[Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany]. / Digitale Hoffnungsträger?

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

[Gut Microbiota and Autism Spectrum Disorders: An Overview of Correlations and Potential Implications for Therapeutic Interventions]. / Darmmikrobiota und Autismus-Spektrum-Störungen: Ein Überblick zu Zusammenhängen und möglichen Implikationen für therapeutische Interventionen.

Gut Microbiota and Autism Spectrum Disorders: An Overview of Correlations and Potential Implications for Therapeutic Interventions Abstract: At the beginning of research on microbiota, researchers focused mainly on the role of microbiota dysbiosis in the development of gastrointestinal diseases. However, over the last years, researchers have also identified correlations with other physical processes and neuropsychiatric diseases such as autism spectrum disorder. These correlations are believed to be at least partly mediated through the brain-gut-microbiome axis. An altered composition of microbiota in patients with autism spectrum disorder was detected compared to healthy controls. Today, the discussion centers around a possible systemic impact of the metabolites of some microbiota or microbiota-induced chronic inflammatory processes on the brain (mediated through the brain-gut-microbiome axis) as an underlying mechanism. Still, the specific underlying mechanisms remain largely unknown, so conclusions on therapeutic implications are difficult to determine. Here, we describe some promising approaches to improving autistic behavior through dietary changes, the use of prebiotics and probiotics, stool transplantation from healthy controls, and restricted absorbance of certain metabolites. We need further clinical studies of high quality to fully understand the pathophysiology of autism spectrum disorder and to improve diagnostic and therapeutic strategies.

Bringing a mentalizing framework to understanding mothers with addiction: The groundbreaking work of Nancy E. Suchman.

Nancy Suchman is remembered as a pioneer whose mentalization-based intervention-Mothering from the Inside Out (MIO)-transformed the treatment of parents struggling with substance use disorders. Specifically, Suchman's work highlighted the neural mechanisms underlying substance use disorders and identified the promotion of parental mentalizing as a key therapeutic focus in enhancing early parent-child relationships. Her work transformed parenting support models for this population of parents. Several randomized controlled trials (RCT) show the effectiveness of MIO in promoting parental reflective functioning (PRF) and positive relational outcomes in parents with substance use disorders and their children. Suchman's MIO model has since been extended to parenting in many contexts. She is also remembered as a generous colleague, a gifted researcher and clinician, and an inspiration to generations of researchers and practitioners working with parents who aspire to raise healthy, secure children despite multiple challenges and adversities. This special issue compiles the work of researchers inspired by Suchman as they carry on her legacy in examining aspects of parental mentalization. Collectively, the research presented yields confirmation of MIO core assumptions, offers new insights into roles of positive sentiment and savoring in mentalization processes, and presents evaluations of MIO in multiple contexts and with new adaptations.

A Nancy Suchman se le recuerda como una pionera cuya intervención basada en la mentalización-Cuidados Maternales de Dentro hacia Afuera (MIO)- transformó el tratamiento de progenitores luchando con trastornos de uso de sustancias. Específicamente, el trabajo de Suchman enfatizó los mecanismos neurales subyacentes en los trastornos de uso de sustancias e identificó el promover la mentalización del progenitor como un enfoque terapéutico clave para mejorar las tempranas relaciones progenitor-niño. Su trabajo transformó los modelos de apoyo a la crianza para este grupo de progenitores. Varios ensayos controlados al azar muestran la eficacia del MIO en cuanto a promover el funcionamiento con reflexión del progenitor y los resultados de una positiva relación en progenitores con trastornos de uso de sustancias y sus niños. El modelo MIO de Suchman desde su creación ha sido expandido a la crianza en muchos contextos. A ella también se le recuerda como una colega generosa, una investigadora y profesional clínica talentosa y como una inspiración para generaciones de investigadores y practicantes profesionales que trabajan con progenitores que aspiran a criar niños saludables y seguros, a pesar de múltiples retos y circunstancias adversas. Este número especial recopila el trabajo de investigadores inspirados por Suchman a medida que ellos continúan el legado en cuanto a examinar aspectos de la mentalización del progenitor. Colectivamente, la investigación presentada aporta la confirmación de las suposiciones centrales del MIO, ofrece nuevas ideas acerca del papel del sentimiento positivo y el aprecio detenido en los procesos de mentalización, y presenta evaluaciones del MIO en contextos múltiples y con nuevas adaptaciones.

