Die Rolle freiberuflicher Hebammen in Netzwerken Frühe Hilfen: Eine quantitative, egozentrierte Netzwerkanalyse
Abstract
Regionale Vernetzung von Angeboten Früher Hilfen erhöht die Wahrscheinlichkeit für gesundes und sicheres Aufwachsen von Kleinkindern. Aus sozialökologischer Perspektive ist anzunehmen, dass Interaktionen im Netzwerk abhängig sind vom Kontext und persönlichen Merkmalen. Erstmalig genutzt wurde die egozentrierte Netzwerkanalyse, um interprofessionelle Vernetzung freiberuflicher Hebammen im Rahmen einer Lokalstudie standardisiert zu untersuchen. Daten von Hebammen und Adressatinnen wurden mit Mehrebenenanalysen und multiplen linearen Regressionen statistisch ausgewertet.
In the context of research on childhood sexual abuse (CSA), researchers face significant challenges due to the emotionally distressing nature of sensitive data (Williamson et al., 2020). The use of ChatGPT (OpenAI, 2023) offers valuable support in this area. This artificial intelligence (AI) tool facilitates efficient data processing while maintaining emotional distance by converting qualitative content into quantifiable formats. This approach not only aids in statistical analysis but also reduces the emotional burden on researchers (van Manen, 2023). The inter-coder reliability of this method has been evaluated and largely confirmed in various forms (Naranjos Velazquez, 2024; in press). In a comparative study, the results of AI models ChatGPT 3.5, ChatGPT 4 and ChatGPT 4o were analysed. Increased consistency was observed beginning with the ChatGPT 4 model, further highlighting the reliability of ChatGPT in processing sensitive information. This presentation explores the ethical and practical implications of AI use in research and discusses the limitations of this AI tool (Naranjos Velazquez, 2023 a ; in press).
ENGLISH BELOW: In Präsentation und Workshop wird eine Form der Netzwerkanalyse praxisorientiert vorgestellt: Egozentrierte Netzwerkanalyse. Es wird diskutiert, inwiefern diese quantitative Methode dabei hilft, ausgewählte Aufgaben im Praxisfeld Kita-Sozialarbeit messbar, sichtbar und damit konkret zu machen: Inwiefern dienen netzwerkanalytische Kennzahlen als Grundlage für strategische Entscheidungen im Rahmen neuer Konzepte für Kita-Sozialarbeit?
***ENGLISH***
In the presentation and workshop, a practical form of network analysis will be introduced: egocentric network analysis. The discussion will focus on how this quantitative method assists in making specific tasks in the field of daycare social work measurable, visible, and concrete. The extent to which network analytic metrics serve as a foundation for strategic decisions within the framework of new concepts for daycare social work will be explored.
Um Familien in belastenden Lebenslagen rund um die Geburt und in den ersten Lebensjahren des Kindes gezielter zu unterstützen, werden in Deutschland regionale Netzwerke Früher Hilfen seit über zehn Jahren verstärkt ausgebaut und gepflegt. Trotz vieler Bemühungen bleiben Herausforderungen bestehen, insbesondere bei der Vernetzung von Akteuren aus dem Gesundheitswesen und der Kin-der- und Jugendhilfe. Das KI-Tool ChatGPT bietet Möglichkeiten, diese Herausforderungen in Bezug auf Ressourcen und Kommunikation anzugehen, indem es Fachkräften Orientierungshilfe bietet und Sprachbarrieren überwindet. Allerdings sind ethische Aspekte und Limitationen bei der Nutzung von ChatGPT zu berücksichtigen. Ebenso ist eine kontinuierliche kritische Reflexion erforderlich.
Um Familien in belastenden Lebenslagen rund um die Geburt und in den ersten Lebensjahren des Kindes gezielter zu unterstützen, werden in Deutschland regionale Netzwerke Früher Hilfen seit über zehn Jahren verstärkt ausgebaut und gepflegt. Trotz vieler Bemühungen bleiben Herausforderungen bestehen, insbesondere bei der Vernetzung von Akteuren aus dem Gesundheitswesen und der Kin-der- und Jugendhilfe. Das KI-Tool ChatGPT bietet Möglichkeiten, diese Herausforderungen in Bezug auf Ressourcen und Kommunikation anzugehen, indem es Fachkräften Orientierungshilfe bietet und Sprachbarrieren überwindet. Allerdings sind ethische Aspekte und Limitationen bei der Nutzung von ChatGPT zu berücksichtigen. Ebenso ist eine kontinuierliche kritische Reflexion erforderlich.
