Originalarbeiten / Original Articles. Skills Lab Pädiatrie: Stärken kommunikativer Fertigkeiten für das Gespräch mit psychosozial belasteten Familien / Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families.

Pediatric Skills Lab: Strengthening Communication Skills for the Conversations with Psychologically burdened Families To identify psychosocially burdened families early and motivate them to seek further assistance is a central aspect of pediatric preventivemedicine.The aim of the feasibility study was to develop the Pediatric Skills Lab to promote methods for identifying and addressing psychosocially burdened families, and to evaluate it. Thirteen primary care pediatricians participated in two trials of the Pediatric Skills Lab, an interdisciplinary developed two-part digital training.They answered questions regarding their work with psychosocially burdened families and their satisfaction with the Pediatric Skills Lab. Overall, there was a high level of satisfaction reported with the Pediatric Skills Lab. Specifically, the presentation of results on the effects of psychosocial stressors, the practical exercises, and the exchange with colleagues during the interactive webinar were highly praised. Criticisms included, for example, the short duration of practical exercises and the lack of sufficient examples and live demonstrations. The Pediatric Skills Lab is a training concept tailored to meet the existing needs. With widespread implementation, it could enhance psychosocial care provision. Consideration should be given to extending the duration of the training to allow formore practical exercises. Future studies building upon this feasibility study should examine the effects of the training. Additionally, ways to integrate the Pediatric Skills Lab into existing curricula formedical education should be explored.

Within- and between-session changes of in-session reflective functioning of mothers in dyadic parent-infant psychotherapy.

This study investigated if in-session reflective functioning (RF) of mothers improved between and within sessions of brief dyadic focused parent-infant psychotherapy (fPIP) for the treatment of regulatory disorders in infants.In-session RF was coded for 44 therapy sessions from N = 11 mothers randomly selected from a RCT on the efficacy of fPIP as part of secondary analyses. A new rating system distinguished self-focused and child-focused in-session RF. Cumulative ordinal regression models were applied to analyze the dynamics of in-session RF within and across sessions, controlling for word count of each statement.While in-session RF improved significantly within sessions, between-session RF improved significantly only in the second session compared to the first with a significant decrease observed in the last session. Child-focused in-session RF was significantly lower than self-focused in-session RF at the beginning of the sessions but improved significantly stronger than self-focused in-session RF during sessions.In-session RF (particularly in child-focused statements) can be regarded as a dynamic change process relevant within each session of dyadic fPIP. Improvements made on a session-by-session basis may not be maintained until the next session. Implications for practitioners and in-session RF research are discussed.

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

[Domestic violence and its psychological consequences during the COVID-19 pandemic-key findings from German-speaking countries]. / Häusliche Gewalt und ihre psychischen Folgen während der COVID-19-Pandemie ­ Zentrale Befunde aus dem deutschsprachigen Raum.

The impact of traumatic experiences on mental health during the COVID-19 pandemic has been insufficiently discussed in the German-speaking countries. Against this background, a working group of scientifically and clinically active colleagues was formed on behalf of the German-Speaking Society for Psychotraumatology (DeGPT). The aim of the working group was to summarize central research findings on the incidence of domestic violence and associated psychological distress during the COVID-19 pandemic in German-speaking countries and to discuss their implications. In addition, associations between pre-existing childhood trauma and psychological distress during the pandemic should be illuminated. The present narrative review was prepared for this purpose.The results of the studies conducted indicate high prevalences of domestic violence during the COVID-19 pandemic, which, however, predominantly correspond to pre-pandemic prevalences. Adults with current or pre-existing interpersonal traumatic experiences during childhood or adolescence reported increased psychological distress during the pandemic compared with adults without such experiences. A number of risk factors (e.g., female gender, lower frequency of social contacts) increased the risk of psychological distress and posttraumatic stress disorder symptoms during the pandemic. According to these findings, people with current or past interpersonal trauma exposure represent a vulnerable group with special support needs during pandemic contexts.

Transactional Relations between Child Functioning and Parenting Stress in the First Years of Life: A Longitudinal Study among Psychosocially Burdened Families.

INTRODUCTION: Previous research reported transactional relations between child functioning and parenting stress. There is limited evidence whether a transactional developmental model also fits children below the age of 12 months, especially in psychosocially burdened families. This study aims to test the fit of a transactional model during the first 3 years of life and examines whether the model differs between families with low and high psychosocial burden. METHODS: A total of 302 psychosocially burdened families were observed over 3 years at age 4, 12, 24, and 36 months. Child behavioral problems and parenting stress were assessed via self-report while psychosocial burden was assessed via external rating at baseline. Cross-lagged panel analysis was used to investigate the fit of a transactional model. RESULTS: A transactional model fitted the data significantly better (Δχ2 = 81.87, p < 0.001) than an autoregressive model reaching acceptable to good fit indices (CFI = 0.96, RMSEA = 0.09). The model indicated moderate stability within and reciprocal effects between child behavioral problems and parenting stress from age 12 to 36 months. From age 4 to 12 months, parenting stress predicted child behavioral problems but not vice-versa. Model fit indices and transactional relations did not substantially differ between families with low and high psychosocial burden, except for child effects on parenting stress during the first year of life, which were only evident in higher burdened families. CONCLUSION: Transactional relations among child and parent variables are evident in the first 3 years of life. Child effects in the first year of life may be restricted to highly psychosocially burdened families. Future research may focus on potential mediating variables such as parental sensitivity or contextual variables like significant life events. Targeted prevention strategies should be adapted to the level of psychosocial burden to account for the differing transactional relations.