Nous honorons et nous souvenons de Nancy Suchman en tant que pionnière dont l'intervention basée sur la mentalisation - le Maternage de l'Intérieur, en anglais Mothering from the Inside Out (MIO) - a transformé le traitement de parents aux prises avec la toxicomanie. Plus particulièrement le travail de Suchman a mis en lumière les mécanismes neuronaux sous-jacents aux troubles lié à l'usage d'une substance et il a aussi identifié la promotion de la mentalisation parentale comme une cible thérapeutique clé pour l'amélioration des relations précoces parent-enfant. Son travail a transformé les modèles de soutien parental pour cette population de parents. Plusieurs essais contrôlés randomisés montrent l'efficacité du MOI pour la promotion du fonctionnement de réflexion parental et des résultats relationnels positifs pour des parents ayant un trouble lié à l'usage d'une substance et leurs enfants. Le modèle MOI de Suchman a depuis été étendu au parentage dans de nombreux contextes. Nous nous souvenons aussi de Nancy Suchman comme étant une collègue généreuse, une chercheuse et une clinicienne talentueuse et une inspiration pour des générations de chercheurs et professionnels travaillant avec des parents qui aspirent à élever des enfants sécures, en bonne santé, malgré de grands défis et l'adversité à laquelle ils peuvent faire face. Ce numéro spécial compile le travail de chercheurs du monde entier, inspiré par Suchman, alors qu'ils perpétuent son héritage en examinant des aspects de la mentalisation parentale. Collectivement ces recherches compilées ici proposent la confirmation des hypothèses principales du MOI, offrent de nouvelles perspectives quant aux rôles du sentiment positif et du fait de savourer dans les processus de mentalisation et présentent des évaluations du MOI dans des contextes multiples et avec de nouvelles adaptations.

Updating the evidence: A systematic review of a decade of Infant and Early Childhood Mental Health Consultation (IECMHC) research.

Infant and Early Childhood Mental Health Consultation (IECMHC) is a preventative, capacity-building intervention in which mental health professionals partner with early childhood professionals to indirectly improve the environments and relationships that young children experience. Prior research has demonstrated that IECMHC is associated with positive outcomes for children, teachers, and classrooms. Over the past decade, IECMHC implementation and research have expanded, warranting an updated review. The current paper provides an update of the IECMHC evidence base. Included studies (n = 16) were systematically gathered, screened, and coded for context, intervention characteristics, methods and measures, outcomes across ecological levels, and alignment with the IDEAS Impact Framework's guiding questions. Our analysis replicates prior reviews, describing the positive impact of IECMHC on outcomes such as child externalizing behavior, teacher self-efficacy, and teacher-child interactions. Beyond updating prior reviews, this analysis describes emerging, nuanced findings regarding the mechanisms of change and the differential impact of IECMHC. We augment our review with descriptions of evaluations that did not meet our inclusion criteria (e.g., IECMHC in the home visiting context, unpublished evaluation reports) to provide context for our findings. Finally, we provide policy and practice implications and articulate an agenda for future research.

[Comparative Single Case Studies on the Course of Disorder of AdolescentWomen with Anorexia NervosaWithin Stationary Youth-Welfare Services]. / Krankheitsverläufe von jungen Frauen mit Anorexia nervosa in der auf Essstörungen spezialisierten stationären Jugendhilfe ­ vergleichende Einzelfallstudien.

The present study aims to examine effect factors that determine the development of symptomatology in the course of a stationary youth-welfare measure of clients with anorexia nervosa. Therefore, four clients were examined, who showed two different patterns in the development of weight gain - two clients showed a relatively fast initial weight gain and improvement whereas two clients, despite being in treatment for more than twelve month, showed less increase of weight gain. Over the course of one year, quantitative and qualitative data have been collected, and interviews were held with the clients, as well as the pedagogical staff.The analysis of the data using a mixed-methods-design suggests that despite similarities regarding comorbidity and pathology, individualized treatment approaches with a high accuracy of fit must be implemented, to be able to meet the demands of the clients and help them make long-lasting progress. Further, the observed clients showed severe deficits regarding their self-worth/self-efficacy, which should be taken into consideration within concepts of treatment.

