Psychosocial support for mothers experiencing psychological stress in early childhood interventions: a mixed-methods evaluation in Austria

Psychosocial support for mothers experiencing psychological stress in early childhood interventions: a mixed-methods evaluation in Austria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial support for mothers experiencing psychological stress in early childhood interventions: a mixed-methods evaluation in Austria Tonja Ofner, Sophie Sagerschnig, Fiona Scolik, Philipp Schöch, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9136961/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Psychological stress during pregnancy and early motherhood is a major public health concern with significant implications for maternal wellbeing and early child development. Persistent stress during this period can adversely affect maternal mental health, parent–child interactions, and the developmental trajectories of infants. Early childhood intervention programs aim to provide preventive support to vulnerable families; however, systematic evaluations of psychosocial services embedded within these programs remain limited. Understanding how such services meet maternal needs and contribute to health outcomes is essential for informing service delivery and policy. This study evaluates two psychosocial services offered to mothers experiencing psychological stress in Tyrol and Vienna as part of the Austrian Early Childhood Intervention Program “Frühe Hilfen”. The study aimed to explore the needs of mothers participating in early childhood interventions and to assess the perceived benefits and challenges of two psychosocial services from the perspectives of both mothers and healthcare providers. Methods A summative evaluation using a mixed-methods design was conducted. Data were collected through focus groups and individual interviews with participating mothers and healthcare providers, complemented by standardized screening instruments to assess maternal mental health and wellbeing. Qualitative data were analyzed using content analysis to identify recurring themes, perceptions, and experiences, while quantitative screening data were analyzed descriptively to examine changes in maternal outcomes. Results Participating mothers valued the services for their low-threshold access, professional support, and flexibility. In Tyrol, mothers reported improvements in mental health and self-efficacy following participation in short-term psychotherapeutic interventions. In Vienna, group therapy sessions facilitated peer support, reduced feelings of isolation, and strengthened parenting confidence. The group setting enabled mothers to share experiences, build trust, and develop supportive networks. Improvements were also reflected in screening scores. At the same time, barriers such as language limitations and limited service capacity were identified. Conclusions Psychosocial services embedded within early childhood interventions can make an important contribution to perinatal and infant mental healthcare. The findings highlight the value of accessible psychosocial support for mothers experiencing psychological stress while identifying structural barriers that should be addressed to improve access and service capacity within the public health systems. early childhood intervention maternal mental health psychosocial services family support access barriers mixed methods evaluation Figures Figure 1 Figure 2 Contributions to the literature Psychological stress during early motherhood affects maternal wellbeing and child development and represents an important public health concern. Evidence on psychosocial services embedded within early childhood intervention programs remains limited. This study examines psychosocial services delivered within Austria’s Early Childhood Intervention Program Frühe Hilfen, drawing on the perspectives of both mothers and service providers. The findings highlight how accessible and flexible support—including short-term therapy and group-based services—can strengthen maternal wellbeing and peer support. The study also highlights barriers to access, such as language limitations and limited service capacity, which are important for public health service planning. Introduction Early childhood is a crucial period in development and recognizing the importance of early intervention, various initiatives have been developed worldwide. They often support families facing challenges, such as socioeconomic disadvantages, parental stress, or mental health issues (Jeong et al., 2021 ; VanLandeghem et al., 2002 ) and promote positive outcomes for young children (Lyons-Ruth et al., 2017 ; Mahoney & Filer 1996 ). Supporting maternal mental health in the early parenting period is a key public health priority, as maternal wellbeing strongly influences early child development and family functioning. Mental illness is the most prevalent complication related to pregnancy in Western countries, affecting about one in five mothers (Bauer et al., 2014 ; Howard et al., 2014 ; O'hara & Swain, 1996 ) and over one in ten fathers (Anding et al., 2016 ; Kim & Swain, 2007 ; O’Brien et al., 2017 ) during the perinatal period (Anding et al., 2015 ). Perinatal mental health is defined as the emotional wellbeing of parents and infants from conception to the first two years postpartum (Kowalenko et al., 2000 ). Significant stigma is associated with mental illness during this period, which can prevent individuals from seeking help. Peer support programs aid in mitigating stigma (Hölzle et al. 2024 ). Noonan et al. ( 2021 ) emphasize the importance of partner and family involvement in interventions for perinatal depression and anxiety and suggest that early childhood interventions should integrate family support to improve outcomes. The effectiveness and economic value of targeted early childhood interventions have been shown (Dodge et al., 2014 ; Peacock et al., 2013 ) and demonstrate the importance of investing in multifaceted programs tailored to local needs. One such comprehensive program is the Austrian Early Childhood Intervention Program “Frühe Hilfen”, a nationwide public health program supporting vulnerable families. This low-threshold approach includes regional networks that reach out to families seeking support and aim to enhance healthy environments for parents and their children (Antony et al. 2021 ; Schachner et al., 2017 ). The program offers a range of services, including home visits, counselling, and access to healthcare, tailored to meet the specific needs of each family (Antony et al. 2021 ). The most common primary professions of Frühe Hilfen family support workers are from the social sector, followed by the educational sector, nursing, and psychology or psychotherapy (Marbler et al. 2024 ). While Frühe Hilfen offers valuable support, the landscape of perinatal and infant mental health care in Austria has limitations. There are regional variations in support programs, the lack of specialization in perinatal mental health, the limited capacity of specialized psychiatric services, and the absence of comprehensive data and national standards (Kern et al., 2024 ; Zechmeister-Koss, 2023 ). The need for further programs is high among the families being supported by Frühe Hilfen. Most needed are clinical psychology and psychotherapy, however, only 68% of the families in need of such a service end up utilizing these supports (Marbler et al., 2024 ). Some services have also been implemented as part of Frühe Hilfen, these include two specific services for mothers with psychological stress, which were evaluated in this project: a short-term psychotherapeutic intervention from the “Gesund ins Leben” (translated into English as “Healthy start to life”) Frühe Hilfen network in Tyrol, and a therapeutic group called “Mutterseelen…gemeinsam” (translated into English as “Mothers’ souls together”) from the Frühe Hilfen network Vienna‐West. The Tyrolean Frühe Hilfen program offers five free sessions with psychotherapists specializing in perinatal mental health issues for families (not just mothers) with an unborn or baby up to one year old, experiencing mental health challenges related to childbirth/having a new child. “Mutterseelen...gemeinsam” is a pedagogical-therapeutic group organized by Frühe Hilfen in Vienna for mothers with mental illness and their babies. Led by a family midwife and a psychotherapist, the group of up to eight mothers and their babies/toddlers (up to 2 years old) meets weekly for two hours over a semester (20 sessions). While mothers with various mental illnesses are welcome, a diagnosis is not required for participation (Sagerschnig et al. 2024 ). The aim of this evaluation was to: Explore the needs and potential benefits of psychosocial services for mothers participating in early childhood interventions, and Generate in-depth insights into the perceived benefits of the two psychosocial services implemented in Tyrol and Vienna. We addressed the following research questions (RQ): RQ1: What factors influence the utilization of and satisfaction within the evaluated psychosocial services in Tyrol and Vienna? RQ2: What benefits are perceived from the evaluated psychosocial services from the perspectives of mothers and healthcare providers? Materials and Methods We used a summative evaluation with a mixed-methods approach, combining qualitative and quantitative data to comprehensively assess the psychosocial support services. Given the primarily descriptive nature of the quantitative component, the evaluation design for this paper can be described as a qualitatively driven mixed-methods design, in which quantitative findings serve a complementary and contextualizing function rather than a hypothesis-testing one (Creswell, J. W., & Clark, V. L. P., 2017). The quantitative component consisted of standardized measures of wellbeing and was analyzed descriptively to provide an indication of potential improvements over time. This design allowed us to capture both the experiential perspectives of mothers and service providers and complementary quantitative indicators of wellbeing, providing a comprehensive understanding of service effectiveness and informing improvements to psychosocial support within early childhood intervention systems. We follow the Reflexive Thematic Analysis Reporting Guidelines (RTARG) (Braun, V., & Clarke, V., 2024 ). While the quantitative data offer structured evidence of changes in wellbeing, the central aim of the study was to generate rich and nuanced accounts of participants’ views, experiences, and preferences regarding the services. The qualitative data therefore served as the main source for understanding how participants made sense of the support received or provided, what they perceived as beneficial, and where unmet needs remained. Integration occurred at the level of interpretation, where descriptive quantitative trends were considered alongside qualitative themes to explore convergence and to contextualize measured changes in wellbeing within participants’ lived experiences (Creswell, J. W., & Clark, V. L. P., 2017; Fetters, M. D., Curry, L. A., & Creswell, J. W., 2013). Data sources are presented side by side in the results section. The evaluation targeted diverse perspectives, including families and family support workers, ensuring a multifaceted understanding of service needs and utilization. This study was requested by employees of Frühe Hilfen delivering mental health programs in Vienna and Tyrol, as they were interested in having their experiences regarding the benefits of the services examined in a more