To provide targeted support for families in stressful life situations around birth and during the first years of the child's life, regional Early Intervention Networks have been increasingly expanded and maintained in Germany for over a decade. Despite many efforts, challenges remain, particularly in connecting actors from the healthcare sector and child and youth welfare services. The AI tool ChatGPT offers potential solutions to address these challenges related to resources and communica-tion. It can provide professionals with guidance and help overcome language barriers by translating content into the primary language or simple language. However, ethical aspects and limitations in using ChatGPT must be considered, and continuous critical reflection is necessary.
Zusammenfassung
Kontaktbeschränkende Maßnahmen waren zur Eindämmung des SARS-CoV-2-Infektionsgeschehens ab Frühjahr 2020 in Deutschland notwendig. Jedoch stellten sie Familien, insbesondere Familien in Belastungslagen, vor besondere Herausforderungen. Der Beitrag geht der Frage nach, inwieweit sich die Coronapandemie bis zum Mai 2021 auf die Lebenssituation der Familien ausgewirkt hat und wie eine längerfristige Betreuung im Kontext der Frühen Hilfen fortgeführt werden konnte. Die Analysen basieren hauptsächlich auf einer qualitativen Studie mit psychosozial belasteten Müttern von jungen Kindern, 2 Befragungen von Gesundheitsfachkräften, die Familien in den Frühen Hilfen längerfristig unterstützen, sowie einer Befragung von kommunalen Akteuren, die für die Steuerung und Umsetzung der Frühen Hilfen in den Kommunen verantwortlich sind.
Psychosozial belastete Familien erleben existenzielle Ängste und eine generelle Überforderung in der Pandemie. Innerfamiliale Konflikte scheinen zuzunehmen. Die längerfristige Unterstützung durch die Frühen Hilfen wurde vom persönlichen Kontakt im häuslichen Umfeld vorrangig in die Distanz verlagert. Obwohl im Verlauf der Pandemie viele Fachkräfte wieder zum ursprünglichen Versorgungskonzept zurückkehrten, werden Elemente der „Hilfe auf Distanz“ weiterhin ergänzend eingesetzt.
Aufgrund der pandemiebedingten zusätzlichen Belastungen der Familien, die in den Frühen Hilfen begleitet werden, war die Fortführung der Unterstützung noch wichtiger als ohnehin schon. Die Formate einer „Hilfe auf Distanz“, die in der Pandemie notgedrungen erprobt wurden, könnten das Potenzial haben, die Hilfeleistungen der Gesundheitsfachkräfte in den Frühen Hilfen zu ergänzen und so zu einem Qualitätsentwicklungsschub beizutragen.
Background:
The necessity of outpatient postpartum care has increased due to shorter hospital stays. In a health care system, where postpartum care after hospital discharge must be arranged by families themselves, this can be challenging for those experiencing psychosocial disadvantages. Therefore, we compared characteristics of users of a midwifery network which referred women to outpatient postpartum care providers with those of women organising care themselves. Additionally, we investigated benefits of the network for women and health professionals.
Methods:
Evaluation of the services of a midwifery network in Switzerland. We combined quantitative secondary analysis of routine data of independent midwives with qualitative telephone interviews with users and a focus group with midwives and nurses. Descriptive statistics and logistic regression modelling were done using Stata 13. Content analysis was applied for qualitative data.
Results:
Users of the network were more likely to be: primiparas (OR 1.52, 95% CI [1.31-1.75, p < 0.001]); of foreign nationality (OR 2.36, 95% CI [2.04-2.73], p < 0.001); without professional education (OR 1.89, 95% CI [1.56-2.29] p < 0.001); unemployed (OR 1.28, 95% CI [1.09-1.51], p = 0.002) and have given birth by caesarean section (OR 1.38, 95% CI [1.20-1.59], p < 0.001) compared to women organising care themselves. Furthermore, users had cumulative risk factors for vulnerable transition into parenthood more often (≥ three risk factors: 4.2% vs. 1.5%, p < 0.001). Women appreciate the services provided. The collaboration within the network facilitated work scheduling and the better use of resources for health professionals.