[On the Evolutionary, Bio-Psychological Foundations of the Human-Animal Relationship]. / Zu den evolutionären, bio-psychologischen Grundlagen der Mensch-Tier-Beziehung.

Ever since, people live in contact with nature and animals, even in relatively non-utilitarian ways. Erich Fromm and Edward Wilson termed this human universal "Biophilia". But why different species can live together in a social way, is explained by a "common social toolbox" of neural, psychological and physiologicalmechanisms, which evolved over phylogeny.Major components of this toolbox are found in the vertebrate brain, which evolved over the past 600 million years in a succession of key innovations and conservative preservation.The tegmental and diencephalic brain hosts a 450 million year old, structurally and functionally virtually unchanged "social network" which, in crosstalk with the mammalian prefrontal cortex or the analogous bird forebrain, enables complex social behaviour - within as well as between species. In addition, this toolbox features common principles of behavioural organization, including the expression and reading of emotions, as well as shared emotional, stress and calming systems. Such a common ground for social behaviour also explains the potential effectiveness of animal-assisted interventions in a wide range of pedagogic and therapeutic settings. However, positive effects aremostly revealed by experience and plausibility, whereas studies on animal- assisted activities and interventions according to biomedical scientific standards are still rare.

[Interventions for Children and Adolescents Living in Foster or Institutional Care - A Systematic Review]. / Interventionen für Kinder und Jugendliche, die in Pflegefamilien oder Jugendhilfeeinrichtungen leben ­ ein systematisches Review.

Children or adolescents living in foster or institutional care received so far insufficient consideration in therapy intervention research. At the same time, they are a high-risk group for developing mental illness. The aim of this systematic review is to record evidence-based psychotherapeutic interventions of the past 15 years on a national and international level that address children and young people living in foster care and youth welfare institutions and their mental health. Through a systematic literature research, interventions for the target group described were identified and analyzed about their specificity and evidence. From 170 publications, ten interventions with sufficient evidence could be included in the present analysis. The result of the current literature research shows that further specialized psychiatric-psychotherapeutic interventions for children in foster care and youth welfare institutions are necessary. Regarding the transferability to the German youth welfare and health system, cross-system and interdisciplinary cooperation is needed. Hereafter further research is required to establish specific and evidence-based intervention approaches.

[Developmental Disturbance or Autistic Spectrum Disorder? Early Intervention in a Psychotherapeutic Parent-Toddler Group]. / Entwicklungsstörung oder Autismus-Spektrum-Störung? Frühe Intervention in einer pychotherapeutischen Eltern- Kleinkind-Gruppe.

Starting in Vienna in the 1920s, Anna Freud's first tentative attempts at observing children became a crucial component of the "double approach" which integrated direct child observation with psychoanalytic reconstruction. This enabled the detailed study of unfolding developmental processes and the construction of a theory of normative as well as pathological child development. Her identification of disturbances that were developmental rather than neurotic led to the broadening of child analysis. Interventions aimed at freeing and supporting development rather giving insight, became known as "developmental therapy".These interventions are used in the parent-toddler groups that embody Anna Freud's endeavour to link psychoanalytic theory, direct observation and clinical practice. Observations of a toddler who attended a psychotherapeutic parent-toddler group with his mother, show how intervening early in the child's life and soon after concerns were identified, contributed to preventing maladaptive affective states and ways of relating from becoming entrenched.

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta-analysis.

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent-infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta-analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta-analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta-analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta-analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: -0.46; 95% confidence interval [CI] [-0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent-infant interaction (SMD: -0.10; 95% CI [-0.46, 0.26]), parental depression (SMD: -1.55; 95% CI [-3.74, 0.64]) or parental global distress (SMD: -0.19, 95% CI [-3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation-based treatment with non-mentalization-based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.

