeconomic resources, service knowledge, and use of universal medical and family education services. The results provide important information for the care of families in various stressful situations and contribute to the assessment of the need for support.

[An urban-rural comparison of family stress and early childhood intervention: Data linkage between two cross-sectional studies]. / Ein Stadt-Land-Vergleich familialer Belastungen und Früher Hilfen.

An urban-rural comparison of family stress and early childhood intervention: Data linkage between two cross-sectional studies Abstract. Background: So far, there is insufficient information about where in Germany which families are reached by home-visiting programs and how well. One example is the provision of home-visiting program by health service professionals (LaB) in early childhood intervention. Research questions: Are there urban-rural differences in psychosocial stress among families? What differences exist in terms of expanding support services, receiving a service, and using the offered LaB? Methods: Data from a representative family survey on psychosocial stress characteristics and the use of services, and a nationwide survey of professionals on the development and expansion of early childhood intervention at the community level were linked. Analyses included descriptive statistics and regression models. Results: Most psychosocial stress characteristics were reported with similar rates in rural and urban areas. Although the LaB program is more widespread in urban regions, it was more likely to be used in rural regions when offered. LaB was more likely to be used by families with migration background, with signs of depression or anxiety of parents, and with a child with perinatal adversities, and less likely when there was a need for expansion of this service. Conclusions: The increased use in rural areas could be due to the fact that there are long distances to few centralized services. Therefore, the outreach character of the LaB program is appreciated, especially among less mobile families.

Long-term effects of targeted prevention programmes for families with young children: A population-based study on parenting stress and children's negative emotionality.

BACKGROUND: Many prevention programmes for families focus parental adversities and adverse childhood experiences. Effects of such programmes are often examined in clinical trials; there is less research on effects under naturalistic conditions. The aim of this study was to examine the longitudinal association between parenting stress and child's negative emotionality, its modification through targeted prevention programmes, and to investigate the effects in the general population. METHODS: Data were taken from a sample of n = 903 families with infants (mean age: 13.3 months) who participated in a baseline study (T1) and a follow-up study (T2) 2 years later. The survey included parental self-report measurements on parenting stress and child's negative emotionality (T1 and T2 each) and targeted prevention programmes (T1 only). An autoregressive cross-lagged panel design was used to analyse the association of parenting stress and the child's negative emotionality, including use of targeted prevention programmes as moderator. We also tested if targeted prevention programmes can reduce parenting stress or child's negative emotionality using Propensity Score Matching (PSM). RESULTS: Parenting stress at T1 affected children's negative emotionality at T2, but children's negative emotionality at T1 did not affect parenting stress at T2. When targeted prevention was included as moderator, the correlation disappeared among programme users. With PSM, there was no direct effect on parenting stress or child's negative emotionality. But a subsample of parents with high parenting stress at T1 who used targeted prevention at T1 reported less child's negative emotionality problems at T2 than parents who scored high in parenting stress but did not receive targeted prevention at T1. CONCLUSION: Results suggest that the spillover from parenting stress to child's negative emotionality may be modified by prevention. Prevention programmes may help to build resources and have a direct positive effect on the child, especially for parents with high parenting stress.

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.

Coparenting Problems and Parenting Behavior as Mediating Links Between Interparental Conflict and Toddlers' Adjustment Difficulties in Germany.

Objective: Interparental conflict has long been acknowledged as a major risk factor for the well-being of children. Empirical studies reveal clear associations between children's maladjustment and frequent destructive conflicts between their parents (van Eldik et al., 2020). Existing research suggests that interparental conflict spills over from the couple to the coparental relationship, undermining parents' skills to cooperate and their parenting competencies. This study addresses the effects of interparental conflict on the behavioral and emotional problems of toddlers. Methods: The analyses were based on longitudinal data from the German Family Panel pairfam. The sample comprised information on N = 828 anchor participants (59.9 % female) and their 3- to 5-year-old children. Results: As expected, the effects of interparental conflict on children's behavioral and emotional problems were mediated by coparenting problems and in part also by negative parenting. Further analyses comparing mothers and fathers revealed a stronger direct path of interparental conflict on coparenting for mothers. Conclusions: The findings provide support for the significance of the interparental relationship and coparenting quality for child development, even in this young age group, and point to the importance of early prevention.

Fathers, mothers and family violence: Which risk factors contribute to the occurrence of child maltreatment and exposure to intimate partner violence in early childhood? Findings in a German longitudinal in-depth study.

BACKGROUND: Family violence, especially child maltreatment and intimate partner violence, in early childhood has a strong impact on negative developmental outcomes. There is evidence of child, parental, and family risk factors. Less is known about paternal than maternal risk factors. OBJECTIVE: To identify maternal and paternal predictors of family violence and predictive constellations of risk factors. PARTICIPANTS AND SETTING: According to psychosocial adversity in a larger study, families were stratified into low-, medium- and high-risk groups. Both, mothers and fathers (n = 197/191), were investigated longitudinally across seven months using self-report questionnaires and ratings of the IFEEL Pictures. METHODS: χ2-tests, logistic regression models, and prediction configural frequency analysis (P-CFA) were employed. RESULTS: Univariate predictors (p < .05) were anxiety and stress in mothers, and insensitivity in recognizing negative child emotions in fathers. Within high-risk levels, paternal adverse childhood experiences (ACE) were a predictor (z = 2.92, p > .01), proven by P-CFA. Logistic regression models including family violence at baseline, sociodemographic variables, univariate predictors, and ACE of both parents revealed maternal anxiety (OR = 1.22, p < .05) and low paternal recognition of negative IFEEL Pictures (OR = 6.00, p < .05) as predictors. P-CFA identified socioemotional problems in children and low paternal recognition of negative child emotions as a predictive risk constellation (z = 2.58, p > .01). CONCLUSION: Analysis of both caregivers in small population samples with oversampled at-risk families leads to a systemic perspective of family violence. The identified risk constellation is highly relevant for early childhood intervention.

