ABSTRACT
Background: Rigorous research trials have demonstrated that early childhood interventions can reach socially disadvantaged families and can have a lasting impact on the healthy development of their children. However, little is known about the internal and contextual factors that contribute to the long-term implementation of such interventions. In this study, we investigated the development of the home visiting program Pro Kind. The program was adapted from the evidence-based US-American Nurse-Family Partnership program and was implemented in Germany in 2006. Using an exploratory approach, we examined factors contributing to the long-term implementation of this program. Methods: Qualitative interviews with program implementers (midwives, social workers, program managers) of the Pro Kind program and key stakeholders in two cities in Germany were conducted. Interview guides were developed to assess participants' perceptions and experiences on how the program had developed over time internally and in the interaction with its environment. Data were collected between March and September 2021. Drawing on the Consolidated Framework for Implementation Research (CFIR), data was coded according to the principles of thematic analysis. Results: A total of 25 individuals (11 program implementers, 14 key stakeholders) were interviewed. The identified factors related to three out of five domains of the CFIR model in our analysis. First, regarding the intervention characteristics, the evidence of effectiveness and the relative advantage of the implementation of the program compared to similar interventions were viewed as contributors to long-term implementation. However, the program's adaptability was discussed as a constraining factor for reaching the target group. Second, concerning the inner setting, stakeholders and program implementers perceived the implementation climate, the leadership engagement and the program's size as relevant factors for networking strategies and program visibility. Third, as part of the outer setting, the degree of networking with external stakeholders was highlighted of great importance for the program. Conclusions: We identified several factors of particular importance for the long-term implementation and sustainability of an early childhood intervention at the practice level, particularly in the local context in Germany. These findings should inform the design of impactful, scalable, and sustainable early childhood interventions targeting disadvantaged families.
ABSTRACT
Impact of Intimate Partner Violence on Child's Cognitive Development - Results from the Evaluation of the Home Visiting Program "Pro Kind" Intimate partner violence (IVP) is a socially relevant problem area of high prevalence. Direct or indirect IVP leads to well documented problems in child socioemotional development. Longitudinal studies on influences of IVP on child's cognitive development are rare. The present study adds to close this gap. We analyze data from n = 535 families living under psychosocial risk conditions. All families took part in the evaluation of the home visiting program "Pro Kind". We administered one item of a parent questionnaire to assess the occurrence of IVP. The child's cognitive development is assessed at the ages of 6, 12, and 24 months of age with the Bayley Scales-II. We test the hypothesis that IVP to the mother causally affects early cognitive development of children in a structural equation model with Cross-Lagged-Panel design. The results show a causal influence of IVP on child's cognitive development during the period from t3 (12 months of child's age) to t4 (24 months of child's age). The explanatory power of results is limited by methodological problems, e. g. the operationalization of IVP with only one item and a high panel mortality. Implications for early prevention and intervention of IVP are derived.
Subject(s)
Child Development , Child of Impaired Parents/psychology , Cognition , House Calls , Intimate Partner Violence/psychology , Mothers/psychology , Child, Preschool , Female , Humans , Infant , Longitudinal StudiesABSTRACT
Factors Influencing Theory of Mind Development in Preschoolers within the Context of Early Interventions The Theory of Mind (ToM) competency is closely related to the child's cognitive, language, and socio-emotional development. In early interventions, skills and developmental processes associated with ToM development are often primary intervention targets, but empirical support for direct or indirect influences of early interventions on ToM development is missing so far. Within the home visiting program "Pro Kind" N = 755 families were accompanied by professionals from the last trimester of pregnancy until the child's second birthday. In the present follow-up study we investigated influences of treatment, pre- and postnatal family environment, parental competencies and child competencies on the ToM ability in a sample of n = 39 five-year-old children using Ctree analyses. Prenatal and current parental stress as well as an enriched family learning environment, and children's language competencies in interaction with temperament significantly predicted ToM competency. The treatment had no direct influence on ToM development. Thus, the results argue for the urgent need to address maternal stress regulation and mentalizing competencies in early interventions during pregnancy, as well as to focus on promoting positive stimulating learning environments and language development after the child's birth.