objective context. Methods Various data collection methods were implemented between Autumn 2022 to Summer 2023 and described below (see Table 1 ). Table 1 Overview of methods used in the evaluation Method Data type Target group Content Part of this paper Online survey Quantitative Families who have previously used Frühe Hilfen Experiences concerning psychosocial health No Focus group 1 Qualitative Family support workers in Tyrol Specific aspects around need and utilization of the evaluated service in Tyrol Yes Focus group 2 Qualitative Family support workers in Vienna Specific aspects around need and utilization of the evaluated service in Vienna Yes Focus group 3 Qualitative Family support workers from across Austria General need and utilization of psychosocial services No Individual interviews 1 Qualitative Intervention participants (mothers) in Tyrol Assessment of satisfaction, perceived benefits, and reduction of psychological stress Yes Individual interviews 2 Qualitative Intervention participants (mothers) in Vienna Assessment of satisfaction, perceived benefits, and reduction of psychological stress Yes Individual interviews 3 Qualitative Service providers (psychotherapists and group leaders) in Tyrol Assessment of areas of impact, perceived benefits, and reduction of psychological stress Yes Individual interviews 4 Qualitative Service providers (psychotherapists and group leaders) in Vienna Assessment of areas of impact, perceived benefits, and reduction of psychological stress Yes Screening instruments Quantitative Intervention participants (mothers) in Tyrol and Vienna Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale 7 (GAD-7), Postpartum Bonding Questionnaire (PBQ) Yes Participant observation Qualitative Intervention participants (mothers) in Vienna Active observation of intervention sessions with mothers, analysis of upcoming topics, perceived satisfaction and dynamics of the group No Background data from FRÜDOK Quantitative Intervention participants (mothers) who were registered in the FRÜDOK system and who had explicitly consented to the data being merged as part of the Informed Consent Form (ICF) The electronic early intervention documentation system FRÜDOK contains information on the families supported and, on the support, services provided to the families by the regional Frühe Hilfen networks No Note: The participant observation was only conducted in Vienna, involving active observation of intervention sessions with mothers. The informed consent form also included information on the participant observation. The observers of the evaluation team made notes on a pre-developed observation sheet. Mothers who were registered in the FRÜDOK system and who had explicitly consented to the data being merged as part of the ICF, their existing five-digit code from FRÜDOK was linked to the code assigned for the evaluation. The information is entered by family support workers and is pseudonymized and secured with a password, stored electronically, used for quality assurance and evaluated for scientific purposes independently of individuals. <> Ethics approval was granted by the Ethics Committee of the Medical Universities in Innsbruck (EK Nr: 1243/2022) and Vienna (EK Nr: 1636/2022). Before data collection, participating mothers, service providers, and family support workers were asked to sign an informed consent form. The interviews followed a guideline developed with the team based on the defined RQs, and reviewed by the responsible researchers (JP, SH), which were adapted following pilot interviews (see Additional File 1). The interviews were optional for participants and not a prerequisite for participation in the psychosocial service and were conducted by TO, SS, FS and MGG. The screening instruments were delivered at the beginning and end of the intervention to measure changes in psychosocial conditions using standardized tools (EPDS, GAD-7, PBQ). These instruments were chosen in coordination with the program providers in Tyrol and Vienna, as there had been prior experience with using the EPDS with supported mothers and there was a requirement to screen for anxiety and attachment relationship disorders, which was the rationale for choosing the GAD-7 and PBQ questionnaires. For more information on the screening instruments see Additional File 2. Data Analysis Transcripts from focus groups and individual interviews were analyzed using qualitative content analysis (Kuckartz, 2018) and data were supported with the software MAXQDA Standard 2022 Version 22.2.1 (VERBI GmbH 2022). Deductive (i.e., a priori formed) main categories were developed from the previously prepared guidelines or observation sheets and data were coded along categories. Subsequently, categories were formed based on the material, inductive codes, and entire data were coded again. During analysis, the code system was revised in an iterative process in the evaluation team and the text passages affected by changes were analyzed several times. Each passage was coded by at least three people (TO, SS, FS, MGG), and to increase intersubjectivity, any discussion points were clarified by creating memos and through personal exchanges. Case summaries were used to structure data material. This created the basis for the elaboration of the results section, in which the summarized content was supported by example quotes. The entire code system can be seen in Additional File 3. Quotes included in this manuscript were translated from German to English by FS and SS and were checked by TO and JP. Quantitative data from the screening tools (EPDS, GAD-7, PBQ) were evaluated descriptively. Frequencies for response categories and mean values for screening scores were calculated. Results General demographics The evaluation covered a wide range of aspects. This following section presents selected key findings that contribute significantly to answering the main questions. All participants of the evaluation were female, additional information on migration background or other socioeconomic factors is not available (see Table 2 ). Table 2 Overview of features of the participants of the evaluation Type of service Perspective Age Additional information Individual therapy sessions in Tyrol Mothers ( n = 14) Range: 20–41 years Mean: 32 years Family support workers ( n = 7) Range: 23–51 years Mean: 36 years Core professions: psychology, pedagogy, midwifery, educational science Psychotherapist (n = 4) Range: 36–52 years Mean 43 years Method: systemic family therapy ( n = 2), psychodrama ( n = 1), existential analysis ( n = 1) Pedagogical-therapeutic group in Vienna Mothers ( n = 23) Current group ( n = 8) Range 27–39 years Mean 34 years Former participants ( n = 15) Range 33–43 years Mean 38 years Family support workers ( n = 7) Range 23–42 years Mean 32 years Core profession: (kindergarten) pedagogy, midwifery, educational science, social work, psychology Group leader ( n = 2) Range 49–50 years Mean 50 years Core profession: psychotherapist ( n = 1), midwife ( n = 1) <> Screening results At the beginning of the intervention all mothers in Tyrol and Vienna completed questionnaires with one exception in the PBQ each, resulting in a total of 22 completed EPDS and GAD-7 questionnaires and 20 PBQ questionnaires. At the second timepoint 21 completed EPDS and GAD-7 questionnaires and 18 PBQ questionnaires were included, see Figs. 1 and 2. Figure 1 Overview of screening results in Tyrol <> Figure 1 Overview of screening results in Tyrol for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1, and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (10) and T2 in low (12). For GAD-7, T1 is highest in mild (8) and T2 in mild (7). For PBQ, T1 is highest in conspicuous (7) and T2 in inconspicuous (8). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments. All 14 mothers in Tyrol had improvements in their EPDS scores. Eight moved from high to low, one from high to moderate, and three from moderate to low. The rest remained in the same categories with an improved score. Eleven mothers improved their GAD-7 scores, two stayed the same, and one worsened by one point. Changes in GAD-7 categories included improvements from severe to moderate/low, moderate to low/minimal, and low to minimal. Most of the PBQ subscales were mostly unremarkable initially. Figure 2 Overview of screening results in Vienna Figure 2 Overview of screening results in Vienna for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1 and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (6) and T2 in low (4). For GAD-7, T1 is highest in severe (3) and T2 in mild (3). For PBQ, T1 is highest in conspicuous (5) and T2 at the same height for conspicuous (3) and in inconspicuous (3). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments. In Vienna, five of the seven mothers improved their EPDS scores. Three moved from high to low, while the rest remained in the same categories. In the GAD-7, five mothers improved, and two in low categories showed slight deteriorations. Changes included improvements from severe to moderate/low, moderate to low, and low to minimal. Two mothers remained in the same category despite slight score deteriorations. Most of the PBQ subscales were mostly unremarkable initially. Qualitative results from Tyrol and Vienna Interview and focus group results are reported below. The duration of the focus groups lasted an average of one hour. The individual interviews lasted 30 minutes on average, ranging from 14 to 70 minutes. Psychological stressors at the start of the service In the interviews at the start of the service, many mothers reported experiencing postpartum depression, psychosis, different anxiety disorders, obsessive thoughts, an emotionally unstable personality disorder, eating disorders, psychosomatic symptoms, or alcohol-related issues. Furthermore, mothers expressed struggles in mother-child-attachment and caring for the baby, as well as financial and relationship difficulties and critical life events. Influencing factors of utilization Mothers and practitioners discussed aspects that influenced them, or they perceived influenced their clients, in seeking the support of Frühe Hilfen and ultimately participating in either the psychotherapy sessions (Tyrol) or mothers’ group therapy sessions (Vienna). The main perceived influencing factors for utilization of the specific services cited by mothers and practitioners alike were low-threshold access and features (free of costs, anonymous etc.), the stigma associated with mental health problems, and difficulties in fulfilling the parental role, which runs counter to the mother’s and others' expectations and self-image. Lack of understanding of the illness - the mothers not knowing or not being able to admit that they are sick enough to use this service, the mother’s physical conditions as well as organizational hurdles (childcare etc.) also appear to contribute to their decision to participate in the programs. Mothers mentioned receiving good information about the service as well as the availability of the service at the necessary time, while therapists also report previous and current therapeutic experiences and language barriers as influencing factors. Additional support through personal contacts (family counsellor, midwife, etc.) also appears to play a role. Table 3 summarizes the main factors influencing the use of specific services, quotes are included to support interpretations. Table 3 Influencing factors for utilization Code Quote Barrier Facilitator Costs associated with using the service ‘The therapy hour is now around 95 euros or 105 euros on average. As a normal person, I can afford maybe one hour a month and not four, as it should be.’ (Family support worker FGT) ‘And of course, taking on the five sessions was also welcome in terms of money, financially speaking, because life becomes more expensive with a baby anyway.’ (Mother #T33) Availability of the service when it was needed ‘My son was born at the end of April, and I contacted her in early summer. And she said: ‘There's no room.’ And I could register for autumn. Which I did. But this waiting time is not good.’ (Mother #VF1) ‘I didn't have to wait at all. I made an appointment and got an appointment the following week. The therapist lives in the same town as me. That was always very flexible with the children. It was great.’ (Mother #T65) Dealing with the fear of stigma ‘You feel a bit bad and think that there's something wrong with me. You often hear that; but many mothers don't talk about it because they think: ‘What kind of mum am I?’ I can't just say that the feelings weren't there, otherwise people will think that maybe I don't love my child.’ (Mother #T34) ‘I have the feeling that the name is also very, very well chosen. Mother soul group , because it simply doesn't involve illness or anything like that. And so, the medical, psychiatric and therapeutic context is not so strong. So, the inhibition threshold is lower.’ (Family support worker FGV) Previous experiences with psychosocial services ‘You can just pick out any therapist with health insurance, yes, but that often backfires. Then you've gone to a lot of effort to overcome these inhibitions and then somehow you have your first one or two experiences, and it doesn't work at all. And then you don't just start again from scratch, but from minus ten, because you then have to overwrite this negative experience again.’ (Family support worker FGV) ‘The fact that a mum I met at Vienna General Hospital had already gone there and said that it was great meant that my inhibitions were lower. So, I signed up straight away.’ (Mother #V3) Type and setting of the service ‘I would say that this was largely due to the circumstances and partly to the administration, who said: "No, we have to do this strictly according to the rules and you can only come from nine to ten and not from ten to eleven, even if there is actually space." I did not find that helpful. I think it would be better, in my opinion, if there was the option to offer this more often or to say: OK, if you can't come to the first 'slot', then you can come to another 'slot'. That would be helpful because sometimes it really is the case that if the child hasn't slept all night and he is asleep at eight o'clock in the morning, then I don't wake him up, no matter what happens. If I can't go to the group because I would be late.’ (Mother #VF3) ‘That's why I was in such good hands in the group, because I simply realized: ‘Wow, there are also people who feel the same or similar.’ It was just really nice, that environment too. The children played there. My son really liked it there too. [...]. It was just a nice setting. I also think the group size was right and the regularity. It was once a week. I really always looked forward to the appointment.’ (Mother #VF2) Psychosocial health literacy ‘Then I thought: ‘Am I even eligible for this service? Am I allowed to take it? Am I bad enough? Doesn't someone else need it more than me?’ Even though I was really rock bottom. I couldn't have been worse off.’ (Mother #VF14) ‘There needs to be more psychoeducation about these stresses during pregnancy. When does it become critical? How does postpartum depression manifest itself? How can I get help? There is a relative lack of knowledge. If you start during pregnancy, you could probably prevent a lot of this. In my opinion, a lot could be done to prevent maternal burnout and postpartum depression.’ (Family support worker FGT) Information about the features of the service ‘I wasn't sure at the beginning whether it was all anonymous. That was very important to me.’ (Mother #65) ‘I think it's a very valuable service, because it's very low threshold. The women receive the information via midwives or people [note: health professionals] who are in the families. This makes it much easier for them to access the practice.’ (PT#4) Experiences with organizational support ‘But you just have to drive to the place. It was quite far away from me. If there had been several locations, it would have been cool or easier for women who are extremely overwhelmed, like me. They'd think twice about whether they really want to make this journey around the world by public transport.’ (Mother #VF15) ‘After talking to the woman [note: psychotherapist delivering the therapy], I had a slightly bad feeling because I wasn't sure whether it was the right thing to do. Then (name removed), who provides my family support, came to see me. She explained everything really well. Then I didn't feel so bad anymore. I'm now really glad that I took advantage of it.’ (Mother #T34) Compatibility with childcare responsibilities ‘My partner is at work at that time. My parents-in-law are in the area, but they weren't always so quick or readily available at the time. [...] It would probably be easier with someone where the mum is in the house and says: “Give me the baby monitor for a moment and then you can go there relaxed”. I've often gone there stressed because you only have to keep to the times with a therapist. If you're a quarter of an hour late, you've lost 15 minutes. If you're late for any other meeting, it's not so bad. You're often not as flexible with children.’ (Mother #T43) ‘I was supposed to come without the baby and therefore had to choose times when my partner could look after the baby. But that worked out quite well because she also was available later in the afternoon or on Friday afternoon. So, it was easy to organize.’ (Mother #T23) Collaboration of the services ‘I have also experienced that sometimes even the family support is perhaps almost an obstacle to seeking therapy. But if you have built up a good relationship and are regularly available as a contact person, then sometimes there is a need for them: “Yes, but I talk to you anyway. That's enough for me anyway.” And then they don't realize that it's not therapy and that we can't offer that. And then sometimes it takes a lot of persuasion.’ (Family support worker FGW) ‘I think it depends a lot on the degree of networking. It helps many families if the organizational process is relatively short and there aren't many small steps to take. For example, with our five units, the psychotherapy units, I have the impression that it's very easy and the hurdle is therefore incredibly small. Because the way it works is that we first ask the therapists whether they can accept someone and then we give the family the contact details of the relevant therapist. Then the family just has to call to make an appointment. Then that's already done. I have the impression that it's easier than having to fill out five forms and make five phone calls here and there. It's often more difficult.’ (Family support worker FGT) FGV = Focus Group Vienna, FGT = Focus Group Tyrol, PT = Psychotherapist, GL = Group Leader, T = Tyrol Current Participant, V = Vienna Current Participant, VF = Vienna Former Participant Satisfaction with evaluated services Mothers were asked to indicate the extent to which they found the service helpful, 1 being the most helpful and 5 being the least helpful rating. In Tyrol, of the 14 parents who responded, eight gave the grade 1 ("very good"), five gave the grade 2 ("good"), and one gave the grade 2 to 3 ("good to satisfactory"). In Vienna, of the 22 mothers who were asked this question, half gave the service a 1, three others rated it 1–2, five respondents gave it a 2, one respondent rated it 2–3, and two respondents gave it a 3. When asked about the general features, mothers rated the evaluated services very positively. In Tyrol, the psychotherapists, the geographical location, and rules/structures (e.g., flexibility in scheduling or rescheduling appointments) were very often highlighted positively. In Vienna, it was particularly the duration of the sessions, the premises, as well as the group size. In Tyrol, mothers reported varied views about the length of the support; for some, it was perceived as very suitable for a first, low-threshold introduction to psychotherapy, many others however believed that the service should be extended to up to 10 sessions, as five sessions are not suitable for more complex topics or situations. In Vienna, the fact that it consists of a fixed, limited group of members was often perceived as positive. The mothers mostly got on well with each other and there was a harmonious atmosphere. Subjective reduction of psychological burden In Tyrol, nine of the 14 respondents estimated the extent of the reduction in psychological stress as “a lot” and the remaining five as “a little”. In Vienna for 16 of the current or former participants in the group program, the psychosocial stress had reduced “a lot”, for two mothers it had reduced “a little” or “not at all” and for three mothers it was unclear. Areas of impact The important of areas of impact differed between the two services, which is likely due to their different context. In Tyrol, understanding their mental illness and feeling more stable in their mental health, were common aspects reported by mothers. Others included reductions in their psychological symptoms and improvements in self-efficacy and self-confidence. In Vienna, the areas of impact that were mentioned by the largest proportion of mothers were mental relief, development of a network, and self confidence in parenting skills. Similar perceived areas of impact were described by practitioners (see Table 4 ). Table 4 Areas of impact Code Quote Having a better understanding of their mental illness and feeling more stable in their mental health ‘Mrs. N. N. said that I have mental exhaustion. In other words, you can just tell that I'm overloaded. By telling me that I have to look at it differently, she was able to help me a lot.’ (Mother#T30) ‘Hearing from someone that this is a phase, albeit a difficult one, but finding your way out of it together is very helpful. You've experienced this several times from the outside. You get the feeling that there is hope.’ (Mother #VF13) Perceived reduction in psychological symptoms through exchange and social integration ‘I was happy to go. I think our appointments were every fortnight. It was a real time for me to talk, because I didn't have anyone in my neighborhood that I could talk to openly. That was really good for me. I also told the therapist a few times that I was looking forward to the appointments. I always had the impression that when I told my friends that I wasn't feeling so well or that I didn't feel fit, I sometimes got cold reactions, or they rolled their eyes. It wasn't the way I imagined it would be. I had the feeling that they didn't like listening to me. They didn't understand why I was imagining it all and dismissed it as nonsense. I didn't do it voluntarily and really got myself into it.’ (Mother #T31) ‘It's a huge relief to realize that you're not alone. My problems are recognized and I don't have to be afraid that they will be taken the wrong way in the group.’ (Mother W #VF13) Development of a network (in Vienna) ‘[...] this network that was created because you can now exchange more information. In the beginning, we set up this WhatsApp group, and in the first few weeks I thought to myself: “What do we need it for?” But now it's really very helpful, you can write something in there straight away if you have something [to share]. So, I wrote down the sore bum or the feeling I had when my parents were looking after the little one. Responses came straight away and then you feel better again, once you've told someone about it and someone responds straight away and writes: “I feel the same way when I'm at work and my little one isn't there”. Those two points have changed the most for me.’ (Mother #V3) Self confidence in parenting skills ‘The fact that I was able to get advice regarding my daughter's diet, for example, gave me more confidence. I learnt from the other women how they deal with the situation.’ (Mother #V6) ‘I've become a bit more relaxed in my dealings with N. N. [child], so I don't stress myself out so much anymore.’ (Mother #T22) Experiencing improvements in relationship with child ‘What has totally changed, however, is that I only felt safe when I was changing my child’s nappy, for example, and otherwise I didn't know how to fill the day with my child, or that the bond wasn't as strong. That is definitely very different.’ (Mother #V3) ‘We're harmonizing again now. I understand her now, and it just works.’ (Mother #T40) Improvement in self-efficacy and self-confidence ‘What has improved is that I no longer completely lose my nerve on many topics, but I know that I can ask someone. If I don't ask on Monday, I can ask on Wednesday at the baby club . It also depends on the severity of the issues. But now I know which books I can look up.’ (Mother #V8) ‘Getting into action. Clients often say: “I'm glad that I'm here now, that I've arrived.” That's the first thing. The second is: “Then I dare to change something, to think about what is actually possible. What can I do? What options do I and my environment have?”’ (Psychotherapist #PT3) Self-acceptance and self-awareness ‘[...] take everything a little more calmly and appreciate it more. You often only see the negative things and what you didn't manage to do during the day. In the group, we also celebrated small things that we had achieved. It was also extremely important to reflect on that.’ (Mother #VF15) ‘Self-acceptance and understanding yourself more was also supported. Why is it like that for me? Clients were able to accept themselves more. It went more in the direction of self-love and acceptance.’ (Psychotherapist # PT1) Dealing with life changes due to the child ‘[...] that I accept that my life has changed. I had serious issues accepting that my previous life was over, that I had gained something and that it had changed. Now, for example, I couldn't imagine my life without [child].’ (Mother #T35) ‘For me it was the issue of stress, I was simply overwhelmed by the situation itself and also because everything went so wrong. My stress reserves were simply at zero right from the start, and then having to fight the day with a new being was terrible. They gave me a few pointers to take the stress out.’ (Mother #VF15) Partnership/family ‘[...] that it can simply be a help when my parents are there - to get new perspectives, to see that in other countries it is perhaps also quite different how other family members also look after the little one.’ (Mother #V3) ‘We are now much more of a unit as a family than before. That's how it feels to me now. That took half a year.’ (Mother #T45) Evaluation of one’s own motherhood ‘We talked about motherhood at the second meeting. We collected flipcharts on what makes a good mother. We didn't realize how harshly you judge yourself as a mother - why I judge myself so harshly and where my insecurities come from. The exercise stayed with me in my mind for the whole semester. It opened my eyes.’ (Mother #V8) ‘That's easier too. But yes, being a mum has generally become easier, more stable, you could say. Things still happen. But everything around it is more stable. The group has certainly helped me to stabilize in my new role because I can reflect honestly. If I can't do that, then I can never find out or know who or how I want to be as a mum. That's more solidified now.’ (Mother #V7) Experiencing less (self-) stigma after the support ‘You just have images in your head that you don't want to correspond to or actually don't correspond to. And there are lots of mums sitting there who have had psychoses, then you see them and think to yourself: “What? Mums like that have had a psychosis?” [...] and then it's all totally put into perspective.’ (Mother #VF1) ‘I'm also very open about it now. If someone asks me how I am or have been, I talk about it openly and even if there's just a little spark and you're not quite sure whether it's normal or not normal: “Please get help”. I think I've already helped women, so that they know they're not alone. And I think that's a lot. You always read that it affects so many women, but once you actually know the women, it's something else.’ (Mother #T29) FGV = Focus Group Vienna, FGT = Focus Group Tyrol, PT = Psychotherapist, GL = Group Leader T = Tyrol Current Participant, V = Vienna Current Participant, VF = Vienna Former Participant <> Discussion Given the high demand for mental health services among perinatal women in Austria, and the limited availability of specialized care, the two evaluated services play a crucial role in the landscape of perinatal and infant mental healthcare (Zechmeister-Koss, 2023 ; Zechmeister-Koss et al., 2024 ). They make an important contribution to improving the wellbeing of young mothers with psychological concerns. Access and reducing barriers Due to their features (e.g., low threshold access: being free of charge, no diagnosis of a mental illness required for participation), their specialization on mothers and close networking with family support, the two evaluated services help to reduce the barriers that frequently exist when using psychosocial services (Hadfield & Wittkowski, 2017 ; Iturralde et al., 2021 ; Millett et al., 2017 ; Sagerschnig/Sator 2018; Sagerschnig et al. 2023 ; Schamschula/Paul 2024; Viveiros & Darling, 2018 ). This support through family support workers, e.g., organizing or accompanying the mother to the first appointment is particularly important in a fragmented healthcare system as in Austria (Kern et al., 2024 ; Simon et al., 2023 ; Zechmeister-Koss, 2023 ). It was somewhat contrary to our expectations that the limited scope of the Tyrolean service was also seen in a positive context, by facilitating accepting help through conveying a ‘feeling of being able to try things out’. As expected, the closed group setting and the target group-specific orientation of the Vienna group program also encouraged participation. Professional support Regarding experiences of mothers with perinatal mental healthcare, a good relationship with qualified practitioners, feeling understood and treated ‘like ordinary people’ by professionals (Hadfield et al., 2019 ) Lever et al., 2020 ), as well as a treatment that is sufficiently tailored to the specific needs of this target group, proved to be important considerations for success and desired by mothers (Millett et al., 2017 ). Regarding the evaluated services, the experience and expertise of the professionals, as well as their attitude (appreciative, empathetic, supportive, welcoming…) were largely perceived positively. This was also found in Coates et al. ( 2016 ), where participants emphasized that supportive counselling provided a crucial safe space for self-reflection and personal growth. Flexible arrangements As mothers described difficulties combining childcare and treatment (Hadfield et al., 2019 ; Iturralde et al., 2021 ; Millett et al., 2017 ) and additionally often experience social pressure to prioritize their children's needs instead of their own mental health issues (Schamschula/Paul 2024), services like those evaluated - with flexible arrangements of appointments (Tyrol) or joint services for parents and children (mainly Vienna) - are especially appreciated and valued (Coates et al., 2016 ; Lever et al., 2020 ; Rossiter et al., 2012 ). Peer support Another important factor influencing satisfaction with the group service in Vienna is the provision of peer support. One aim of the group service is to bring mothers out of possible isolation and connect them with peers. By being a closed group, the mothers could build trust in each other and internalize that they are not alone with their problems. Westgate et al. ( 2023 ) similarly emphasized the value of interventions that facilitate peer interactions among women experiencing perinatal depression. These interventions foster meaningful relationships, validate individual experiences, alleviate feelings of loneliness, and create opportunities for participants to connect with others who are further along in their recovery journey. Relief through exchange with peers and through the feeling of being socially integrated as well as development of a network are areas of impact that are mentioned most often in our study. This is in line with results from Hadfield et al. ( 2019 ) who found that peer support and social integration significantly reduced feelings of isolation and stigma, while enhancing mental health and parenting confidence. Limitations of the services Currently the services can only reach women with sufficient knowledge of German, so certain vulnerable groups cannot benefit from them. Iturralde et al. ( 2021 ) emphasizes that it is important to consider cultural differences when developing programs and to respond to specific needs and values of different ethnic groups. This can be achieved through the involvement of culturally competent professionals and the provision of information in different languages. In addition, the limited scope of the service in Tyrol means that it is not sufficient for mothers with more complex problems, and the limited capacity of the service in Vienna leads to waiting times. Another limitation is the low involvement of fathers in the services. When involvement of the partner was reported, it was perceived as useful by mothers in our study. Literature also shows that the involvement of the family and male partners/fathers is very important in the treatment of women with perinatal mental health problems (Lever et al., 2019 ; Noonan et al., 2021 ; Walton et al., 2014 ) and often desired by the patients, (Millett et al., 2017 ; Powell et al., 2020 ) and their partners (Feeley et al., 2016 ). In addition, fathers with young children often experience perinatal illnesses themselves (Anding et al., 2016 ; Kim & Swain, 2007 ; O’Brien et al., 2017 ), are often undiagnosed due to limitations of screening tools (Schöch et al. 2024 ) and are especially confronted with stigma. Galasinski ( 2013 ) highlights in this context the stigma arising from conflicting discourses about masculinity and mental illnesses. Strengths and limitations of the evaluation The use of different qualitative and quantitative approaches and the inclusion of different perspectives made it possible to obtain a comprehensive picture. The applied screening instruments are tried and tested for their application in this target group. The EPDS and GAD-7 questionnaires proved to be very suitable for this evaluation, the suitability of the PBQ questionnaire, however, can be critically questioned. It was selected to investigate the topic of attachment, but most results were already unremarkable at the first measurement. Due to the relatively short-term follow-up, only statements on short-term benefits can be made based on the screening results. The qualitative interviews with participating mothers and specialists were all conducted using guidelines to ensure