[Families with infants and toddlers in the COVID-19 pandemic: parental stress and child development considering social class]. / Familien mit Säuglingen und Kleinkindern in der COVID-19-Pandemie: Belastungserleben und Entwicklungsauffälligkeiten unter Berücksichtigung der sozialen Lage.

INTRODUCTION: It is now well established empirically that families and children who could not attend educational and childcare institutions during the COVID-19 pandemic experienced disadvantages. This is particularly true for families in poverty. However, little is known about the situation of families with young children. The aim of the paper is to investigate (1) to what extent families with infants and toddlers also experienced their situation during the pandemic as stressful, (2) whether there were differences depending on social class, (3) how the pandemic affected the healthy development of infants and toddlers, and (4) to what extent class-related differences can also be identified in this. METHODS: The German National Centre for Early Prevention conducted a nationally representative survey of families with children of age 0 to 3 years in April to December 2022, "Kinder in Deutschland 0­3 2022" (N = 7821). The KiD 0­3 study combines a parent survey on family psychosocial burden and resources with pediatric documentation of child development. RESULTS: Parents with very young children experienced their situation in the COVID-19 pandemic as stressful. A clear difference depending on social class emerged. Both from the parents' perspective and in pediatric judgment, the pandemic had a negative impact on social and affective development even in young children. These effects were more pronounced in children from families experiencing poverty than in children from families not receiving basic government benefits. DISCUSSION: In order to mitigate the psychosocial consequences of the COVID-19 pandemic for families and to improve children's chances of growing up in a healthy way that promotes their development, it is necessary to support families in need without stigmatization.

How are families in Germany doing in 2022? Study protocol of a nationally representative, cross-sectional study of parents with children aged 0-3 years.

BACKGROUND: In order for Early Childhood Intervention (ECI) to be effective, data-based information on families' resources, burden and current use of support services for families with young children, as well as on children's health and development is needed. The study Kinder in Deutschland [Children in Germany]-KiD 0-3 2022 aims at providing these data to help us understand families' situation and needs in Germany now, including families' experience of the COVID-19 pandemic. METHOD: The study will recruit up to 300 pediatricians who will invite parents of children aged up to 48 months to participate in the study during a well-child visit. Parents (goal N = 8,000) will complete an online-questionnaire with their own web-enabled device. Pediatricians will complete a short questionnaire about each participating family. The questionnaires cover family psychosocial burden and resources, child health and development, use of family support services, as well as the families' experiences of the COVID-19 pandemic. Data will be analyzed to assess patterns of families´ psychosocial burdens and resources, use of support services for families with young children, and children´s health and development. Concordance between parent and pediatrician report will be assessed and comparisons with the predecessor study of 2015 will be drawn. DISSEMINATION: Findings will be disseminated through scientific conferences, open access peer-reviewed journals, and dissemination channels of the National Centre for Early Prevention. DISCUSSION: The present study will provide parent and pediatrician reports on how families with young children are doing in Germany. These data will be used to inform Germany's early childhood intervention (ECI) program ("Frühe Hilfen") on current needs of families with young children.

[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.

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.

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.

[Early childhood intervention from a distance-opportunities and challenges in supporting psychosocially stressed families in the COVID-19 pandemic]. / Frühe Hilfen aus der Distanz ­ Chancen und Herausforderungen bei der Unterstützung psychosozial belasteter Familien in der COVID-19-Pandemie.