Subject(s)
Early Intervention, Educational , Personality Development , Theory of Mind , Child, Preschool , Emotional Adjustment , Female , House Calls , Humans , Infant , Infant, Newborn , Language Development , Longitudinal Studies , Male , Mother-Child Relations/psychology , Pregnancy , Risk Factors , Socialization , Stress, Psychological/complications , Stress, Psychological/psychologyABSTRACT
BACKGROUND: Pro Kind is a German adaptation of the US Nurse Family Partnership program. It is an intervention based on home visits targeting first-time mothers from disadvantaged populations. Pro Kind was implemented as a randomized control trial from 2006 to 2012 with N = 755 first-time mothers (TG n = 394, CG n = 391). The 7-8-year follow-up aims to assess the mid-term effects of the program. METHODS/DESIGN: Mid-term outcomes are being assessed by trained assessors. In a multimethod approach telephone interviews, on-site interviews, observations and developmental tests will be held in order to assess children's and mothers' life satisfaction, mental health, cognitive and social development, parenting behavior, signs of child abuse or neglect as well as the family's socio-economic status. Furthermore, administrative data will be accessed to obtain information regarding the mother's usage of pediatric health care, welfare usage and employment history. DISCUSSION: Results regarding the mid-term effects of the intervention from the Pro Kind Follow-up will provide a scientific basis for future primary prevention programs as well as help stakeholders legitimizing early childhood investments. TRIAL REGISTRATION: German Clinical Trial Registration DRKS-ID, ID: DRKS00007554 . Registered on 11 June 2015, updated on 6 October 2017.
Subject(s)
Child Behavior , Child Development , Education, Nonprofessional/methods , Home Care Services , House Calls , Mothers/psychology , Nurses, Community Health , Parenting/psychology , Age Factors , Child , Female , Germany , Health Status , Housing , Humans , Male , Maternal Health , Mental Health , Mother-Child Relations , Patient Acceptance of Health Care , Poverty , Randomized Controlled Trials as Topic , Social Support , Time Factors , Vulnerable PopulationsABSTRACT
We evaluate the effects of home visiting targeted towards disadvantaged first-time mothers on maternal and child health outcomes. Our analysis exploits a randomized controlled trial and combines rich longitudinal survey data with unique administrative health data. In a context in which the target group has comprehensive health care access, we find no effects of home visiting on most types of health utilization, health behaviors, and physical health measures. However, the intervention has a positive effect on some maternal mental health outcomes, reducing depression reported in the survey data by eleven percentage points and prescription of psycholeptics recorded in the administrative data by seven percentage points.
Subject(s)
Child Health , Health Status , House Calls , Maternal Health , Program Evaluation/methods , Adolescent , Child Health/statistics & numerical data , Child, Preschool , Female , Health Care Surveys , Humans , Infant , Maternal Health/statistics & numerical data , Mental Health , Postnatal Care , Young AdultABSTRACT
Based on the US Nurse-Family Partnership (NFP) program, the German home visiting program "Pro Kind" offered support for socially and financially disadvantaged first-time mothers from pregnancy until the children's second birthday. A multi-centered, longitudinal randomized controlled trial (RCT) was conducted to assess its effectiveness on mothers and children. A total of 755 women with multiple risk factors were recruited, 394 received regular home visits (treatment group), while 361 only had access to standard community services (control group). Program influences on family environment (e.g., quality of home, social support), maternal competencies (e.g., maternal self-efficacy, empathy, parenting style), and child development (e.g., cognitive and motor development) were assessed from mothers' program intake in pregnancy to children's second birthday based on self-reports in regular interviews and developmental tests. Generalized estimating equations (GEE) models showed small, but significant positive treatment effects on parental self-efficacy, and marginally significant effects on social support, and knowledge on child rearing. Maternal stress, self-efficacy, and feelings of attachment in the TG tend to show a more positive development over time. Subgroup effects were found for high-risk mothers in the TG, who reported more social support over time and, generally, had children with higher developmental scores compared to their CG counterparts. Post hoc analyses of implementation variables revealed the quality of the helping relationship as a significant indicator of treatment effects. Results are discussed in terms of implementation and public policy differences between NFP and Pro Kind.