Conclusions:
The network enabled midwives and nurses to reach families who might have struggled to organise postpartum care themselves. It also facilitated the work organisation of health professionals. Networks therefore provide benefits for families and health professionals.
Zusammenfassung
In dem Beitrag werden zentrale theoretische Begriffe sowie empirische Ergebnisse zu Netzwerkeffekten auf Gesundheit vorgestellt. Es werden die Wirkmechanismen soziale Unterstützung, soziale Integration, sozialer Einfluss und soziale Ansteckung diskutiert. Der Beitrag fordert die Unterscheidungen von (1) direkten vs. indirekten, (2) positiven vs. negativen Gesundheitseffekten durch (3) verschiedene Akteure oder Sektoren des Netzwerkes. Abschließend wird festgestellt, dass zu dieser differenzierteren Betrachtung von Netzwerkeffekten auf Gesundheit bisher nur wenig konsolidierte Evidenz existiert. Daraus ergibt sich die Forderung nach vermehrten Forschungsanstrengungen.
Zusammenfassung
Arbeitslosigkeit führt zu Beeinträchtigungen der physischen und psychischen Gesundheit.
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.
Im Auftrag des Nationalen Zentrums Frühe Hilfen (NZFH) hat das DIJuF gemeinsam mit Prof. Dr. Torsten Schaumberg (FH Nordhausen) und Prof. Dr. Harald Horschitz (Rechtsanwalt, HS Ludwigsburg) eine Rechtsexpertise rund um Fragen zum Einsatz von Familienhebammen und Familien-Gesundheits-und Kinderkrankenpflegerinnen und -pflegern erstellt. Hintergrund ist die gesetzliche Heimatlosigkeit dieses besonderen Brückenangebots zwischen Jugend- und Gesundheitshilfe, die nicht nur im Hinblick auf ihre Vergütungssituation immer wieder problematisch ist, sondern auch für die praktische Tätigkeit eine Vielzahl rechtlicher Fragestellungen aufwirft.
Die Expertise enthält drei Rechtsgutachten, eines zum Arbeits-, Sozialversicherungs- und Umsatzsteuerrecht, eines zum Sozialrecht sowie eines zum Haftungsrecht. Das Lydia Schönecker und Thomas Meysen haben die Herausgeberschaft für das Gesamtwerk übernommen.
Background:
Around 13 percent of families with newborns in Germany are in need of support from the early prevention networks. Cooperation between the professionals working in healthcare and social welfare is essential for improving children’s development opportunities. Freelance midwives are respected partners in the early prevention networks but there has been very little research on their view of this cooperation.
Aim:
The study analyses key behavioral concepts of midwives in the context of interprofessional cooperation and early prevention.
Method:
The qualitative study is based on 27 problem-centered interviews with freelance midwives in Germany. Access to the field was gained through posts on local mailing lists, adverts in professional midwifery journals, participation in conventions and by involving professionals acting as gatekeepers. The interviews were conducted based on a script, were digitally voice recorded and lastly transcribed. Data evaluation was carried out using a qualitative text analysis.
Results:
Establishing a relationship of trust between midwives and their clients was identified as the focal point for midwives’ cooperation in early prevention networks. This relationship shapes the working relations between midwives and clients as well as between midwives and child and outh welfare professionals. Some midwives build on the women’s trust in order to refer them to services provided by the Youth Welfare Office, others use it to set themselves apart from the latter.
Conclusion:
The key challenge of freelance midwives is to carve out their role as a cooperation partner within the networks of early prevention without undermining the trust of their clients. This requires a clear and comprehensible framework for all actors involved in these networks.
Keywords: Early prevention, freelance midwife, interprofessional cooperation, trust.
Available at:
https://www.egms.de/static/pdf/journals/zhwi/2017-4/zhwi000009.pdf
Objective:
To explore how midwives perceive patient preferences related to midwifery care in Germany.
Design:
This qualitative study, which was part of a larger study, used a hermeneutic-interpretive approach and involved focus group interviews with midwives. Data collection and analysis were done in a conjoined fashion between April 2015 and September 2016.
Setting:
Four focus group interviews were conducted in four different federal states of Germany.