better comparability and to improve rigor. As the interviews and the online survey were based on voluntary participation, a self-selection bias in the group of respondents is possible. Furthermore, social desirability bias in response behavior cannot be ruled out. Retrospective questions (interviews with mothers who used the service in the years before), could be affected by recall bias. In addition, mostly mothers who had already received support from Frühe Hilfen took part. It can therefore be assumed that these mothers are generally open to psychosocial services. Implications for policy and practice Based on the evaluation results, the following implications for policy and practice can be summarized (see Table 5 ). The findings highlight the importance of embedding psychosocial services within existing early childhood intervention systems. The close integration with Frühe Hilfen facilitated access to support for mothers experiencing psychological stress while enabling coordination between family support services and therapeutic care. Such integrated models may strengthen preventive approaches to maternal and infant mental health within public health systems. Flexible service delivery formats, including adaptable scheduling, language-sensitive provision, and practical support such as childcare, appear important for ensuring equitable access to psychosocial support for mothers experiencing psychological stress. Table 5 Recommendations Topic Recommendations Expansion of Services It is recommended to tailor service duration to mothers’ needs. In Tyrol this would mean a base of five sessions, expandable to ten if necessary. In Vienna, offering multiple groups at different locations and times (morning/afternoon) with varying focuses (e.g., pregnant women, single parents, fathers) is suggested. To better integrate mothers with migration backgrounds, group leaders from similar backgrounds should be involved. Target-Specific Design To ensure equal access, therapy in foreign languages should be offered. Due to mothers’ psychological burdens, online sessions or home visits could be considered. Arranging external childcare would help mothers access therapy. Structure and Communication The close connection between the evaluated services and Frühe Hilfen is seen as beneficial for both families and those providing treatment and should therefore be maintained. It might be useful to establish clear communication and networking structures to support the exchange. Maintaining flexible scheduling in an individual setting helps accommodate childcare and work hours. Rules and expectations, like bringing children to sessions, need to be clearly communicated to mothers. Awareness of the service Clear and broad information about the services should be provided, especially to healthcare professionals and families, focusing on who can access the services. To reduce stigma and fear, details about anonymity and confidentiality should be emphasized. Content and Interventions Based on mixed feedback, participants of group services should be more involved in selecting session content. Regular feedback should be sought to adjust as needed. Sessions should end with a review, and individual follow-up meetings should be offered after emotionally intense sessions. <> Abbreviations RQ Research question RTARG Reflexive Thematic Analysis Reporting Guidelines EDPS Edinburgh Postnatal Depression Scale GAD-7 Generalized Anxiety Disorder Scale 7 PBQ Postpartum Bonding Questionnaire MAXQDA Max Qualitative Data Analysis – computer assisted data analysis software program FRÜDOK Frühe Hilfen Dokumentation: Online Documentation System for National Centre for Early Chilhood Support, Frühe Hilfen FGV Focus Group Vienna FGT Focus Group Tyrol PT Psychotherapist GL Group Leader T Tyrol Current Participant V Vienna Current Participant VF Vienna Former Participant ICF Informed Consent Form Declarations Ethics approval and consent to participate: This study was performed in line with the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Medical Universities in Innsbruck (EK Nr: 1243/2022) and Vienna (EK Nr: 1636/2022). Participants provided informed consent, and ethical guidelines were strictly followed throughout the study. Each participant was assigned a unique five-digit code to ensure anonymity, and all documents were securely stored - access to raw data was restricted to the evaluation team. Consent for publication: Not applicable Availability of data and materials: The Additional Files contain the interview guidelines, screening instruments employed in the study, and the analytical code system developed for data analysis. Further deidentified research materials can be obtained from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: The research leading to these results received funding from the Austrian Ministry of Social Affairs, Health, Care and Consumer Protection. This research was also funded in part by the Austrian Science Fund (FWF) [grant DOI 10.55776/cm6]. For open access purposes, authors have applied a CC BY public copyright license to any author accepted manuscript version arising from this submission. The funders had no role in the study design, data collection, analysis or interpretation, manuscript preparation, or the decision to submit the manuscript for publication. Authors' contributions: Conceptualization, T.O., S.S., F.S., P.S., J.L.P.; methodology, T.O., S.S., F.S., P.S., J.L.P.; validation, T.O., S.S., F.S., P.S.; formal analysis, T.O., S.S., F.S., P.S.; investigation, T.O., S.S., F.S.; resources, J.L.P.; T.O.; data curation, T.O., S.S, F.S.; writing—original draft preparation, T.O., S.S., F.S., P.S., J.L.P.; writing—review and editing, T.O., S.S., F.S., P.S., J.L.P.; visualization, F.S.; supervision, J.L.P.; project administration, T.O., P.S. All authors have read and agreed to the published version of the manuscript. Acknowledgements: We would like to express our sincere gratitude to all individuals and institutions involved in this evaluation. Our thanks go to the initiators and implementation partners of “Netzwerk Gesund ins Leben” (Tyrol) and “gut begleitet – Frühe Hilfen Wien”, and to independent collaborator Martina Glatz-Grugger for her valuable contributions. We appreciate the early input from Dr. Sabine Haas (Nationales Zentrum Frühe Hilfen (NZFH.at)) and Dr. Zechmeister-Koss (Director, Austrian Institute of Health Technology Assessment) who provided insight on the study design. We are especially grateful to all participants who took part in the interviews, focus groups, and online survey—your openness and time made this research possible. We thank our colleagues at Gesundheit Österreich GmbH for their constructive feedback and advice throughout the project. The personal commitment of everyone involved was essential to the successful implementation of this study. Finally, we gratefully acknowledge all those who provided administrative and organizational support, as well as the project’s funding bodies. References Anding JE, Röhrle B, Grieshop M, Schücking B, Christiansen H. Couple comorbidity and correlates of postnatal depressive symptoms in mothers and fathers in the first two weeks following delivery. J Affect Disord. 2016;190/:300–9. https://doi.org/10.1016/j.jad.2015.10.033 . Anding J, Röhrle B, Grieshop M, Schücking B, Christiansen H. Early detection of postpartum depressive symptoms in mothers and fathers and its relation to midwives’ evaluation and service provision: a community-based study. Front Pead. 2015;3/:62. https://doi.org/10.3389/fped.2015.00062 . Antony G, Bengough T, Marbler C, Sagerschnig S. The Austrian Early Childhood Intervention Programme: Support for families with young children in burdened life circumstances to improve relational health and well-being. Perspect Infant Mental Health. 2021;29/1:16–21. Bauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B, Hogg S. The costs of perinatal mental health problems. London: Centre Mental Health Lond School Econ. 2014;44/:1. https://eprints.lse.ac.uk/598 85/1/__lse.ac.uk_storage_LIBRARY_Seconda ry_libfile_shared_repository_Content_Bauer%2 C%20M_Bauer_Costs_perinatal_%20mental_20 14_Bauer_Costs_perinatal_mental_2014_author .pdf . Braun V, Clarke V. (2024). Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Palliative medicine , 38(6), 608–616. https://doi.org/10.1177/02692163241234800 Coates D, Davis E, Campbell L. The experiences of women who have accessed a perinatal and infant mental health service: a qualitative investigation. Adv Mental Health. 2016;15/1:88–10. https://doi.org/10.1080/18387357.2016.1242374 . Creswell JW, Clark VLP. Designing and conducting mixed methods research. Sage; 2017. Dodge KA, Goodman WB, Murphy RA, O’Donnell K, Sato J, Guptill S. Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. Am J Public Health. 2014;104/S1:S136–43. https://doi.org/10.2105/ajph.2013.301361 . Feeley N, Bell L, Hayton B, Zelkowitz P, Carrier ME. Care for Postpartum Depression: What Do Women and Their Partners Prefer? Perspect Psychiatr Care. 2016;2016/52:120–30. https://doi.org/10.1111/ppc.12107 . Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–56. https://doi.org/10.1111/1475-6773.12117 . Galasinski D. Fathers, Fatherhood and Mental Illness. Palgrave Macmillan; 2013. Hadfield H, Glendenning S, Bee P, Wittkowski A. Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis. J Child Fam stud. 2019;2019/28:3519–32. https://doi.org/10.1007/s10826-019-01535-0 . Hadfield H, Wittkowski A. Women’s Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Women’s Health. 2017;62/6:723–36. https://doi.org/10.1111/jmwh.12669 . Hölzle L, Schöch P, Hörtnagl C, Buchheim A, Lampe A, Zechmeister-Koss I, Paul JL. Identifying and synthesizing components of perinatal mental health peer support – a systematic review. Front Psychiatry. 2024;20/15:1–13. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384/9956:1775–88. https://doi.org/10.1016/s0140-6736(14)61276-9 . Iturralde E, Hsiao CA, Nkemere L, Kubo A, Sterling SA, Flanagan T, Avalos L. Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy Childbirth. 2021;2021/21:512. https://doi.org/10.1186/s12884-021-03969-1 . Jeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med. 2021;18/5:e1003602. https://doi.org/10.1371/journal.pmed.1003602 . Kern J, Edlinger M, Zechmeister-Koss I. (2024). Uptake of Mental Health Benefits in Women Before and During the Perinatal Period - An Analysis of Austrian Health Insurance Data. AIHTA Project Report . ISSN online 1993 – 0496. Kim P, Swain JE. (2007). Sad dads: paternal postpartum depression. Psychiatry (Edgmont) 4/2:35. PMID: 20805898; PMCID: PMC2922346. Kowalenko N, Barnett B, Fowler C, Matthey S. The Perinatal Period: Early Intervention for Mental Health. Clinical Approaches to Early Intervention in Child and Adolescent Mental Health. Austrlian Early Intervention Network for Mental Health in Young People; 2000. Lever BT, Kandiah A, Johnson S, Howard LM, Morant N. A qualitative investigation of models of community mental health care for women with perinatal mental health problems. J Mental Health. 2020;30/5:594–600. https://doi.org/10.1080/09638237.2020.1714006 . Lever TB, Billings J, Morant N, Bick D, Johnson S. Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England. BMJ Open. 2019;9/7:e030208. https://doi.org/10.1136/bmjopen-2019-030208 . Lyons-Ruth K, Todd Manly J, Von Klitzing K, Tamminen T, Emde R, Fitzgerald H, Paul C, Keren M, Berg A, Foley M. The worldwide burden of infant mental and emotional disorder: Report of the task force of the world association for infant mental health. Infant Mental Health J. 2017;38:695–705. https://doi.org/10.1002/imhj.21674 . Mahoney G, Filer J. How responsive is early intervention to the priorities and needs of families? Top Early Child Special Educ. 1996;16/4:437–57. https://doi.org/10.1177/027112149601600405 . Marbler C, Sagerschnig S, Scolik F, Winkler P. Frühe Hilfen. Zahlen, Daten und Fakten 2023. Wien: FRÜDOK Jahresbericht. Gesundheit Österreich; 2024. Millett L, Taylor BL, Howard LM, Bick D, Stanley N, Johnson S. Experiences of Improving Access to Psychological Therapy Services for Perinatal Mental Health Difficulties: a Qualitative Study of Women’s and Therapists’ Views. Behav Cogn Psychother. 2017;46/4:421–36. https://doi.org/10.1017/s1352465817000650 . Noonan M, Jomeen J, Doody O. A review of the involvement of partners and family members in psychosocial interventions for supporting women at risk of or experiencing perinatal depression and anxiety. Int J Environ Res Public Health. 2021;18/10:5396. https://doi.org/10.3390/ijerph18105396 . O'Hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. Int Rev psychiatry. 1996;8/1:37–54. https://doi.org/10.3109/09540269609037816 . O’Brien AP, McNeil KA, Fletcher R, Conrad A, Wilson AJ, Jones D, Chan SW. New fathers’ perinatal depression and anxiety—Treatment options: An integrative review. Am J Men's Health. 2017;11/4:863–76. https://doi.org/10.1177/1557988316669047 . Peacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: a systematic review. BMC Public Health. 2013;13/:1–14. https://doi.org/10.1186/1471-2458-13-17 . Powell C, Bedia S, Nathab S, Pottsa L, Trevilliona K, Howard L. Mothers' experiences of acute perinatal mental health services in England and Wales: a qualitative analysis. J Reproductive Infant Psychol. 2020;40/5:1–13. https://doi.org/10.1080/02646838.2020.1814225 . Rossiter C, Fowler C, Mcmahon C, Kowalenko N. Supporting depressed mothers at home: Their views on an innovative relationship-based intervention. Contemp Nurse. 2012;41/1:90–100. https://doi.org/10.5172/conu.2012.41.1.90 . Sagerschnig S, Grabenhofer-Eggerth A, Kern D. Modell für einen verbesserten Zugang zur psychosozialen Versorgung für Kinder und Jugendliche. Wien: Gesundheit Österreich; 2023. Sagerschnig S, Ofner T, Scolik F. Psychosoziale Angebote und Frühe Hilfen. Evaluation spezifischer Angebote bei psychischen Belastungen im Rahmen der Frühen Hilfen; 2024. Sagerschnig, Sophie; Grabenhofer-Eggerth, Alexander; Kern, Daniela;; Sator, Marlene;Zuba, Martin (2018): Inanspruchnahme von Psychotherapie und psychiatrischer Rehabilitation im Kontext der Angebote. Gesundheit Österreich, Wien. Schachner A, Hesse N, Rappauer A, Stadler-Vida M. Umsetzung von regionalen Frühe-Hilfen-Netzwerken in Österreich - Endbericht der summativen Evaluation. queraum. Wien: kultur- und sozialforschung; 2017. Schamschula M, Paul JL. Deconstructing stigmatising narratives: a qualitative analysis of contrast devices in interviews with mothers with a mental illness. BMC Psychol. 2024;12/1:433. Schöch P, Hölzle L, Lampe A, Hörtnagl C, Zechmeister-Koss I, Buchheim A, Paul JL. (2024): Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps. In: frontiers in Public Health 2024/12:1–18. Simon J, Boyer P, Caldas-de-Almeida JM, Knapp M, McCrone P, Gorwood P, Oertel W, Arango C, Treasure J, Young AH, Destrebecq F, Quoidbach V. Viewpoint: Assessing the value of mental health treatments in Europe. Eur Psychiatry. 2023;66/1:3. https://doi.org/10.1192/j.eurpsy.2023.2419 . VanLandeghem K, Curtis D, Abrams M. (2002). Reasons and strategies for strengthening childhood development services in the healthcare system. Natl Acad State Health Policy Portland https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2002 _oct_reasons_and_strategies_for _strengthening_childhood_devel opment_services_in_the_healthcare_ system_vanlandeghem_nashp_630_ pdf.pdf Viveiros CJ, Darling E, K. Barriers and facilitators of accessing perinatal mental health services: The perspectives of women receiving continuity of care midwifery. Midwifery. 2018;2018/65:8–15. https://doi.org/10.1016/j.midw.2018.06.018 . Walton GD, Ross LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S. Decisional conflict among women considering antidepressant medication use in pregnancy. Archives Women’s Mental Health. 2014;17/6:493–501. https://doi.org/10.1007/s00737-014-0448-1 . Westgate V, Manchanda T, Maxwell M. Women’s experiences of care and treatment preferences for perinatal depression: a systematic review. Archives Women’s Mental Health. 2023;2023/26:311–9. https://doi.org/10.1007/s00737-023-01318-z . Zechmeister-Koss I. (2023). Perinatal and infant mental health care in Austria. A mapping report of existing prevention, screening and care structures, with a specific focus on Tyrol. AIHTA Project Report . ISSN online 1993 – 0496. Zechmeister-Koss I, Hörtnagl C, Lampe A, Paul JL. (2024): Perinatal and infant mental health care in Austria. In: Neuropsychiatrie 2025/39:11–19. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1EvalPsychServices.docx Additional File 1 – Interview Guidelines Additionalfile2EvalPsychServices.docx Additional File 2 – Screening instruments Additionalfile3EvalPsychServices.docx Additional File 3 – Code System Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 01 Apr, 2026 Editor assigned by journal 24 Mar, 2026 Submission checks completed at journal 24 Mar, 2026 First submitted to journal 16 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9136961","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618251922,"identity":"456d6e0d-02f9-4c18-aa67-127039ad2d3b","order_by":0,"name":"Tonja Ofner","email":"","orcid":"","institution":"Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG)","correspondingAuthor":false,"prefix":"","firstName":"Tonja","middleName":"","lastName":"Ofner","suffix":""},{"id":618251924,"identity":"a342525d-6423-4632-92f3-9e131da20c8b","order_by":1,"name":"Sophie Sagerschnig","email":"","orcid":"","institution":"Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG)","correspondingAuthor":false,"prefix":"","firstName":"Sophie","middleName":"","lastName":"Sagerschnig","suffix":""},{"id":618251925,"identity":"d1da4579-f893-497c-9381-404671348bcd","order_by":2,"name":"Fiona Scolik","email":"","orcid":"","institution":"Austrian National Public Health Institute (Gesundheit Österreich GmbH, GÖG)","correspondingAuthor":false,"prefix":"","firstName":"Fiona","middleName":"","lastName":"Scolik","suffix":""},{"id":618251926,"identity":"39e81e03-94b6-477c-adf5-f2dacc434dfc","order_by":3,"name":"Philipp Schöch","email":"","orcid":"","institution":"Innsbruck Medical University","correspondingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Schöch","suffix":""},{"id":618251928,"identity":"060c7e70-7972-44f2-a264-cec1c77bcb16","order_by":4,"name":"Jean Lillian Paul","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACxgYog4+9EcRkJkELG89BJC0HiLGOTSKBgTgtzO3Nzx4w7rBLbJN83MB0o8Kagb/9AOPnD/gc1nPM3IDxTHJim3RiA3POmXQGiTMJzBL4bGGckWAmwdjGDNLS/ju37TADww0GBvxa5j//BtRSD3TYwQbm3H+HGeRvMDD/wG8LD8iWw4ltEoxALQ2HGQxuAIMCr5aenDKJxDPHjdt4QH45ls5jeCaxzeIMHi2G7ce3SXzcUS3bz378AXNOjbWc3PHDh29U4NPSACQSGxACPEjRix3Ig12HX80oGAWjYBSMdAAA8yhLYFX8OcgAAAAASUVORK5CYII=","orcid":"","institution":"Innsbruck Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jean","middleName":"Lillian","lastName":"Paul","suffix":""}],"badges":[],"createdAt":"2026-03-16 11:08:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9136961/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9136961/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106382484,"identity":"0adbd8ac-42c7-48c8-a973-62313701f160","added_by":"auto","created_at":"2026-04-08 05:28:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":47283,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of screening results in Tyrol for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1, and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (10) and T2 in low (12). For GAD-7, T1 is highest in mild (8) and T2 in mild (7). For PBQ, T1 is highest in conspicuous (7) and T2 in inconspicuous (8). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments.\u003c/p\u003e","description":"","filename":"Figure1EvalPsychServicesAustria.png","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/1ef6d026f10cb771e9d41c9b.png"},{"id":106404431,"identity":"630390b1-b7a7-4011-a31a-8339583aed8d","added_by":"auto","created_at":"2026-04-08 09:16:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46273,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of screening results in Vienna for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1 and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (6) and T2 in low (4). For GAD-7, T1 is highest in severe (3) and T2 in mild (3). For PBQ, T1 is highest in conspicuous (5) and T2 at the same height for conspicuous (3) and in inconspicuous (3). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments.\u003c/p\u003e","description":"","filename":"Figure2EvalPsychServicesAustria.png","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/35ad2420e7cff3594dbcdfcd.png"},{"id":106405690,"identity":"98c2ae33-1b24-4e8d-bb26-35e6835d23fe","added_by":"auto","created_at":"2026-04-08 09:28:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1132824,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/f3c18451-e1dc-4a4d-ac63-7af1260a71cb.pdf"},{"id":106404652,"identity":"175861f5-1c1f-4290-bf72-ae977b1ae992","added_by":"auto","created_at":"2026-04-08 09:16:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50586,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAdditional File 1 – Interview Guidelines\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Additionalfile1EvalPsychServices.docx","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/cdad106069860daa181056cd.docx"},{"id":106382487,"identity":"ac8320ab-f6a8-42b8-bc5b-b172cd22e99c","added_by":"auto","created_at":"2026-04-08 05:28:18","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":47340,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAdditional File 2 – Screening instruments\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Additionalfile2EvalPsychServices.docx","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/c137598f97e155e9caa8e05a.docx"},{"id":106382485,"identity":"5cf9c734-75bc-44d3-b323-5225e5e77210","added_by":"auto","created_at":"2026-04-08 05:28:18","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":53930,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eAdditional File 3 – Code System\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Additionalfile3EvalPsychServices.docx","url":"https://assets-eu.researchsquare.com/files/rs-9136961/v1/530b48078601eb47be0ca74a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychosocial support for mothers experiencing psychological stress in early childhood interventions: a mixed-methods evaluation in Austria","fulltext":[{"header":"Contributions to the literature","content":"\u003cul\u003e\n \u003cli\u003ePsychological stress during early motherhood affects maternal wellbeing and child development and represents an important public health concern.\u003c/li\u003e\n \u003cli\u003eEvidence on psychosocial services embedded within early childhood intervention programs remains limited.\u003c/li\u003e\n \u003cli\u003eThis study examines psychosocial services delivered within Austria\u0026rsquo;s Early Childhood Intervention Program Fr\u0026uuml;he Hilfen, drawing on the perspectives of both mothers and service providers.\u003c/li\u003e\n \u003cli\u003eThe findings highlight how accessible and flexible support\u0026mdash;including short-term therapy and group-based services\u0026mdash;can strengthen maternal wellbeing and peer support.