I-PREGNO - prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials.

BACKGROUND: The transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families. AIMS: The research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period. METHODS: In two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group. DISCUSSION: The intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria. TRIAL REGISTRATION: Both trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022.

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.

[Adverse Childhood Experiences in Mothers and Intergenerational Family Violence]. / Negative Kindheitserfahrungen von Müttern und generationenübergreifende familiäre Gewalt.

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.

Psychosocial Stressors and Resources in Parents Using Home-Visiting Programs in Early Childhood: A Study Protocol.

Psychosocial stressors and resources present in the early life of a child play a crucial part in determining outcomes later in life. Preventive early childhood intervention services aim to reduce negative and increase positive outcomes. Home-visiting programs are an example for preventive services that are common in many countries.The present study focusses on a wide spread home-visiting program in Germany and has three main objectives: First, to characterize the professionals that conduct and the families who participate in the program. Second, to study relations between a broad range of resources and stressors. Third, to analyse potential outcome variables for future efficacy studies on early childhood intervention services. The goal is to recruit 130 professionals and 500 families from 20 cities and municipalities in Germany. For families with two caregivers, both are invited to participate. Questionnaire topics for professionals and families include a range of stressors and resources, need for support, and the work focus of the professionals. Statistical analyses will mainly be descriptive, exploring the complex interplay of stressors and resources in vulnerable families.These results will not only provide insights into how the program is currently conducted and whom it serves, but might also help to further accelerate the program and the training of professionals.

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.

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.

Child Abuse Potential in Young German Parents: Predictors, Associations with Self-reported Maltreatment and Intervention Use.

Since child maltreatment has highly negative effects on child adjustment, early identification of at-risk families is important. This study focuses on longitudinal risk factors for child maltreatment and associations between abuse risk and occurrence. It also examines whether abuse risk and involvement in early childhood intervention are associated. The sample comprises 197 German caregivers with children under 3 years of age. Data was collected in two waves. The Brief Child Abuse Potential Inventory assessed abuse risk. Socio-demographic, parent, child and family-related risk factors were measured using screening tools. The analysis revealed that parental characteristics (psychopathology, own maltreatment experiences etc.) were associated with concurrent abuse risk. Longitudinal changes in abuse risk were linked to caregiver education and child-related factors. Cumulative risk did not explain more variance than specific risk factors. Significant associations with caregiver-reported abuse were found, and data suggest that some burdened families cannot be reached by early childhood intervention.

[Working with Fathers to Prevent Child Abuse. A Pilot Evaluation of the Caring Dads Program in Germany]. / Arbeit mit Vätern zur Prävention von Kindesmisshandlung Eine Pilotevaluation des Caring Dads Programms in Deutschland.

Working with Fathers to Prevent Child Abuse. A Pilot Evaluation of the Caring Dads Program in Germany Selective and indicated prevention programs for fathers at high risk of (repeated) child maltreatment are lacking within early childhood intervention and child protection. The Canadian Caring Dads Program has been started in Germany in 2008. The aim of this study was to examine fathers who participated in a Caring Dads program in Düsseldorf, Hanover or Groß-Gerau until 2016. The study of n = 60 fathers and n = 34 mothers included the longitudinal examination of self-reported aggression, parenting behaviors and co-parenting in fathers as well as quality of life and co-parenting in mothers, the comparison of fathers participating in the program in Germany and Canada (n = 59/64) and a postal catamnesis (n = 20). Results have shown mean improvements in paternal aggression (d = .39) and parenting behaviors (d = .80, categorized: φ = .46) as well as maternal co-parenting (d = .46) and paternal behavior toward the partner (d = .47). In one-fourth to one-third of fathers at risk-levels, improvements controlled for measurement errors by the Reliable Change Index were clinically significant. German fathers reported higher motivation for change (t1/t2: d = 1.37/1.59) and verbal aggression (t1/t2: d = 1.29/1.36) compared to Canadian fathers. The catamnesis showed subjectively significant improvements in family relationships and parenting from the paternal point of view. The evaluation does not provide any evidence of culturally induced barriers of implementing Caring Dads in Germany.