Fall From Grace: Increased Loneliness and Depressiveness Among Extraverted Youth During the German COVID-19 Lockdown.

The COVID-19 pandemic has substantially affected young people's social and emotional life. Based on longitudinal data provided by 843 adolescents (57.3% female) of the German Family Panel (pairfam), we investigated effects of extraversion on changes in loneliness and depressiveness between 2018 and 2019 and the first German COVID-19 lockdown in the first half of 2020. Findings of latent change modeling show that highly extraverted adolescents experienced a larger rise in depressiveness, and a third of this total effect was mediated through increases in loneliness. These results contradict previous work evidencing lower depressiveness among extraverted youth and challenge the notion of extraversion as a mere protective factor. Under conditions of restricted access to others, this personality trait may become a burden.

Sibling relationship pattern in the context of abuse and neglect: Results from a sample of adult siblings.

BACKGROUND: Siblings take care of each other and provide comfort and support. However, the sibling relationship is often also characterized by conflict and rivalry. Accordingly, the sibling relationship can be described by four patterns: harmonious, hostile, distanced, and emotional-intense. The sibling relationship pattern (SRP) depends on the sibling constellation, but also to a large extent on the family environment. Surprisingly little research has focused on the effects of child maltreatment on the SRP. OBJECTIVE: This paper investigates the impact of maltreatment on the SRP during childhood. PARTICIPANTS AND SETTING: 4568 adults provided information about their adverse experiences and SRP while growing up. METHODS: Multinomial logistic regression analyses were calculated to identify unique predictors for different SRP. RESULTS: The number of different types of maltreatment predicted a hostile SRP. A low number was associated with a harmonious SRP. Considering the specific influence of types of maltreatment, emotional abuse was predictive for the hostile and the emotional-intense SRP compared to the distanced and the harmonious SRP. Emotional neglect was predictive for either a distanced or a hostile SRP compared to a harmonious or emotional-intense SRP. CONCLUSIONS: Child maltreatment influences the SRP in childhood. It increases the likelihood of a hostile and less harmonious SRP. However, for some types of maltreatment, especially in the absence of emotional abuse or emotional neglect, exceptions occur. Further research needs to untangle dynamics between siblings throughout childhood. For practice, the findings warrant the need for specific interventions to improve the sibling relationship in cases of child maltreatment.

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.

A systemic perspective on children's emotional insecurity in relation to father: links to parenting, interparental conflict and children's social well-being.

Focusing on the father-child-relationship in a family systems perspective, this paper investigates longitudinal links of parenting, interparental conflict, and positive regard by both parents, to their emotional insecurity with father and mother. Furthermore, to clarify fathers' contribution to children's social development, aspects of the relationship to both parents are jointly considered. The sample was drawn from the German family panel pairfam and included 372 family triads with parents' and children's self-reports. Findings revealed consistent associations between interparental conflict and lack of positive regard and emotional insecurity, while parenting had no independent links with children's emotional insecurity or social adjustment. Controlling for the stability of child outcomes, interparental conflict predicted children's lower prosocial behavior and higher peer rejection. In addition, peer rejection was predicted by children's emotional insecurity with father. The findings are in line with the emotional security hypothesis and highlight the importance of the father-child-relationship for developing positive peer relationships.

[Psychosocial Risk Factors and Negative Emotionality in Early Childhood: Mothers' Perspective]. / Psychosoziale Belastungsfaktoren und negative Emotionalität in der frühen Kindheit: die Perspektive der Mütter.

Psychosocial Risk Factors and Negative Emotionality in Early Childhood: Mothers' Perspective Based on a nationally representative study of parents, this study examines risk factors for mothers' perceptions of young children's negative emotionality, focusing the role of mothers' educational resources and related psychosocial risk factors. Participants were 7,311 mothers with children below age 48 month. Mothers' perception of child emotionality was assessed through two factors, irritability and defiance. Findings from regression analyses showed a stable negative relationship between maternal education and perceived defiance of the child. Although this effect was partly mediated by further psychosocial risk factors, lower education was consistently related with higher perceived defiance. Perceived irritability, in contrast, was not affected by mother's education. Further analyses showed age-specific effects (stronger effects for younger children) as well as a predictive value of mothers' perceptions regarding the occurrence of child abuse or neglect. The results are discussed in the context of early prevention programs in Germany, emphasizing the relevance of identifying risk-groups and offering early and multidimensional prevention.

Risk of maltreatment for siblings: Factors associated with similar and different childhood experiences in a dyadic sample of adult siblings.

Siblings share the same environment and thus potentially a substantial number of risk factors for child maltreatment. Furthermore, the number of siblings and the sibling constellation itself might pose a risk for child maltreatment. Little is known about the likelihood that more than one child in a family is maltreated and which factors increase the risk. This study sought to investigate similarities and differences in maltreatment in siblings and risk factors associated with the maltreatment of more than one child from the same family. Data on maltreatment during childhood and adolescence, family background, and sibling constellation were collected from 870 pairs of siblings. In the dyadic analyses, siblings reported similar maltreatment experiences, especially when any type of maltreatment was considered. Parents' mental health problems were significant predictors for maltreatment of at least one sibling. Father's mental health problems were predictive of maltreatment of both or only the younger sibling, mother's mental health problems of both or only the older sibling. Closeness in age and same gender of siblings did not emerge as a consistent predictor. The increasing number of siblings was a risk factor for any type of maltreatment of both siblings. The results highlight the need for preventive measures for families with a large number of children and with parents with mental health problems as well as a repeated risk assessment of all siblings in a family when one sibling was maltreated.