El funcionamiento de reflexión del progenitor (PRF) es un factor importante de predicción de la afectividad del infante, y las intervenciones que se enfocan en díadas progenitor/infante/niño pequeñito que experimentan problemas significativos tienen la posibilidad de mejorar el PRF. La meta de esta revisión fue evaluar la eficacia de las intervenciones diádicas que se enfocan en los progenitores de infantes y niños pequeñitos, para mejorar el PRF y un número de resultados secundarios. Se llevó a cabo una revisión sistemática y un meta-análisis en los que se investigaron bancos de información electrónica claves hasta octubre de 2018. Se identificaron estudios elegibles y se sacó de ellos la información. Se sintetizó esa información usando meta-análisis y la misma fue presentada tanto en términos de dimensión de efectos como la proporción de riesgo. Se identificaron seis estudios que aportaron un total de 521 participantes. Los resultados de seis meta-análisis mostraron un moderado, poco significativo y limítrofe mejoramiento en cuanto al PRF en el grupo de intervención (SMD: -0.46; 95% CI -0.97, 0.04), una reducción significativa en la afectividad desorganizada (RR: 0.50; 95% CI: 0.27, 0.90), pero no así en la afectividad segura (OR: 0.71; 95% CI: 0.19, 2.64), y ninguna evidencia de beneficio para la interacción progenitor-infante (SMD: -0.09; 95% CI: -0.51, 0.32). Se dio un mejoramiento grande no significativo en la depresión del progenitor (SMD: -1.55; 95% CI -3.74, 0.64), pero no hubo evidencia de beneficio en cuanto a la angustia total (SMD: -0.19; 95% CI: -3.04, 22.65). Se discuten las implicaciones para la futura investigación.

Le fonctionnement parental réfléchi (en anglais Parental Reflective Functioning, soit PRF) est un facteur de prédiction important de l'attachement du bébé, et les interventions qui ciblent les dyades parent-bébé/petit enfant qui font l'expérience de problèmes importants ont le potentiel d'améliorer le fonctionnement PRF. Le but de cette article était d'évaluer l'efficacité d'interventions dyadiques ciblant les parents de bébés et de petits enfants, en améliorant le fonctionnement PRF et un bon nombre de résultats secondaires. Une revue et une méta-analyse ont été faites, les bases de données électroniques clés ayant été passées au crible en octobre 2018. Les études pouvant être utilisées ont été identifiées et les données ont été extraites. Les données ont été synthétisées en utilisant une méta-analyse et exprimées sous forme d'ampleur de l'effet et de risque relatif. Six études ont été identifiées, pour un total de 521 participants. Les résultats de six méta-analyses ont montré une amélioration limite non importante modérée dans le PRF dans le groupe d'intervention (SMD: -0,46; 95% CI -0,97, 0,04), une réduction importante dans l'attachement désorganisé de l'enfant (RR: 0,50; 95% CI: 0,27, 0,90) mais non dans l'attachement sécure (OR: 0,71; 95% CI: 0,19, 2,64), ainsi qu'aucune preuve de bénéfice pour l'interaction parent-bébé (SMD: -0,09; 95% CI -0,51, 0,32). Il y avait une grande amélioration non-importante dans la dépression parentale (SMD: -1,55; 95% CI -3,74, 0,64) mais aucune preuve de bénéfice dans la détresse globale (SMD: -0,19; 95% CI: -3,04, 22,65. Les implications pour les recherches futures sont discutées.

[Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury]. / Entwicklung einer Online-Intervention für die Versorgung von sich selbstverletzenden Jugendlichen und jungen Erwachsenen.

Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury Nonsuicidal self-injury (NSSI) is a prevalent phenomenon in adolescence. Despite the existence of effective psychotherapeutic interventions, the majority of affected adolescents and young adults do not receive any treatment. Structural (e. g., no specific interventions, limited resources, limited accessibility) as well as individual factors (e. g., low help-seeking behavior) impede access to adequate clinical care for adolescent NSSI. Online interventions offer the possibility to provide specific interventions independent of one's location or local healthcare structures. Because of its high confidentiality and accessibility, the Internet also reaches adolescents with low help-seeking behavior. There is already evidence for online interventions concerning different mental health issues, like depression and anxiety. However, regarding NSSI, there are no effective, online interventions. Thus, we developed an online intervention based on an already evaluated short term program specific for adolescents and young adults with NSSI within the German STAR consortium (STAR: Self-Injury - Treatment, Assessment, Recovery). Within a randomised controlled trial, the intervention will be evaluated regarding its efficacy.

Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions.

The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother-infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.