[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.

[Growing up under adversity in Germany : Design and methods of a developmental study on risk and protective mechanisms in families with diverse psychosocial risk]. / Aufwachsen unter familiärer Belastung in Deutschland : Design und Methoden einer entwicklungspsychologischen Studie zu Risiko- und Schutzmechanismen bei Familien mit unterschiedlicher psychosozialer Belastung.

Family adversity comprises many risk factors for parents and children. The German early intervention approach Frühe Hilfen aims at providing enduring, effective, and scientifically validated prevention and intervention for effective child protection against those risks. The study on risk and protective mechanisms in the development of families with diverse psychosocial risks aims at identifying those mechanisms that cause and stabilize or moderate and diminish maltreatment and neglect, as well as cognitive, social, and emotional developmental deviations in risk families, specifically in the current German social and child protection system. The study examines the development of competence and early behavior problems in a sample of infants and toddlers and the interaction quality with their caregivers by applying a longitudinal sequential-cohort design. The assessments include developmental tests, systematic observations, and questionnaire data. First results suggest stable risk group membership and moderate stability of single risk factors.

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.

Recommendations for the Development of Family-Based Interventions Aiming to Prevent Unhealthy Changes in Energy Balance-Related Behavior during the Transition to Parenthood: A Focus Group Study.

Feasible interventions addressing unhealthy changes in energy balance-related behavior (EBRB) during pregnancy and early postpartum are needed. This study identified the needs and wishes of expecting and first-time parents concerning EBRB interventions during the transition to parenthood. Thirteen focus group discussions (n = 74) were conducted. Couples provided information about whether an intervention targeting unhealthy EBRB changes during pregnancy and postpartum would be acceptable, how such an intervention should look like, and in which way and during which period they needed support. Guided by the TiDIER checklist, all quotes were divided into five main categories (i.e., 'what', 'how', 'when and how much', 'where', 'for and from whom'). Interventions should aim for changes at the individual, social, environmental and policy levels. The accessibility and approach (indirect or face-to-face) together with communicational aspects should be taken into account. A focus should go to delivering reliable and personalized information and improving self-regulation skills. Interventions should be couple- or family-based. Authorities, healthcare professionals, the partner and peers are important sources for intervention delivery and support. In the prevention of unhealthy EBRB changes around childbirth, the involvement of both parents is needed, while health care professionals play an important role in providing personalized advice.

Self-Reported Psychosocial Stress in Parents With Small Children.

BACKGROUND: Psychosocial stress in early childhood can impair children's health and development. Data on the prevalence of psychosocial stress in families with infants and toddlers in Germany are lacking. Such data could be used to determine the need for prevention and to plan the appropriate preventive measures. METHODS: In 2015, a representative cross-sectional study called Kinder in Deutschland- KiD 0-3 was conducted by questionnaire in pediatricians' practices across Germany. Parents taking their children to the U3-U7a child development checks were asked to self-report information about stress in their families. The data were analyzed with descriptive statistics and chi-square tests. RESULTS: Data from 7549 families went into the analysis. Stressful situations commonly reported by the parents included unplanned pregnancy (21.3%), parenthoodrelated stress (e.g., self-doubt as to parenting competence, 29.6%), and lack of familial and social support for problems and questions arising in relation to the child, as well as for temporary child care (19.7%). Most types of psychosocial stress varied as a function of the child's age group, as categorized by the particular examination for which the child was presenting at the time of the survey (U3-U7a). Couple distress, lack of social support, signs of depression or anxiety symptoms, or inner anger were more commonly reported by parents attending the later examina - tions. Such problems could be addressed by supportive measures (e.g., parent counseling, early child intervention). CONCLUSION: Psychosocial stress affects a large percentage of the parents of small children. A large proportion of parents of small children suffer from psychosocial stress. This should be monitored for accumulation and stability across child development checks and addressed as appropriate. Family practitioners and pediatricians are important partners for effective cooperation between the social system and the health-care system, and for the provision of preventive measures where appropriate.

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.

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 (ß = 00.08), stress (ß = 0.06), education (ß=-0.19) and alcohol use (ß = .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.