Subject(s)
Child Development , Family , House Calls , Adult , Child , Female , Humans , Pregnancy , Young AdultABSTRACT
Parents' commitment to and usage of early intervention are key variables in understanding discrepancies in families' susceptibility to these services. Although the important role of fathers in infant development is widely recognized, early interpersonal predictors of paternal involvement in home-visiting programs have been understudied. This article aims to fill this gap by regressing parents' postnatal involvement on prenatal partnership satisfaction and quality of the helping relationship in a sample of 124 socially and financially disadvantaged families. Paternal program engagement was predicted by partnership satisfaction whereas the perceived quality of the helping relationship best predicted maternal program engagement, with demographical characteristics controlled. Maternal program engagement also mediated the relationship between partnership satisfaction and paternal program engagement. The results are discussed against the theoretical background.
ABSTRACT
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.
Subject(s)
Child Abuse/prevention & control , Early Intervention, Educational/trends , Intention , Psychosocial Deprivation , Quality Assurance, Health Care/trends , Adolescent , Child , Child Abuse/trends , Child, Preschool , Cooperative Behavior , Education/trends , Forecasting , Germany , Health Plan Implementation/trends , Health Planning/trends , Humans , Infant , Interprofessional Relations , Patient Care Team/trends , Risk Factors , Social SupportABSTRACT
OBJECTIVE: Erythropoietin has been reported to possess neuroprotective properties in animal studies. No previous studies have investigated the neurodevelopmental outcome of extremely low birth weight (ELBW) infants treated with recombinant human erythropoietin (rEpo) and evaluated it at school age. METHODS: Of 200 ELBW infants treated from 1993 to 1998, 171 (86%) survived, and 148 (87%) were followed up to the age of 10 to 13 years. The neurodevelopmental and school outcome of the ELBW infants receiving rEpo treatment for stimulation of erythropoiesis in the first weeks of life (n = 89) was compared to that of untreated children (n = 57). To test for a neuroprotective effect of erythropoietin therapy, analyses of variance (ANOVAs) were conducted with erythropoietin treatment and intraventricular hemorrhage (IVH) as independent variables and Hamburg-Wechsler Intelligence Test for Children-III (HAWIK-III) intelligence quotient (IQ) scores as dependent variables. RESULTS: The rEpo group scored significantly better than untreated children in the overall developmental assessment (55% vs 39% normally developed, p < 0.05) as well as in the psychological examination (mean composite HAWIK-III IQ score, 90.8 vs 81.3, p < 0.005). The results of ANOVAs show that these differences were ascribable to children with IVH. Whereas those children with IVH treated with rEpo scored significantly better than untreated children (52% vs 6% normally developed, composite HAWIK-III IQ score, 90.3 vs 67.0), treated and untreated children without IVH did not differ in their outcome. The treatment and control groups were comparable in perinatal parameters relevant to prognosis. INTERPRETATION: The results of our observational study confirm the hypothesis of a neuroprotective effect of rEpo in ELBW infants with IVH. This offers a promising preventative therapeutic option for the treatment of these high-risk infants.
Subject(s)
Developmental Disabilities/drug therapy , Erythropoietin/therapeutic use , Infant, Extremely Low Birth Weight/physiology , Infant, Premature, Diseases/drug therapy , Adolescent , Age Factors , Analysis of Variance , Chi-Square Distribution , Child , Developmental Disabilities/diagnostic imaging , Developmental Disabilities/mortality , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnostic imaging , Infant, Premature, Diseases/mortality , Intelligence Tests , Longitudinal Studies , Male , Nervous System Diseases/drug therapy , Nervous System Diseases/etiology , Neuropsychological Tests , Recombinant Proteins , Treatment Outcome , Ultrasonography/methodsABSTRACT
Visual stimulation by repetitive flashes of light can lead to an entrainment of the alpha rhythm in electroencephalogram recordings (also called photic driving). We report a comparison of simultaneously recorded electric and magnetic data in a photic driving experiment, adapted to the individual alpha rhythm of 10 healthy volunteers. We show that there is a stronger frequency entrainment in magnetoencephalogram than in electroencephalogram recordings in all volunteers, which indicates a possible tangential brain activity underlying the dominant entrainment effect. The entrainment in the magnetoencephalogram lasts over significantly more frequencies and is most effective in the region around the individual alpha and a half alpha. For different channels, we found different degrees of entrainment showing topological and time-varying properties.