Participants:
The sample of 20 qualified midwives was heterogeneous with regards to age, educational level, professional experience, type of midwifery care provided, and setting (employed, caseload, education) in which they provided services.
Findings:
Three main themes were identified: Strengths and limitations of midwives' present professional profile (midwives' area of responsibility, range of services, and competency); lack of midwives and midwifery services; women's experiences of conflict in interprofessional care. Each main theme is broken down into several aspects of content. Many women are not aware of the scope of professional knowledge and expertise of midwives. Moreover, the poor delineation of midwives' and obstetricians' areas of competency in Germany's hospitals seems to be disadvantageous for the women. Midwives feel that due to context implications they cannot live up to the quality of midwifery care they aspire to. Lack of midwives results in midwives being overwhelmed, women underserved, and both disappointed.
Conclusions/implications for practice:
On the one hand, new models of midwifery/maternity care need to be developed to solve some of the existing problems; on the other hand, new forms of interprofessional cooperation and management of transition of care points are required. Overall it is important that changes are implemented in such a way that women are enabled, and welcome, to clearly state their preferences for midwifery and maternity care. Particularly in Germany, tertiary education of midwives is needed to broaden their expertise and place them on an equal footing with obstetricians.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Introduction
Psychosocial resources of parents are vital for the health and development of their children. Families in stressful circumstances should receive early seamless care to strengthen their parental resources. Independent midwives provide ambulant postpartum care in most families in Switzerland, and hence could play an important role in the early assessment and care of families at risk.
Methods
Comprehensive routine data of Swiss independent midwives were used for secondary analysis. Frequencies of known psychosocial risk factors were derived and compared to other data sources. Group comparisons were made with respect to family characteristics and midwifery care.
Results
Only some of the considered risk factors are representable in the midwives‘ data. 18.6% of all families have one and 6.25% have multiple such representable risk factors. Immigrant mothers from developing and emerging countries, very young or older mothers and large families are thereby particularly often affected. Burdened families receive more home visits, but have a later onset of ambulant postpartum care. They suffer more often from breast-feeding problems and are more frequently referred to other disciplines.
Discussion
Independent midwives in Switzerland document some of the known psychosocial risk factors and adapt their care in routine practice. The collection of data with a better coverage of the known psychosocial risk factors, ideally using validated assessment instruments, is recommended, and further research is required for a more in-depth understanding of the current interdisciplinary collaboration and the needs of families and care providers.
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.
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.
Background: “Early Prevention” means the support of families with, or expecting, an infant whose living situation is overstraining their capacity to cope. In 2009, the legislative assembly of Saxony-Anhalt passed a law which calls for the constitution of “local networks for child protection” in each of its cities and counties. There is some evidence, however, that intersectoral cooperation between professionals of the health care system and the social services is a rather big challenge. Aim: The survey was intended to collect data on the knowledge and attitudes of free-lance midwives in Saxony-Anhalt regarding early prevention and child protection as well as their active participation in multi-professional and intersectoral networks of early prevention. This study is part of a larger one, which also included other professionals of the health care system. Methods: By means of an online survey, free-lance midwives were asked to respond to 12 sections of items referring to early prevention and child protection, mostly offering a four-point Likert-scale. Results: The subjective views of 42 midwives are presented. They were familiar with the concept of “early prevention”, but indicated a lack of knowledge pertaining to laws, data protection, regional support measures by institutions and professionals as well as local coordinators. They affirmed various measures to facilitate their active participation in the networks. Conclusion: Recommendations regarding regular provision of information, ongoing education, quality assurance, and future research are derived from the data.
