The COVID-19 pandemic, well-being, and transitions to post-secondary education.

This study examines the immediate and intermediate effects of the COVID-19 pandemic on the well-being of two high school graduation cohorts (2020 and 2021) and how changes in well-being affect students' educational plans and outcomes. Our unique panel data on 3697 students from 214 schools in 8 German federal states contain prospective survey information on three dimensions of well-being: mental health problems, self-rated health, and life satisfaction. Data is collected several months before (fall 2019), shortly before and soon after (spring 2020) as well as several months after (fall/winter 2020/21) the beginning of the COVID-19 pandemic. Applying difference-in-differences designs, random effect growth curve models, and linear regression models, we find that school closures had a positive immediate effect on students' well-being. Over the course of the pandemic, however, well-being strongly declined, mainly among the 2021 graduation cohort. We show that a strong decline in mental health is associated with changes in educational and career plans and transition outcomes. As adverse life experiences in adolescence are likely to accumulate over the life course, this study is the first to exhibit potential long-lasting negative effects of the COVID-19 pandemic on education and careers of young individuals.

What contributes to the long-term implementation of an evidence-based early childhood intervention: a qualitative study from Germany.

Background: Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Methods: Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. Results: A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. Conclusions: We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.

Prenatal and Infancy Home Visiting in Germany: 7-Year Outcomes of a Randomized Trial.

OBJECTIVES: Given the lasting positive effects of prenatal and infancy home visiting in the United States on disadvantaged mothers and children at school age, we analyzed the follow-up effects of a German home visiting program (ProKind). We hypothesized improvements in 3 domains at child age 7 years: (1) child development and life satisfaction, (2) maternal mental health and life satisfaction, and (3) adverse parenting, abusive parenting, and neglectful parenting. METHODS: We conducted a randomized controlled trial of home visiting, enrolling 755 pregnant, low-income women with no previous live births. The intervention comprised 32.7 home visits by family midwives and/or social pedagogues until child age 2 years. Assessments were completed on 533 7-year-old firstborn offspring to evaluate 8 primary hypotheses. RESULTS: We found significant positive effects for 4 of the 8 primary hypotheses. Mothers in the intervention group reported fewer behavioral problems among their children in the Child Behavior Checklist (effect size [ES] = 0.21; 95% confidence interval [CI]: 0.03 to 0.38), less child abusive parenting (ES = 0.19; 95% CI: 0.00 to 0.37), fewer maternal mental health problems (ES = 0.25; 95% CI: 0.07 to 0.43), and higher maternal life satisfaction (ES = 0.25; 95% CI: 0.07 to 0.43). Additional preregistered subgroup analyses regarding child sex revealed larger effects for boys and mothers of boys. CONCLUSIONS: The results suggest that in a western European welfare state, home visiting targeting disadvantaged mothers has lasting effects in important outcome domains. Therefore, home visits also appear to be an effective and efficient public health intervention in European settings.

The effects of home visiting on mother-child interactions: Evidence from a randomized trial using dynamic micro-level data.

BACKGROUND: Home visiting programs constitute an important policy to support vulnerable families with young children. One of their principal aims is to improve infant-parent relationships, so a key measure of their effectiveness is based on observational measures of parent-children interactions. In the present study we provide novel evidence on the effectiveness of home visiting programs in improving mother-child interactions within a randomized controlled trial (RCT) of the Pro Kind program. A major goal of the Pro Kind program is to promote child development by strengthening the intuitive parenting skills of mothers. On this basis, the following research question is addressed in this paper: What is the impact of the Pro Kind home visitation program on the quality of mother-child interaction? METHODS: A randomly chosen subsample of the original sample was selected to participate on video recordings. This subsample of 109 mother-child dyads was videotaped during a 3-min typical play situation at the participants' homes when the child was aged 25 months. We use a novel micro-coding system which allows us to examine how the intervention affected the dynamic feedback responses of both mothers and children in three key measures of behavior: orientation, positive contingency, and negative/lack of contingency. The analysis was conducted using a set of static probit models and dynamic cross-lagged panel probit models for each measure. RESULTS: The intervention significantly improved the interactions between girls and their mothers, by increasing the prevalence of orientation and positive contingency (and reducing that of negative/lack of contingency). This was achieved by increasing both the persistence of positive behaviors and also the probability of switching from negative to positive behaviors in the treatment group. Mixed impacts were detected for boys. CONCLUSIONS: Overall, it can be said that the Pro Kind program has a positive impact on the quality of mother-daughter interaction. However, our findings might also influence the design and delivery of home visiting programs, to the extent that they suggest that more attention has to be devoted to the interactions between boys and their mothers. Furthermore, the results show the importance of careful dynamic modelling of interactions data from videotaped observations to have a more complete understanding of the effectiveness of home visiting programs.

Effects of early childhood intervention on fertility and maternal employment: Evidence from a randomized controlled trial.

This paper presents the results of a randomized study of a home visiting program implemented in Germany for low-income, first-time mothers. Besides improving child health and development, a major goal of the program is to improve the participants' economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, household composition, well-being, and fertility behavior. The study reveals that the intervention decreased maternal employment by 9.3 percentage points and increased subsequent births by 6.4 percentage points, in part through a reduction in abortions.

Follow-up study regarding the medium-term effectiveness of the home-visiting program "Pro Kind" at age 7 years: study protocol for a randomized controlled trial.

BACKGROUND: Pro Kind is a German adaptation of the US Nurse Family Partnership program. It is an intervention based on home visits targeting first-time mothers from disadvantaged populations. Pro Kind was implemented as a randomized control trial from 2006 to 2012 with N = 755 first-time mothers (TG n = 394, CG n = 391). The 7-8-year follow-up aims to assess the mid-term effects of the program. METHODS/DESIGN: Mid-term outcomes are being assessed by trained assessors. In a multimethod approach telephone interviews, on-site interviews, observations and developmental tests will be held in order to assess children's and mothers' life satisfaction, mental health, cognitive and social development, parenting behavior, signs of child abuse or neglect as well as the family's socio-economic status. Furthermore, administrative data will be accessed to obtain information regarding the mother's usage of pediatric health care, welfare usage and employment history. DISCUSSION: Results regarding the mid-term effects of the intervention from the Pro Kind Follow-up will provide a scientific basis for future primary prevention programs as well as help stakeholders legitimizing early childhood investments. TRIAL REGISTRATION: German Clinical Trial Registration DRKS-ID, ID: DRKS00007554 . Registered on 11 June 2015, updated on 6 October 2017.

Evaluating the effects of a targeted home visiting program on maternal and child health outcomes.

We evaluate the effects of home visiting targeted towards disadvantaged first-time mothers on maternal and child health outcomes. Our analysis exploits a randomized controlled trial and combines rich longitudinal survey data with unique administrative health data. In a context in which the target group has comprehensive health care access, we find no effects of home visiting on most types of health utilization, health behaviors, and physical health measures. However, the intervention has a positive effect on some maternal mental health outcomes, reducing depression reported in the survey data by eleven percentage points and prescription of psycholeptics recorded in the administrative data by seven percentage points.