La reciente llamada para aumentar proporcionalmente las intervenciones sobre el desarrollo en la niñez con base en la evidencia, en países de ingresos más bajos e ingresos medios, y en el caso de grupos minoritarios en países de ingresos altos, ha visto numerosas sugerencias para entrenar un mayor número de trabajadores laicos de la salud mental que puedan realizar estas funciones. Mientras que los estudios han concluido con que conceptos provenientes de ambientes de países desarrollados, tales como afectividad, sensibilidad de los padres y contención, venden y encuentran relevancia dentro de escenarios de países en desarrollo, el tratamiento de factores contextuales y culturales y las tensiones de interconexiones culturales en la introducción de estos programas en escenarios de países en desarrollo requiere consideración. Utilizando las experiencias de dos exitosos programas madre-infante de visitas a casa en Sudáfrica como ejemplos, este artículo discute algunos de los retos en cuanto a la provisión de programas de salud mental infantil basados en la afectividad y subraya la necesidad de la cuidadosa consideración de un número de factores referentes al reclutamiento, supervisión y dirección de trabajadores laicos de la salud mental antes de que se lleve a cabo la introducción a gran escala.

L'injonction récente à intensifier les programmes d'intervention de développement de la petite enfance fondés sur des données probantes, dans des pays en voie de développement, et pour des groupes minoritaires dans les pays riches, a déclenché de nombreuses suggestions de formation d'un plus grand nombre de travailleurs laïcs de la santé mentale afin de remplir ces fonctions. Alors que des études ont établi que des concepts issus de contextes de pays développés, tels que l'attachement, la sensibilité parentale et la discipline trouvent acquisition et raison d'être au sein de contextes développés, la gestion de facteurs contextuels et culturels et les tensions d'interfaçage culturel dans le lancement de ces programmes dans des contextes de pays en voie de développement exigent d'être considérées et tenues en compte. A partir des expériences de deux programmes de Visite à Domicile Mère-Nourrisson Sud- Africains comme exemples, cet article discute certains des défis dans la prestation de programmes de Santé Mentale du Nourrisson basés sur l'attachement et met en lumière le besoin de considération attentionnée à un nombre de facteurs ayant trait au recrutement, à la supervision et à la gestion de travailleurs laïcs de santé avant que soit lancée une version à grande échelle du programme.

Infant mental health home visiting in the context of an infant-toddler court team: Changes in parental responsiveness and reflective functioning.

This article describes an infant-toddler court team in Michigan, the community-based participatory research approach to the implementation evaluation, and the resulting changes in parenting. Like other court teams, Michigan's Baby Court is led by a science-informed jurist, and all service providers are knowledgeable about the developmental needs of young children and engage in collaborative communication throughout the case. Relationship-based treatment in the form of infant mental health home-visiting was provided to families. Sixteen parents participated in pre- and posttest evaluation visits to assess changes in parents' reflective functioning and interactions with their child. Findings suggest improvements in parents' responsiveness, positive affect, and reflective functioning, with moderate effects. Higher risk parents demonstrated significant changes in reflective functioning, as compared to those at lower risk. These findings add to and support the limited literature on the effectiveness of infant-toddler court teams, which include relationship-based and trauma-informed services.

Este artículo describe un equipo judicial para casos de infantes y niños pequeños en Michigan, el acercamiento de investigación participativo basado en la comunidad para la evaluación de la implementación, así como los resultantes cambios en la crianza. Como otros equipos judiciales, El Tribunal de Michigan para los Bebés está encabezado por un jurista versado en la ciencia y todos los servidores tienen conocimiento acerca de las necesidades de desarrollo de los niños pequeños y participan en la comunicación colaborativa a lo largo del caso. Las familias recibieron un tratamiento con base en la relación, en forma de Visitas de Salud Mental Infantil a Casa. Dieciséis progenitores participaron en la evaluación anterior y posterior a la examinación con el fin de evaluar los cambios en el funcionamiento reflexivo de los padres y las interacciones con su niño. Los resultados sugieren mejoramientos en la sensibilidad de los progenitores, el afecto positivo y el funcionamiento reflexivo, con efectos moderados. Los progenitores de más alto riesgo demostraron cambios significativos en el funcionamiento reflexivo comparados con aquellos de más bajo riesgo. Estos resultados contribuyen y apoyan los estudios impresos acerca de la efectividad de los equipos judiciales para casos de infantes y niños pequeños, los cuales incluyen servicios basados en la relación y fundados en la comprensión del trauma.