Zusammenfassung
Es ist eine seit langem bekannte und vielfach belegte Tatsache, dass familiäre psychosoziale Belastungen das Risiko für Kindesmisshandlung und –vernachlässigung sowie für Verzögerungen der kindlichen Entwicklung erhöhen. Was jedoch noch fehlt, sind verlässliche, repräsentative Daten zur Prävalenz von psychosozialen Belastungen in Familien mit kleinen Kindern in Deutschland. Solche Daten werden dringend benötigt, da der bundesweite Auf- und Ausbau von Angeboten und Netzwerken Früher Hilfen mit politischen Initiativen auf allen föderalen Ebenen aktuell verstärkt vorangetrieben wird. Um die Hilfelandschaft effektiv zu gestalten, ist fundiertes Wissen um psychosoziale Belastungen von Familien kleiner Kinder dringend erforderlich. Nur so kann auf den Hilfe- und Unterstützungsbedarf von Familien – zum Wohle der Kinder - adäquat reagiert werden. Die Erforschung der Lebensbedingungen, in denen Säuglinge und Kleinkinder aufwachsen, stellt für die Forschung eine methodische Herausforderung dar, da psychosozial hochbelastete Familien eher schwierig für die Teilnahme an einer Studie zu gewinnen sind und die Fragen von den Studienteilnehmern potentiell als heikel wahrgenommen werden könnten. Die KiD 0-3 Prävalenzstudie wurde 2015 an Familien mit 0-3-jährigen Kindern durchgeführt und wird zum ersten mal einen systematischer Überblick über die Verteilung empirisch bestätigter Risikofaktoren in Deutschland geben.
Having the Best Intentions is Necessary but not Sufficient – Quality Dimensions for Early Childhood Interventions Early childhood interventions are a promising strategy to improve the development of children in socially disadvantaged families and to reduce their risk for abuse and neglect. However, proven effects are small with substantial variations between existing programs depending on differences in program planning and implementation. On the basis of international findings on the effectiveness of early childhood intervention, health promotion, and implementation research, we provide an overview of different quality aspects in the development, implementation, and evaluation of early childhood interventions, and a framework for future quality assessment of early childhood intervention programs in Germany. Scaling up of these programs should be accompanied by intensive quality assessment and development in order to achieve the intended outcomes.
Developmental Psychopathology is a multidisciplinary approach to the study of processes and mechanisms involved in the emergence of psychopathology. The editors of this volume have assembled leaders in the area currently working on some of the most thorny questions challenging this nascent field. Among the topics discussed are schizophrenia, autism, depression, eating disorders, and antisocial behaviour. This volume will have considerable appeal to researchers, graduate students, and clinicians alike. Being both child-focused and adult-focused, the volume should appeal to workers with life span orientations as well as to others working in a specific area of development.
Was versteht man unter sozialwissenschaftlicher Netzwerkforschung? Jan Arendt Fuhse liefert einen umfassenden Überblick über den aktuellen Stand und führt in einfachen Schritten und gut verständlich in das praktische Arbeiten ein. Dabei werden Empfehlungen für die Wahl von Methoden und Hinweise für die theoretische Interpretation gegeben, sowie vor häufigen Fehlern und Problemen gewarnt. Knappe Definitionen, Literaturempfehlungen und ein Glossar erleichtern die Orientierung im unübersichtlichen Dickicht der sozialen Netzwerke.
Das Konzept Blended Learning soll anhand eines Pilotprojektes im dualen Studium an der IUBH dargestellt und erläutert werden. Im Mittelpunkt des Artikels steht zum einen die Frage, wie das Blended Learning Konzept in der Praxis umgesetzt wurde und wie die einzelnen didaktischen Hilfsmittel von den Studierenden angenommen werden. Bisher wurde der Blended-Learning-Ansatz als Kombination von Selbststudium und Präsenzlehrveranstaltungen umgesetzt. Wir wollen anhand der Evaluierungsergebnisse für den Kurs „Grundlagen des Marketing“ ermitteln, wie die Studierenden mit dem Konzept zurechtkommen, wo sie Vorteile sehen und wo es Optimierungspotenzial zur Erhöhung der Zufriedenheit der Studierenden gibt. Außerdem zeigen wir langfristige Weiterentwicklungsmöglichkeiten des Blended Learning Modells auf.
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.
This qualitative study, conducted in Portugal, aimed to understand professionals' perspectives on the collaborative processes between the Early Childhood Intervention (ECI) and the Child Protection Systems. Participants in this study were 19 professionals from 7 Local Intervention Teams of the ECI system, including 8 professionals with coordinating roles. We conducted content analysis following semi-structured interviews. Participants described collaboration as the cooperation between professionals and services, aiming to improve intervention with children and families. Professionals argued that the main advantage of a collaborative relationship was the promotion of effective interventions. However, collaborative practices were mainly described as limited due to communication problems (e.g., insufficient, untimely). Finally, professionals suggested that limited time and resources were the greatest barriers to collaboration while close contacts and relationships among professionals were viewed as the main facilitators. Implications for practice and policy towards enhancing collaboration processes are discussed.