As of spring 2020, contact-restricting measures were necessary to contain the incidence of infection with the SARS-CoV­2 virus in Germany. However, these restrictions posed particular challenges to families, especially families in high-stress situations. This paper examines how the COVID-19 pandemic affected the life of families and if long-term support in the context of early childhood intervention could be continued. The following analyses are based on qualitative research with psychosocially stressed mothers of young children, two surveys of health professionals who provide long-term support to families in early childhood intervention, and a survey of municipal actors who are responsible for the management and implementation of early childhood intervention in German communities.During the pandemic, families in high-stress conditions report existential fears and general overstrain. Intrafamilial conflicts seem to increase. Home visits in the context of long-term psychosocial support were initially primarily replaced by phone calls, video calls or other forms of "support from a distance." During the course of the pandemic, many professionals have begun conducting home visiting again, but several elements of support from a distance continue to be used as a supplement.Due to the pandemic-related additional burdens on the families who were accompanied by early childhood intervention, the continuation of support was even more important than it already was. Having been tested by necessity during the pandemic, several formats of support from a distance may have the potential to complement the usual assistance provided by health professionals in early childhood intervention and thus contribute to its quality development push.

[Demand-driven communication strategy of the Federal Centre for Health Education (BZgA) during the COVID-19 pandemic]. / Bedarfsbezogene Kommunikationsstrategie der Bundeszentrale für gesundheitliche Aufklärung (BZgA) während der COVID-19-Pandemie.

With the declaration of a pandemic situation of national significance by the German Bundestag, the Federal Centre for Health Education (BZgA) is fulfilling its task of providing information for understanding the pandemic situation and implementing the necessary protective measures in a clear manner throughout Germany within the framework of the adapted National Pandemic Plan COVID-19. The BZgA targets its information according to the needs of specific groups and actively involves multipliers.In order to incorporate the perspectives of the population as well as those of prevention and health promotion professionals into the services developed by the BZgA, given the particularly initial low level of knowledge in the population, various methods and data sources were used: the COVID-19 Snapshot Monitoring (COSMO) population survey, the monitoring of citizens' enquiries via telephone and e­mail to the BZgA, surveys of counselling professionals from nationwide telephone and online counselling centres, surveys of health professionals in early help (NZFH) and interdisciplinary practice expert hearings. Beyond providing pure information, practical and everyday offers should be developed and provided according to WHO guidelines and evidence-based criteria of effective communication in order to support the competences for a gradual adaptation to a "new normality".The paper describes the data-based and evidence-informed development process of communication content and offers, their dissemination via existing websites and channels for other topics as well as their integration into the new online platform www.zusammengegencorona.de . This demonstrates how demand-driven and target group-specific communication offers can be implemented beyond the classic and proven campaign appearance.

Specific considerations for research on the effectiveness of multisectoral collaboration: methods and lessons from 12 country case studies.

BACKGROUND: The success of the Sustainable Development Goals (SDGs) is predicated on multisectoral collaboration (MSC), and the COVID-19 pandemic makes it more urgent to learn how this can be done better. Complex challenges facing countries, such as COVID-19, cut across health, education, environment, financial and other sectors. Addressing these challenges requires the range of responsible sectors and intersecting services - across health, education, social and financial protection, economic development, law enforcement, among others - transform the way they work together towards shared goals. While the necessity of MSC is recognized, research is needed to understand how sectors collaborate, inform how to do so more efficiently, effectively and equitably, and ascertain similarities and differences across contexts. To answer these questions and inform practice, research to strengthen the evidence-base on MSC is critical. METHODS: This paper draws on a 12-country study series on MSC for health and sustainable development, in the context of the health and rights of women, children and adolescents. It is written by core members of the research coordination and country teams. Issues were analyzed during the study period through 'real-time' discussions and structured reporting, as well as through literature reviews and retrospective feedback and analysis at the end of the study. RESULTS: We identify four considerations that are unique to MSC research which will be of interest to other researchers, in the context of COVID-19 and beyond: 1) use theoretical frameworks to frame research questions as relevant to all sectors and to facilitate theoretical generalizability and evolution; 2) specifically incorporate sectoral analysis into MSC research methods; 3) develop a core set of research questions, using mixed methods and contextual adaptations as needed, with agreement on criteria for research rigor; and 4) identify shared indicators of success and failure across sectors to assess MSCs. CONCLUSION: In responding to COVID-19 it is evident that effective MSC is an urgent priority. It enables partners from diverse sectors to effectively convene to do more together than alone. Our findings have practical relevance for achieving this objective and contribute to the growing literature on partnerships and collaboration. We must seize the opportunity here to identify remaining knowledge gaps on how diverse sectors can work together efficiently and effectively in different settings to accelerate progress towards achieving shared goals.

[Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention]. / Frühe Hilfen für Kinder psychisch kranker Eltern ­ Forschungsergebnisse des Nationalen Zentrums Frühe Hilfen.

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.

[The health sector and early childhood intervention: intersectoral collaboration in research]. / Gesundheit und Frühe Hilfen: Die intersektorale Kooperation im Blick der Forschung.

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.

[Midwives and Nurses in Early Childhood Intervention: The Benefit of Additional Qualification]. / Gesundheitsfachkräfte in den Frühen Hilfen: Wie nützlich ist die Zusatzqualifikation? Eine quantitative Studie.

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 (GruppeGFK + Quali) and (2) mothers cared for by a midwife or nurse without additional qualification (GruppeGFK). 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: GruppeGFK + Quali: mean = 2.57; GruppeGFK : 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.

[The Zanzu web portal : A contribution to the sexual health of migrants]. / Das Webportal Zanzu : Ein Beitrag zur sexuellen Gesundheit von Migrantinnen und Migranten.

BACKGROUND: "Zanzu - my body in words and images" - zanzu.de is a multilingual web portal that brings together information about different aspects of sexual health. It was developed to address specific needs of migrants, including barriers to access. Zanzu provides quality-assured information on the topics of body, sexuality, HIV/STIs, family planning, sexuality and rights. METHOD: A few months after launching the web portal, a formative evaluation was conducted. The following questions were central in the evaluation: Can the web portal be used in the context of counseling? What experiences have there been with various types of deployment and how do intermediaries (i. e., counselors) assess the portal? RESULTS: The results confirm that Zanzu has already contributed positively to counselling migrants and that the comprehensive nature of the service is strongly welcomed. A few of the interviewees acknowledged it had been challenging to integrate a digital service into a conventional counselling session. In addition, there were questions about the suitability of some of the illustrations for all people being counselled. DISCUSSION: Access to information is a precondition to take self-determined decisions. This is equally true in the sensitive field of sexual and reproductive health. A few months after its launch, Zanzu has already succeeded in providing more information to an important population. The ideas for improvement that have been gathered in the framework of the present evaluation will be the basis for the ongoing development of Zanzu, making it even better able to meet the needs of different target groups and in different contexts.

[The assessment of family resources and need for help: Construct validity and reliability of the Systematic Exploration and Process Inventory for health professionals in early childhood intervention services (SEVG)]. / Familiäre Ressourcen und Hilfebedarfe erfassen: Zur Konstruktvalidität und Reliabilität des Systematischen Explorations- und Verlaufsinventars für Gesundheitsfachkräfte in den Frühen Hilfen (SEVG).

BACKGROUND: Health professionals in early childhood intervention and prevention make an important contribution by helping burdened families with young children cope with everyday life and child raising issues. A prerequisite for success is the health professionals' ability to tailor their services to the specific needs of families. METHODS: The "Systematic Exploration and Process Inventory for health professionals in early childhood intervention services (SEVG)" can be used to identify each family's individual resources and needs, enabling a valid, reliable and objective assessment of the conditions and the process of counseling service. The present paper presents the statistical analyses that were used to confirm the reliability of the inventory. RESULTS: Based on the results of the reliability analysis and principal component analysis (PCA), the SEVG seems to be a reliable and objective inventory for assessing families' need for support. It also allows for calculation of average values of each scale. CONCLUSION: The development of valid and reliable assessments is essential to quality assurance and the professionalization of interventions in early childhood service.

[Obstacles for the use of early childhood prevention services : The role of expected ability to control sources]. / Barrieren für die Inanspruchnahme Früher Hilfen : Die Rolle der elterlichen Steuerungskompetenz.

