Improving psychosocial services for vulnerable families with young children: strengthening links between health and social services in Germany

Correspondence to: I Renner [email protected]

In Germany, a priority within health and social care for over a decade has been improving parents’ interactions with and care for their children. This was in response to a large study in 2007 of children’s health and development¹ that identified 20% of children aged 3 to 17 years were at risk of a mental health disorder.² Furthermore, gaps in the child protection system were becoming obvious, with high profile cases of child neglect leading to public demand for urgent action. Burdened families were slipping through the net of social support and welfare and being driven towards susceptibility to negligent parenting and in worst cases child maltreatment.

Low socioeconomic status is closely linked to poor child health and development outcomes, as well as increased risk of adverse experiences in early childhood.³⁴ For example, in Germany, 26.0% of children living in families of low socioeconomic status show symptoms of mental health problems, compared with 9.7% of children in families with high socioeconomic status.⁵ Poverty is associated with a broad range of psychosocial burdens, including early parenthood and parental adverse childhood experiences.6 These problems might lead to lower parental capabilities, potentially acting as mediators for children’s poorer health and development, as well as higher risk for maltreatment.

Germany’s Early Childhood Intervention (ECI) programme, implemented in 2006, supports the goal of providing equal opportunities for all children to develop their full potential. Subsequent expansion has been driven by the increasing proportion of children living in families receiving social benefits, rising from 12.5% in 2011 to 14.6% in 2017.⁷ Despite overall prosperity and strong economic growth in Germany, the need for ECI is greater than ever.

The German programme (Frühe Hilfen) comprises prevention oriented, voluntary psychosocial services offered to all pregnant women and families with a child aged 0-3 years, with additional support for those in difficult circumstances. This approach is aligned with the evidence based Nurturing Care for Early Childhood Development Framework, launched during the 71st World Health Assembly in May 2018.⁸

One major challenge to improving psychosocial care for families is the “prevention dilemma”⁹; voluntary preventive services are used more by families with a lower level of need than by those who would...