Hintergrund Wochenbettbetreuung findet überwiegend im ambulanten Sektor statt. Hebammen übernehmen den gesundheitlichen Versorgungsauftrag und begleiten junge Familien. Die Literaturstudie geht den Fragen nach, wie Hebammen ihre Betreuungsprozesse in der ambulanten Wochenbettbetreuung gestalten und welche Aspekte Einfluss auf die Arbeit haben. Methode Zur Darstellung der Studienlage wurde eine systematische Literatursuche durchgeführt. Einbezogen wurden Studien, die die Perspektive von Hebammen zu ihrer Tätigkeit in der ambulanten Wochenbettbetreuung integrieren. Diese wurden auf Grundlage einer thematischen Analyse ausgewertet. Ergebnisse Neben der Beobachtung des gesundheitlichen Wohlbefindens von Mutter und Kind stehen psychosoziale Aspekte sowie die professionelle Begleitung und Beratung zu Fragen rund um die neue Lebenssituation als Familie im Vordergrund der Wochenbettbetreuung. Hebammen fühlen sich nicht immer ausreichend in dem Umgang mit komplexen psychosozialen Problemen vorbereitet und wünschen sich mehr Wissen sowie einen besseren Zugang zu Informationen. Neben zeitlichen Einschränkungen beeinflussen Kontinuität sowie unterschiedliche Betreuungsstrategien die Arbeit. Diskussion Die ambulante Wochenbettbetreuung stellt sich als komplexes Handlungsfeld in einer wichtigen Lebensphase von Frauen und Familien dar. Neben der Möglichkeit der Gewährleistung von Betreuungskontinuität sind entsprechende Wissensbestände und Fertigkeiten der Hebammen erforderlich. Fazit Die Entwicklung theoriegeleiteter Konzepte, eine Verbesserung der Aus- und Weiterbildungsprogramme sowie ein klar definierter Versorgungsauftrag können die berufliche Handlungspraxis von Hebammen unterstützen.
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.
Background
In the last 10 years, the systematic crosslinking and networking of offerings in community-based health promotion in different fields, and the personnel behind them, has seen growing significance in Germany. While several fields use online communities as a means of building and managing networks (e. g., for working in distributed teams), such systems aren’t yet common in the public health sector.
Objectives
We study an online community that aims to aid the networking of health promotion personnel, e. g., in the domains of early childhood intervention (Frühe Hilfen), health equity, and the prevention of addiction. Our goal is to identify the potential of online networking in the field.
Methods
In a qualitative interview study of experts in the field, we collected feasible ways to aid in critical work incidents. In quantitative surveys, users of the online community at hand rated usability and other motivational factors. Log file data assessed actual usage of different platform features.
Results
The results indicate that the target group’s primary demands are tools for the retrieval of high-quality information and for managing existing networks. High usability of the platform and beneficial organizational structures are requirements for broad usage. Under the current circumstances, users’ readiness to share their own documents and information is low.
Conclusions
We make recommendations on how to implement our findings and describe requirements for successful tapping of the described potentials.
Cambridge Core - Research Methods In Politics - Egocentric Network Analysis - by Brea L. Perry
Das umfassende Handbuch zur Beratung und Psychotherapie: 0-3 Jahre
Dieses Buch versammelt die renommierten deutschsprachigen Experten auf dem Gebiet. Durch die Ausweitung auf Kleinkinder wird der Bereich der frühen Kindheit von 0 bis 3 Jahren abgedeckt. Das Buch stellt nicht nur Beratungskonzepte dar, sondern auch darüber hinausgehende vertiefende psychotherapeutische Behandlungskonzepte.
- Im Handbuch werden auch die Grundlagen ausführlich dargestellt, sowohl was die körperliche und seelische Entwicklung des Kindes angeht, als auch korrespondierende Veränderungen und Belastungen in Partnerschaft und Familie.
- Im zentralen Teil des Buches werden die Probleme und Störungsbilder bei den 0-3-jährigen Säuglingen und Kleinkindern und die Interventionen dargestellt.
- Die unterschiedlichen Belastungen von Familien werden im Hinblick auf das Behandlungskonzept gesondert aufgegriffen.