BACKGROUND: It is well established that preventive measures for pregnant women and families with small children do not reach all families alike. Often enough, it is those families, who due to heightened stresses and strains might gain the most from these measures, who cannot be reached (dilemma of prevention). GOAL: This investigation explores whether parents can be grouped according to their views on health, prevention and measures available to young families, and whether belonging to one of the identified groups explains differences in the use of (primary and secondary) preventive measures for pregnant women and young families. METHOD: In the context of home visits, parents of children aged two to four years (N = 273) completed questionnaires. Additionally, 203 parents took part in qualitative interviews. RESULTS AND DISCUSSION: Based on interview data, parents from different sociocultural backgrounds could be grouped along their expected ability to control sources for parental support (Steuerungskompetenz). Parents high and low in Steuerungskompetenz differ regarding their knowledge of, use of, and satisfaction with (primary) preventive measures. Steuerungskompetenz explains the use of primary preventive measures above and beyond socioeconomic control variables as well as family stresses and strains. The use of secondary preventive measures is better explained by family stresses and strains. Results are discussed in terms of untapped services, needs and possibilities of target group-oriented approach.

[Knowledge and use of different support programs in the context of early prevention in relation to family-related psychosocial burden]. / Inanspruchnahme von Angeboten der Frühen Hilfen und darüber hinaus durch psychosozial belastete Eltern.

BACKGROUND: The Federal Initiative for Early Prevention (funded by German ministry BMFSFJ), through the development of specific assistance programmes, supports families that suffer from psychosocial burden. As nationally representative data are missing, the National Centre for Early Prevention carried out a national survey on the psychosocial burden experienced by families with children aged 0-3 years. AIMS: Ascertainment of the connections between family-related psychosocial burden and knowledge and use of different assistance programmes. DATA AND METHODS: Via paediatricians, 8063 parents were recruited to complete a questionnaire on objective burden, subjective experience of burden as well as knowledge and use of assistance programmes. Differences in knowledge and use between educational groups were tested by means of chi-squared tests. Very good knowledge of available assistance programmes and the offer and acceptance of aid by family midwives were subjected to regression analyses. RESULTS: Clear differences in knowledge and use of individual assistance programmes between educational groups were observed. Many programmes are predominantly used by better educated families, although there are exceptions, for example in the case of family midwives. Despite generally small group differences, less-educated families are the proportionally largest user group of family midwives. Furthermore we present average predicted percentages of knowledge and use for specific groups of psychosocially burdened parents as derived from the regression analyses. DISCUSSION: The results are discussed in the context of barriers to access for individual assistance programmes as well as their match with families' needs in the practice of early prevention.

[Family midwives and nurses in early childhood intervention : Have they been successful?]. / Gesundheitsfachkräfte in den Frühen Hilfen : Hat sich ihr Einsatz bewährt?

BACKGROUND: The federal initiative promotes support offered by family midwives and nurses in early childhood intervention. So far, the initiative has contributed to the fact that many municipalities in Germany provide support to burdened families with young children in order to help them cope with everyday life and child-raising issues. This investigation aims to provide scientific insight into the question of if (and how) families benefit from the support of family midwives and nurses. METHODS: To answer this question, the National Centre on Early Prevention conducted an online survey. In a two-wave longitudinal study, 190 family midwives and nurses took part in the survey and reported data concerning resources, stresses, strains and improvements of 937 families. RESULTS: Families with relatively higher resources and lower stresses benefit from the support of family midwives and nurses, whereas families under more extreme stresses and strains do not seem to benefit to the same extent. Nevertheless, for a majority of the latter families, midwife and nurse services were still beneficial, as the professionals were able to arrange more adequate, i. e. more intense, support offered by the child and youth welfare system in Germany. DISCUSSION: Families in stressful living circumstances seem to benefit from family midwife and nurse services. However, further research proposals (i. e. CTs) are requested, whereby the appropriate outcome variables to measure the effect should be selected.