\u003c/li\u003e\n \u003cli\u003eThe study also highlights barriers to access, such as language limitations and limited service capacity, which are important for public health service planning.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eEarly childhood is a crucial period in development and recognizing the importance of early intervention, various initiatives have been developed worldwide. They often support families facing challenges, such as socioeconomic disadvantages, parental stress, or mental health issues (Jeong et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; VanLandeghem et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and promote positive outcomes for young children (Lyons-Ruth et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Mahoney \u0026amp; Filer \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). Supporting maternal mental health in the early parenting period is a key public health priority, as maternal wellbeing strongly influences early child development and family functioning. Mental illness is the most prevalent complication related to pregnancy in Western countries, affecting about one in five mothers (Bauer et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Howard et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; O'hara \u0026amp; Swain, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e) and over one in ten fathers (Anding et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Kim \u0026amp; Swain, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; O\u0026rsquo;Brien et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) during the perinatal period (Anding et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Perinatal mental health is defined as the emotional wellbeing of parents and infants from conception to the first two years postpartum (Kowalenko et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Significant stigma is associated with mental illness during this period, which can prevent individuals from seeking help. Peer support programs aid in mitigating stigma (H\u0026ouml;lzle et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Noonan et al. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) emphasize the importance of partner and family involvement in interventions for perinatal depression and anxiety and suggest that early childhood interventions should integrate family support to improve outcomes.\u003c/p\u003e \u003cp\u003eThe effectiveness and economic value of targeted early childhood interventions have been shown (Dodge et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Peacock et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) and demonstrate the importance of investing in multifaceted programs tailored to local needs. One such comprehensive program is the Austrian Early Childhood Intervention Program \u0026ldquo;Fr\u0026uuml;he Hilfen\u0026rdquo;, a nationwide public health program supporting vulnerable families. This low-threshold approach includes regional networks that reach out to families seeking support and aim to enhance healthy environments for parents and their children (Antony et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Schachner et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The program offers a range of services, including home visits, counselling, and access to healthcare, tailored to meet the specific needs of each family (Antony et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The most common primary professions of Fr\u0026uuml;he Hilfen family support workers are from the social sector, followed by the educational sector, nursing, and psychology or psychotherapy (Marbler et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile Fr\u0026uuml;he Hilfen offers valuable support, the landscape of perinatal and infant mental health care in Austria has limitations. There are regional variations in support programs, the lack of specialization in perinatal mental health, the limited capacity of specialized psychiatric services, and the absence of comprehensive data and national standards (Kern et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zechmeister-Koss, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The need for further programs is high among the families being supported by Fr\u0026uuml;he Hilfen. Most needed are clinical psychology and psychotherapy, however, only 68% of the families in need of such a service end up utilizing these supports (Marbler et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Some services have also been implemented as part of Fr\u0026uuml;he Hilfen, these include two specific services for mothers with psychological stress, which were evaluated in this project: a short-term psychotherapeutic intervention from the \u0026ldquo;Gesund ins Leben\u0026rdquo; (translated into English as \u0026ldquo;Healthy start to life\u0026rdquo;) Fr\u0026uuml;he Hilfen network in Tyrol, and a therapeutic group called \u0026ldquo;Mutterseelen\u0026hellip;gemeinsam\u0026rdquo; (translated into English as \u0026ldquo;Mothers\u0026rsquo; souls together\u0026rdquo;) from the Fr\u0026uuml;he Hilfen network Vienna‐West.\u003c/p\u003e \u003cp\u003eThe Tyrolean Fr\u0026uuml;he Hilfen program offers five free sessions with psychotherapists specializing in perinatal mental health issues for families (not just mothers) with an unborn or baby up to one year old, experiencing mental health challenges related to childbirth/having a new child. \u0026ldquo;Mutterseelen...gemeinsam\u0026rdquo; is a pedagogical-therapeutic group organized by Fr\u0026uuml;he Hilfen in Vienna for mothers with mental illness and their babies. Led by a family midwife and a psychotherapist, the group of up to eight mothers and their babies/toddlers (up to 2 years old) meets weekly for two hours over a semester (20 sessions). While mothers with various mental illnesses are welcome, a diagnosis is not required for participation (Sagerschnig et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aim of this evaluation was to:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eExplore the needs and potential benefits of psychosocial services for mothers participating in early childhood interventions, and\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGenerate in-depth insights into the perceived benefits of the two psychosocial services implemented in Tyrol and Vienna.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWe addressed the following research questions (RQ):\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRQ1: What factors influence the utilization of and satisfaction within the evaluated psychosocial services in Tyrol and Vienna?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRQ2: What benefits are perceived from the evaluated psychosocial services from the perspectives of mothers and healthcare providers?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe used a summative evaluation with a mixed-methods approach, combining qualitative and quantitative data to comprehensively assess the psychosocial support services. Given the primarily descriptive nature of the quantitative component, the evaluation design for this paper can be described as a qualitatively driven mixed-methods design, in which quantitative findings serve a complementary and contextualizing function rather than a hypothesis-testing one (Creswell, J. W., \u0026amp; Clark, V. L. P., 2017). The quantitative component consisted of standardized measures of wellbeing and was analyzed descriptively to provide an indication of potential improvements over time. This design allowed us to capture both the experiential perspectives of mothers and service providers and complementary quantitative indicators of wellbeing, providing a comprehensive understanding of service effectiveness and informing improvements to psychosocial support within early childhood intervention systems. We follow the Reflexive Thematic Analysis Reporting Guidelines (RTARG) (Braun, V., \u0026amp; Clarke, V., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile the quantitative data offer structured evidence of changes in wellbeing, the central aim of the study was to generate rich and nuanced accounts of participants\u0026rsquo; views, experiences, and preferences regarding the services. The qualitative data therefore served as the main source for understanding how participants made sense of the support received or provided, what they perceived as beneficial, and where unmet needs remained. Integration occurred at the level of interpretation, where descriptive quantitative trends were considered alongside qualitative themes to explore convergence and to contextualize measured changes in wellbeing within participants\u0026rsquo; lived experiences (Creswell, J. W., \u0026amp; Clark, V. L. P., 2017; Fetters, M. D., Curry, L. A., \u0026amp; Creswell, J. W., 2013). Data sources are presented side by side in the results section. The evaluation targeted diverse perspectives, including families and family support workers, ensuring a multifaceted understanding of service needs and utilization. This study was requested by employees of Fr\u0026uuml;he Hilfen delivering mental health programs in Vienna and Tyrol, as they were interested in having their experiences regarding the benefits of the services examined in a more objective context.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eVarious data collection methods were implemented between Autumn 2022 to Summer 2023 and described below (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of methods used in the evaluation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMethod\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eData type\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eTarget group\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eContent\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePart of this paper\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOnline survey\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamilies who have previously used Fr\u0026uuml;he Hilfen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eExperiences concerning psychosocial health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFocus group 1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamily support workers in Tyrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecific aspects around need and utilization of the evaluated service in Tyrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFocus group 2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamily support workers in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpecific aspects around need and utilization of the evaluated service in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFocus group 3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFamily support workers from across Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneral need and utilization of psychosocial services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIndividual interviews 1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention participants (mothers) in Tyrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment of satisfaction, perceived benefits, and reduction of psychological stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIndividual interviews 2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention participants (mothers) in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment of satisfaction, perceived benefits, and reduction of