- Zum Schluss werden auch präventive Konzepte dargestellt, die im immer wichtiger werdenden Bereich der sogenannten „Frühen Hilfen“ im deutschsprachigen Raum eine große Rolle spielen.
Geschrieben für Kinder- und Erwachsenen-Psychotherapeuten, Psychiater, Kinderärzte, Sozialpädagogen (z. B. in der Jugendhilfe), Psychologen (z. B. an Beratungsstellen), Hebammen, Familienhelfer, Studierende.
Das Praxisbuch, das jede Fachfrau, jeder Fachmann zur Hand haben sollte, wenn es um die Unterstützung von Säuglingen und Kleinkindern sowie deren Familie geht
A variety of conceptualizations of the relationship between therapist and client, as well as the impact the quality of this relationship has on the client, are reviewed. Different hypotheses about bow the alliance might influence therapeutic progress are also presented. The review pays attention to both the historical and conceptual dimensions of this issue, and provides a summary of the empirical bases of the claims made of the value of a good alliance. The article concludes with a discussion of an integrated model of the alliance and a discussion of the clinical and training implications of our current understanding of this concept. © 1995 John Wiley & Sons, Inc. J Clin Psychol/In Session 56: 163–173, 2000.
Mehrere Jahre hat ein Expertengremium unter Beteiligung namhafter Hebammenwissenschaftlerinnen Masnahmen
zur Gesundheitsforderung vor, wahrend und nach der Geburt erarbeitet. Im Februar 2017 wurde als Konsens
das Nationale Gesundheitsziel „Gesundheit rund um die Geburt und im ersten Lebensjahr“ dem Deutschen
Bundestag ubergeben. Nun ist es entscheidend, dass die Empfehlungen bekannt gemacht und umgesetzt
werden.
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.
In this completely revised edition of one of the foundational texts of network sociology, Harrison White refines and enlarges his groundbreaking theory of how social structure and culture emerge from the chaos and uncertainty of social life. Incorporating new contributions from a group of young sociologists and many fascinating and novel case studies, Identity and Control is the only major book of social theory that links social structure with the lived experience of individuals, providing a rich perspective on the kinds of social formations that develop in the process. Going beyond traditional sociological dichotomies such as agency/structure, individual/society, or micro/macro, Identity and Control presents a toolbox of concepts that will be useful to a wide range of social scientists, as well as those working in public policy, management, or associational life and, beyond, to any reader who is interested in understanding the dynamics of social life.
Online-Erhebungen werden in der empirischen Sozialforschung zunehmend eingesetzt. Sie sind kostengünstig, lassen sich schneller und mit größeren Stichproben durchführen und bieten zahlreiche Qualitätsvorteile. Zudem vereinfachen internetbasierte Befragungen die Integration von offenen und standardisierten Fragen und erlauben auf diese Weise die Erfassung von Motiven, Bedeutungen, Begründungen und subjektiven Sichtweisen. Diese Vorteile machen sie auch für den Einsatz im Rahmen von Evaluationen interessant. Teure Transkriptionen entfallen, so dass die Durchführung von Mixed Methods-Erhebungen erleichtert wird.
Dieses Buch gibt eine detaillierte und praxisnahe Einführung in die Konzeption, Durchführung und Auswertung von Online-Befragungen mit Mixed Methods. Bezüge zu den Standards für Evaluation der Gesellschaft für Evaluation (DeGEval) helfen, die Qualität eigener Evaluationen zu erhöhen, und eine Checkliste hilft bei der praktischen Umsetzung.