Cet article décrit une équipe au tribunal des bébés-jeunes enfants dans l'état américain du Michigan, une approche de recherche participatoire basée sur la communauté au sujet de l'évaluation de la mise en œuvre et les changements résultants dans le parentage. Comme les autres tribunaux le Tribunal pour Bébés du Michigan est dirigé par un juriste qui s'informe à partir de données scientifiques. Tous les prestataires de service sont au fait des besoins en matière de développement des jeunes enfants, et ils procèdent à une communication collaborative tout au long du cas. Un traitement basé sur la relation sous la forme de Visites à Domiciles de Santé Mentale du Nourrisson a été offert aux familles. Seize parents ont participé à des visites d'évaluation pré- et post-test afin d'évaluer les changements dans le fonctionnement de réflexion des parents et dans les interactions avec leur enfant. Les résultats suggèrent des améliorations dans la réaction des parents, l'affect positif et le fonctionnement de réflexion, avec des effets modérés. Les parents au risque le plus élevé ont fait preuve de changements importants dans le fonctionnement de réflexion par rapport à ceux qui étaient à moindre risque. Ces résultats s'ajoutent aux recherches limitées sur l'efficacité des équipes de tribunal pour nourrisson-jeune enfant (qui comportent les services basés sur la relation et les services basés sur le trauma) et les soutiennent.

CONTEXTUAL ISSUES FOR IMPLEMENTATION AND EVALUATION OF HOME-VISITATION PROGRAMS FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES: AN INTRODUCTION TO THE TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

Home-visiting programs have become a key component of evidence-based services for pregnant women, new mothers, their infants, and their families. When Congress authorized the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) in 2010, it set aside 3% of the $1.5 billion in funding to support home-visiting programs operated by tribes, Tribal MIECHV programs have been funded in 14 states and have served over 3,100 families, providing nearly 55,000 home visits to families at risk for poor child, maternal, and family outcomes. In this Introduction to the Special Issue of the Infant Mental Health Journal on the Tribal MIECHV initiative, we provide some key contexts of the work of the Tribal MIECHV grantees as well as an overview of the issues covered in the other articles.

[Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders]. / Elterliche Mentalisierungsfähigkeit und der Zusammenhang mit elterlicher Belastung bei frühkindlichen Regulationsstörungen.

Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders Parents' capacity to reflect on their child as a mental agent, is defined as an important competence for the early parent-infant relationship. One way to operationalize this is parental reflective functioning (PRF) that distinguishes between mentalizing and non-mentalizing modes of reflection. Until today PRF has not been investigated in samples of infants/toddlers with early regulatory disorders. Goal of the present study is to investigate PRF by comparing a clinical group with parents of infants/toddlers with early regulatory disorders (N = 98) with a healthy control group (N = 27) and testing if PRF is related to parenting stress, past mental illness of the mother, and stress factors related to pregnancy and birth. A semi-structured clinical interview, the Parenting Stress Index, the Symptom-Check-List-90R-S, the Parental Reflective Functioning Questionnaire, and an anamnestic questionnaire were used. Compared to the control group, mothers of infants/toddlers with early regulatory disorders reported significant more prementalizing. Prementalizing in the total sample was significantly predicted by parenting stress, accounting for 16.3 % of the variance. None of the other independent variables significantly predicted prementalizing. Results are discussed in relation to early regulatory disorders and implications for clinical practice.

MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM.

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

[Treatment of parent-adolescent conflicts with the therapy program for adolescents with disturbances of self-esteem, performance and relationships (SELBST) ­ concept and results of a pilot study]. / Behandlung von Eltern-Jugendlichen-Konflikten nach dem Therapieprogramm für Jugendliche mit Selbstwert-, Leistungs- und Beziehungsstörungen (SELBST) ­ Konzeption und Ergebnisse einer Pilotstudie.

