Sekundäre Prävention im Kindes- und Jugendalter in Deutschland

[The School Entrance Examination: Attempted Evaluation by Interviewing Parents, Pediatricians and Schools]

INTRODUCTION

In Germany, school entry examinations (SEU) are mandatory in all (federal) states, the scope and methods of investigation are laid down in state ordinances. The SEUs are performed by the pediatric services (KJGD) of the public health departments. An evaluation of the entire SEU is still pending. Therefore, in 2018, an evaluation of the SEU was carried out in the health department of the city of Frankfurt am Main by interviewing parents, schools and pediatricians.

METHOD

With specifically developed questionnaires, parents as well as administrators of elementary schools and pediatricians were asked about their assessment of and their experiences with the SEU. Certain sentences were to be rated on a 5-point Likert scale. For the evaluation, the positive answers (totally agree / agree) and the negative answers (disagree / strongly disagree) were summarized.

RESULTS

A total of 2,021 parental, 46 school and 37 physician questionnaires were evaluated. The response rate of parents was 90%, that of schools and pediatricians 45% and 56%, respectively and thus significantly worse. Ninety-one percent of parents rated the SEU as useful in addition to their pediatrician check-ups, and 94% considered hearing and vision tests to be particularly important. Eighty-five percent considered the SEU as an important means of undertaking support measures before school entry. Ninety-one percent of school administrators rated the results of the SEU as helpful, 26% of them stated that key areas, including social behavior were given insufficient consideration in the SEU. Many school administrators wanted more support from the health department, e. g. inclusion issues (59%), parenting evening lectures (61%) or general health support (74%). Ninety-one percent of pediatricians also rated the SEU positively. However, misjudgments of the school doctors and uncertainty of the parents as well as rare exchanges/communication were criticized.

CONCLUSION

The overall feedback was positive and the significance of the SEU was not questioned. However, the KJGD should try to better meet the needs of schools for more support and pediatricians' desire for better cooperation. Through a modification of the SEU, capacities could be created for other important tasks of the KJGD, for instance the examination of school newcomers from foreign countries, health promotion in schools, and medical advice to schools.

[Pediatrician-parent interaction and early prevention : A review about the limits in addressing psychosocial risks during well-child visits]

BACKGROUND

Pediatricians can be a door opener to early prevention for families at risk. The German well-child program is well-established, but there is a gap between the structural possibilities and the observed placements.

OBJECTIVE

The aim of this review is to show how pediatricians and parents talk about psychosocial risks under the very structured conditions of well-child visits. The challenges and traps of the framed interactions will be described and options for early prevention will be shown.

METHODS

The review is primarily based on the work of conversational and ethnomethodological studies reconstructing the pediatrician's discussion with parents about psychosocial issues in the family.

RESULTS

Well-child visits are a highly routinized practice. Talking about family issues for both partners is a difficult task. Discussions about psychosocial issues are seldom and vague . Predominantly, they work cooperatively on reciprocal normalization of the child's development. Based on this shared orientation, pediatricians make an early, mostly general, prescription of parental tasks, supporting the child in the next developmental step. This kind of routine anticipatory counselling puts some pressure on the parents. Parents under unknown stress could be overburdened with this advice.

CONCLUSION

In the script of well-child visits, there are no slots that indicate to pediatricians and parents when, which, how and for what purpose psychosocial issues can be discussed and negotiated. For implementing such slots in well-child visits, three steps are necessary: a structured and regular assessment of psychosocial issues, a trained pediatrician in motivational interviewing and a social worker guiding the family in the network of early prevention.

[Case finding in early prevention networks - a heuristic for ambulatory care settings]

BACKGROUND

One goal of early prevention is the support of families with small children up to three years who are exposed to psychosocial risks. The identification of these cases is often complex and not well-directed, especially in the ambulatory care setting.

OBJECTIVE

Development of a model of a feasible and empirical based strategy for case finding in ambulatory care.

METHODS

Based on the risk factors of postpartal depression, lack of maternal responsiveness, parental stress with regulation disorders and poverty a lexicographic and non-compensatory heuristic model with simple decision rules, will be constructed and empirically tested. Therefore the original data set from an evaluation of the pediatric documentary form on psychosocial issues of families with small children in well-child visits will be used and reanalyzed.

RESULTS

The first diagnostic step in the non-compensatory and hierarchical classification process is the assessment of postpartal depression followed by maternal responsiveness, parental stress and poverty. The classification model identifies 89.0 % cases from the original study. Compared to the original study the decision process becomes clearer and more concise.

CONCLUSIONS

The evidence-based and data-driven model exemplifies a strategy for the assessment of psychosocial risk factors in ambulatory care settings. It is based on four evidence-based risk factors and offers a quick and reliable classification. A further advantage of this model is that after a risk factor is identified the diagnostic procedure will be stopped and the counselling process can commence. For further validation of the model studies, in well suited early prevention networks are needed.