Obiectives: To update the 1993 report from the Canadian Task Force on the Periodic Health Examination (now the Canadian Task Force on Preventive Health Care) by reviewing the evidence for the effectiveness of interventions aimed at preventing child maltreatment described in the scientific literature over the past 6 years. Options: Screening: a variety of techniques including assessment of risk indicators. Prevention: programs including home visitation; comprehensive health care programs; parent education and support, combined services and programs aimed specifically at preventing sexual abuse. Outcomes: Occurrence of one or more of the subcategories of physical abuse, sexual abuse, neglect and emotional abuse in childhood. Evidence: MEDLINE, PSYCINFO, ERIC and several other databases were searched, experts were consulted, and published recommendations were reviewed. Original research articles and overviews that examined screening for or prevention of child maltreatment were included in the update. No meta-analysis was performed because the range of manoeuvres precluded comparability. Benefits, harms and costs: Because of the high false-positive rates of screening tests for child maltreatment and the potential for mislabelling people as potential child abusers, the possible harms associated with these screening manoeuvres outweigh the benefits. Two randomized controlled trials showed a reduction in the incidence of childhood maltreatment or outcomes related to physical abuse and neglect among first-time disadvantaged mothers and their infants who received a program of home visitation by nurses in the perinatal period extending through infancy. It is expected that a reduction in incidence of child maltreatment and other outcomes will lead to substantial government savings. Evidence remains inconclusive on the effectiveness of a comprehensive health care program, a parent education and support program, or a combination of services in preventing child maltreatment. Education programs designed to teach children prevention strategies to avoid sexual abuse show increased knowledge and skills but not necessarily reduced abuse. Values: The systematic review and critical appraisal of the evidence were conducted according to the evidence-based methodology of the Canadian Task Force on Preventive Health Care. Recommendations: There is further evidence of fair quality to exclude screening procedures aimed at identifying individuals at risk of experiencing or committing child maltreatment (grade D recommendation). There is good evidence to continue recommending a program of home visitation for disadvantaged families during the perinatal period extending through infancy to prevent child abuse and neglect (grade A recommendation). The target group for this program is first-time mothers with one or more of the following characteristics: age less than 19 years, single parent status and low socioeconomic status. The strongest evidence is for an intensive program of home visitation delivered by nurses beginning prenatally and extending until the child's second birthday. There is insufficient evidence to recommend a comprehensive health care program (grade C recommendation), a parent education and support program (grade C recommendation) or a combination of home-based services (grade C recommendation) as a strategy for preventing child maltreatment, but these interventions may be recommended for other reasons. There is insufficient evidence to recommend education programs for the prevention of sexual abuse (grade C recommendation); whether such programs reduce the incidence of sexual abuse has not been established. Validation: The members of the Canadian Task Force on Preventive Health Care reviewed the findings of this analysis through an iterative process. The task force sent the final review and recommendations to selected external expert reviewers, and their feedback was incorporated. Sponsors: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.
early intervention;mental retardation;children;genetic mechanisms;behavioral problems
Im Bereich der Fruhen Hilfen und im Kinderschutz sind fruhe und multiprofessionell angelegte Hilfen unerlasslich. Die dazu notwendige Kooperation von verschiedenartig strukturierten Institutionen und unterschiedlich qualifizierten Fachkraften gelingt eher, wenn die entsprechenden Vereinbarungen unabhangig von einem besonderen Einzelfall herbeigefuhrt und im weniger belasteten Alltag regelmasig praktiziert werden. Nur dann funktioniert die Zusammenarbeit auch bei extremen Fallen und die mitwirkenden Institutionen und Fachkrafte erleben die Kooperation als Hilfe und Absicherung und nicht als zusatzliche Komplikation. Voraussetzung fur eine derartige Entwicklung forderlicher Rahmenbedingungen vor Ort ist eine evidenzbasierte Kenntnis der Auswirkungen unterschiedlich strukturierter Kooperationsbeziehungen und Rahmenbedingungen. Dies erfordert empirisch basierte Datenerhebungen mit dem Ziel der Weiterentwicklung von lokalen Netzwerkstrukturen. Drei geeignete und leicht einsetzbare Instrumente bzw. Vorgehensweisen fur solche Erhebungen wurden entwickelt und an Beispielen erprobt.
Schlagworter
Fruhe Hilfen – Kinderschutz – Kooperation – Vernetzung
Prevention, intervention and child protection in early childhood essentially need well-established interdisciplinary systematic networking. Individual, heterogeneous and complex needs of families cannot be met by one profession alone. Successful cooperation of various institutions and professions is based on fixed arrangements and cooperation pathways. Networking has to be systematically established in everyday routine to be able to work in difficult emergency cases of child protection. Only well established cooperation is experienced as a support for the participants of the network and not as an additional complication. Prerequisite for such a development of favorable conditions is an evidence-based knowledge of the impact of different structures of cooperation, relations and conditions. This requires data collection with the aim of further empirically based development of local network structures. Three tools for such surveys have been developed and tested in the field.
Keywords
child protection – cooperation – early prevention and intervention – networking