Objective: Parent-adolescent conflicts often comprise the reasons for the referral of adolescents in treatment facilities. However, studies on the effects of behavioral interventions with this indication are rarely published, even in the international literature. In an explorative study, we assessed the efficacy and the acceptance of systemic-behavioral treatment modules of the treatment program for adolescents with disturbances of self-esteem, performance and relationships (SELBST). Method: Ten adolescents aged 12 to 18 years (mean age 14,7 years) and their parents with severe parent-adolescents conflicts according to clinical judgment and with increased parent and adolescent ratings of conflicts on the Conflict-Behavior-Questionnaire-Cologne were included in the study. Results: Analyses of pre to post changes showed a reduction in conflicts and/or an increase in conflict-solving skills as rated by the parents on various outcome measures. However, parents had problems attending the family sessions regularly and to implement therapeutic tasks in the daily family routine which may have limited the effects of the intervention. Conclusions: There is preliminary evidence that SELBST is a useful program for the treatment of parent-adolescent conflicts. To further increase the effectiveness of the program, knowledge from this trial has been considered in the development of the manual.

[Grief in Children und Adolescents as a Result of Acute Traumatization]. / Trauer bei Kindern und Jugendlichen als Folge von akuter Traumatisierung.

Grief in Children und Adolescents as a Result of Acute Traumatization Specifities of grief in children after trauma will be presented as well as potential reactions to acute traumatization and resulting needs of children and adolescents in order to discuss adequate interventions.

SUBSTANCE-ABUSING PREGNANT WOMEN: PRENATAL INTERVENTION USING ULTRASOUND CONSULTATION AND MENTALIZATION TO ENHANCE THE MOTHER-CHILD RELATIONSHIP AND REDUCE SUBSTANCE USE.

Substance-abusing pregnant and parenting women are considered one of the most challenging, but important, target groups for developing early parenting interventions. Some valuable efforts to develop such interventions have been made in the organizational sector in Finland. However, there is a great need for new ways of work that would simultaneously concentrate in substance-abuse treatment and enhance parenting in public healthcare settings. The present article describes the background, content, and protocol of a new prenatal intervention developed for substance-abusing pregnant women in a hospital setting in public healthcare. The intervention includes two new elements and pathways aimed to enhance the mothers' curiosity toward her developing child and provide motivation to stay abstinent from substance use. The pathways are interactive ultrasound consultation and a new pregnancy diary, both using a parental mentalization focus. The intervention elements, experiences from running the intervention, evaluation protocol, and general characteristics of the study sample gained (n = 90) are described and discussed. Two case vignettes from the study sample are presented, and the applicability of this prenatal work with other groups and settings is considered.

[Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care]. / Auswirkungen von strukturellen Interventionen auf wiederholte kritische Ereignisse in der stationären Kinder- und Jugendpsychiatrie.

Effects of Ward Interventions on Repeated Critical Incidents in Child and Adolescent Psychiatric Inpatient Care. The aim of this study was to evaluate the effects of several ward interventions (transition to an open ward concept, individualized treatment plans, tiered crisis-management, staff training, quality control) on repeated critical incidents, non-restrictive and restrictive measures. The outcome variables were compared in two time periods, 2007 and 2011. The study included 74 critical incident reports of 51 child and adolescent inpatients that had at least one hospital stay and one critical incident in the selected time periods. Aggressive, self-harming, and absconding incidents were included. The quantitative results suggest that ward interventions can contribute to a reduction of repeated critical incidents and restrictive measures. The qualitative evaluation suggests a cultural change of crisis management.

[Is it beneficial to involve family member? A literature review to psychosocial interventions in family-centered nursing]. / Ist es hilfreich, Famiilienmitglieder einzubeziehen? Eine Literaturübersicht zu psychosozialen Interventionen in der familienzentrierten Pflege.

BACKGROUND: Families influence the wellbeing of patients and are influenced by illness themselves. Involving caregivers in patient care was examined in multiple studies. AIM: The aim of this literature review was to investigate the different approaches to family-centered interventions (FI) and to evaluate the tested outcomes as well as the detected effect sizes. METHODS: This search for a systematic literature review of randomized controlled trials and metaanalyses revealed three Meta Analyses with studies until 2007 and six randomized controlled studies from 2007 to 2012. RESULTS: FI showed small to middle positive effects on the outcomes depression, mental health, anxiety of patients and family members and on caregiver burden. A conclusive effect on physical health could not be shown. The results strongly depend on the enrolled patient population, the targeted participants of FI, as well as the focus, type and dose of FI. The studies showed vast differences in the length and type of intervention, the target population and the selection of outcomes. Comparing outcomes was difficult due to the use of different outcome measures. CONCLUSION: Further research with various populations, different FI intensity but with same, valid outcome measures is needed.