Learning from mothers who received focused parent-infant psychotherapy for the treatment of their child's regulatory disorders.

OBJECTIVE: Gaining a deeper understanding of how focused parent-infant psychotherapy (fPIP) works by asking mothers about their experiences. METHOD: Purposeful sampling was used to select participants who before had participated in an RCT on fPIP. Nine mothers of infants with early regulatory disorders who had received fPIP were interviewed. Eight cases received full-protocol treatment, one case was a treatment drop-out. Semi-structured interviews were audio-recorded, transcribed verbatim and analyzed applying grounded theory methodology. RESULTS: Seven major categories evolved: (1) engaging in therapy while maintaining autonomy, (2) relating to an emotionally responsive therapist and resolving ruptures, (3) involvement of partners in therapy facilitates multiple perspectives, (4) understanding the meaning of the child's signals and increasing acceptance of difficult behaviors, (5) feeling supported by advice that is attuned to the families' needs, (6) insight into parental contributions to the child's problems and (7) feeling strengthened as a mother and recognizing one's own needs. CONCLUSION: Findings highlight which aspects of fPIP mothers find most helpful and most challenging. Aspects that compromised the change process seemed related to the specific needs of this population and therapeutic setting. The results may guide therapists and inspire future development in interventions for treating infant regulatory disorders.

[The Importance of Adaptive Treatment Strategies for Treatment Outcome in fSKEPT]. / Die Bedeutung adaptiver Behandlungsstrategien für den Therapieerfolg in der fokussierten psychodynamischen Säugling-/Kleinkind-Eltern-Psychotherapie.

The manualized focused infant/toddler-parent psychotherapy fSKEPT is a psychodynamic focal treatment of early childhood regulatory disorders, in which either a conflict-related or a personality functioning-related treatment focus is carried out. The aim of the study is to review the effectiveness of fSKEPT depending on two different therapeutic treatment focuses. For this purpose, n = 81 families who received fSKEPT were examined as part of secondary analyzes of a randomized controlled study. The therapeutic treatment focus did not predict the effectiveness for any of the examined target criteria (maternal psychological stress F(1,70) = 0.71, p = .401, maternal depression F(1,70) = 0.18, p = .678, infant regulatory symptoms F(1,70) = 0.11, p = .753, maternal self-efficacy F(1,70) = 0.038, p = .847, maternal reflective functioning F(1,50) = 0.56, p = .458). In a subsample of n = 33 families (40 % of the total sample) we tested whether the therapeutic interventions used in the therapy correspond to the treatment focus of the therapists. No significant difference was found between personality functioning-specific interventions (t(28) = 1.71, p = .099) and unspecific interventions (t(28) = 1.77, p = .087) when comparing the two treatment focus groups. In the conflict focus group significantly more conflict-specific interventions were used (t(28) = 2,71, p = .011). The results demonstrate the effectiveness of the focus concept of the fSKEPT treatment. The focus and the flexible individual adaptation of the interventions in the course of the treatment may help offering parents with different psychological vulnerabilities and ressources an equally effective treatment. In addition, the relevance of unspecific interventions and relationship-promoting aspects of the treatment are discussed.

The Efficacy of Brief Parent-Infant Psychotherapy for Treating Early Regulatory Disorders: A Randomized Controlled Trial.

OBJECTIVE: Early regulatory disorders (ERD) place considerable strain on the parent-infant relationship and are associated with high parental distress. Brief (4-session) psychodynamic-based focused parent-infant psychotherapy (fPIP) treats ERD by strengthening the quality of the parent-infant relationship. This randomized controlled trial investigates the efficacy of fPIP for treating ERD compared to standard pediatric care (treatment as usual [TAU]). METHOD: Participants were 154 mothers and infants from 4 to 15 months who met criteria for persistent excessive crying, sleeping disorders, feeding disorders, or regulation disorders of sensory processing and were randomly assigned to fPIP (n = 81) or TAU (n = 73). Assessments took place at baseline and at the end of treatment after 12 weeks. Primary outcomes were the infants' regulatory symptoms and remission rate. Secondary outcomes were parents' psychological distress, depression, parenting stress, maternal self-efficacy, parental reflective functioning, and observer-rated emotional availability. RESULTS: fPIP was superior to TAU in reducing infants' overall symptoms (p = .004, η2 = 0.05, CI = 0.01-0.12), night-waking disorders (p = .030, odds ratio = 3.12, CI = 1.21-9.22), and mothers' psychological distress (p = .000, η2 = 0.08, CI = 0.03-0.16) and depression (p = .002, η2 = 0.06, CI = 0.02-0.13). There was a trend suggesting that fPIP led to increased maternal self-efficacy and parental reflective functioning. CONCLUSION: Results underscore the efficacy of brief fPIP in significantly reducing symptoms in infants with ERD and their mothers. Generalizability is restricted to low psychosocial risk samples with highly distressed mothers and comorbid ERD with a predominance of night-waking disorders. CLINICAL TRIAL REGISTRATION INFORMATION: The Efficacy of a Brief Parent-Infant Psychotherapy for the Treatment of Early Regulatory Disorders: A Randomized Controlled Trial; https://www.drks.de/drks_web/; DRKS00005739.