psychological stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIndividual interviews 3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eService providers (psychotherapists and group leaders) in Tyrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment of areas of impact, perceived benefits, and reduction of psychological stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIndividual interviews 4\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eService providers (psychotherapists and group leaders) in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAssessment of areas of impact, perceived benefits, and reduction of psychological stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eScreening instruments\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention participants (mothers) in Tyrol and Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEdinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale 7 (GAD-7), Postpartum Bonding Questionnaire (PBQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eParticipant observation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention participants (mothers) in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eActive observation of intervention sessions with mothers, analysis of upcoming topics, perceived satisfaction and dynamics of the group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBackground data from FR\u0026Uuml;DOK\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention participants (mothers) who were registered in the FR\u0026Uuml;DOK system and who had explicitly consented to the data being merged as part of the Informed Consent Form (ICF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe electronic early intervention documentation system FR\u0026Uuml;DOK contains information on the families supported and, on the support, services provided to the families by the regional Fr\u0026uuml;he Hilfen networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: The participant observation was only conducted in Vienna, involving active observation of intervention sessions with mothers. The informed consent form also included information on the participant observation. The observers of the evaluation team made notes on a pre-developed observation sheet. Mothers who were registered in the FR\u0026Uuml;DOK system and who had explicitly consented to the data being merged as part of the ICF, their existing five-digit code from FR\u0026Uuml;DOK was linked to the code assigned for the evaluation. The information is entered by family support workers and is pseudonymized and secured with a password, stored electronically, used for quality assurance and evaluated for scientific purposes independently of individuals.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026lt;\u0026lt; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e should go here \u0026gt;\u0026gt;\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003e was granted by the Ethics Committee of the Medical Universities in Innsbruck (EK Nr: 1243/2022) and Vienna (EK Nr: 1636/2022). Before data collection, participating mothers, service providers, and family support workers were asked to sign an informed consent form. The interviews followed a guideline developed with the team based on the defined RQs, and reviewed by the responsible researchers (JP, SH), which were adapted following pilot interviews (see Additional File 1). The interviews were optional for participants and not a prerequisite for participation in the psychosocial service and were conducted by TO, SS, FS and MGG. The screening instruments were delivered at the beginning and end of the intervention to measure changes in psychosocial conditions using standardized tools (EPDS, GAD-7, PBQ). These instruments were chosen in coordination with the program providers in Tyrol and Vienna, as there had been prior experience with using the EPDS with supported mothers and there was a requirement to screen for anxiety and attachment relationship disorders, which was the rationale for choosing the GAD-7 and PBQ questionnaires. For more information on the screening instruments see Additional File 2.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eTranscripts from focus groups and individual interviews were analyzed using qualitative content analysis (Kuckartz, 2018) and data were supported with the software MAXQDA Standard 2022 Version 22.2.1 (VERBI GmbH 2022). Deductive (i.e., a priori formed) main categories were developed from the previously prepared guidelines or observation sheets and data were coded along categories. Subsequently, categories were formed based on the material, inductive codes, and entire data were coded again. During analysis, the code system was revised in an iterative process in the evaluation team and the text passages affected by changes were analyzed several times. Each passage was coded by at least three people (TO, SS, FS, MGG), and to increase intersubjectivity, any discussion points were clarified by creating memos and through personal exchanges. Case summaries were used to structure data material. This created the basis for the elaboration of the results section, in which the summarized content was supported by example quotes. The entire code system can be seen in Additional File 3. Quotes included in this manuscript were translated from German to English by FS and SS and were checked by TO and JP.\u003c/p\u003e \u003cp\u003eQuantitative data from the screening tools (EPDS, GAD-7, PBQ) were evaluated descriptively. Frequencies for response categories and mean values for screening scores were calculated.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eGeneral demographics\u003c/h2\u003e \u003cp\u003eThe evaluation covered a wide range of aspects. This following section presents selected key findings that contribute significantly to answering the main questions. All participants of the evaluation were female, additional information on migration background or other socioeconomic factors is not available (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverview of features of the participants of the evaluation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eType of service\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePerspective\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eAge\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eAdditional information\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIndividual therapy sessions in Tyrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMothers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange: 20\u0026ndash;41 years\u003c/p\u003e \u003cp\u003eMean: 32 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily support workers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange: 23\u0026ndash;51 years\u003c/p\u003e \u003cp\u003eMean: 36 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCore professions: psychology, pedagogy, midwifery, educational science\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychotherapist (n\u0026thinsp;=\u0026thinsp;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange: 36\u0026ndash;52 years\u003c/p\u003e \u003cp\u003eMean 43 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMethod: systemic family therapy (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2), psychodrama (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), existential analysis (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePedagogical-therapeutic group in Vienna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMothers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCurrent group\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003cp\u003eRange 27\u0026ndash;39 years\u003c/p\u003e \u003cp\u003eMean 34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFormer participants\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003cp\u003eRange 33\u0026ndash;43 years\u003c/p\u003e \u003cp\u003eMean 38 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily support workers (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange 23\u0026ndash;42 years\u003c/p\u003e \u003cp\u003eMean 32 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCore profession: (kindergarten) pedagogy, midwifery, educational science, social work, psychology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup leader (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRange 49\u0026ndash;50 years\u003c/p\u003e \u003cp\u003eMean 50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCore profession: psychotherapist (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1), midwife (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026lt;\u0026lt; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e should go here\u0026gt;\u0026gt;\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eScreening results\u003c/h3\u003e\n\u003cp\u003eAt the beginning of the intervention all mothers in Tyrol and Vienna completed questionnaires with one exception in the PBQ each, resulting in a total of 22 completed EPDS and GAD-7 questionnaires and 20 PBQ questionnaires. At the second timepoint 21 completed EPDS and GAD-7 questionnaires and 18 PBQ questionnaires were included, see Figs.\u0026nbsp;1 and 2.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure 1\u003c/strong\u003e \u003cp\u003eOverview of screening results in Tyrol\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u0026lt;\u0026lt; Fig.\u0026nbsp;1 should go here\u0026gt;\u0026gt;\u003c/h2\u003e \u003cp\u003e \u003cb\u003eFigure\u0026nbsp;1\u003c/b\u003e Overview of screening results in Tyrol for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1, and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (10) and T2 in low (12). For GAD-7, T1 is highest in mild (8) and T2 in mild (7). For PBQ, T1 is highest in conspicuous (7) and T2 in inconspicuous (8). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments.\u003c/p\u003e \u003cp\u003eAll 14 mothers in Tyrol had improvements in their EPDS scores. Eight moved from high to low, one from high to moderate, and three from moderate to low. The rest remained in the same categories with an improved score. Eleven mothers improved their GAD-7 scores, two stayed the same, and one worsened by one point. Changes in GAD-7 categories included improvements from severe to moderate/low, moderate to low/minimal, and low to minimal. Most of the PBQ subscales were mostly unremarkable initially.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFigure 2\u003c/strong\u003e \u003cp\u003eOverview of screening results in Vienna\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e\u003c\u003c Fig. 2 should go here\u003e\u003e\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eFigure\u0026nbsp;2\u003c/b\u003e Overview of screening results in Vienna for three instruments EPDS GAD-7 and PBQ. Gray solid bars represent values at T1 and yellow striped bars represent values at T2. Categories for EPDS are high moderate and low. Categories for GAD-7 are severe moderate and mild. Categories for PBQ are minimal conspicuous and inconspicuous. The height of each bar indicates the number of participants in each category. For EPDS, T1 is highest in high (6) and T2 in low (4). For GAD-7, T1 is highest in severe (3) and T2 in mild (3). For PBQ, T1 is highest in conspicuous (5) and T2 at the same height for conspicuous (3) and in inconspicuous (3). This figure allows comparison of the distribution of participant scores between T1 and T2 for all categories and instruments.\u003c/p\u003e \u003cp\u003eIn Vienna, five of the seven mothers improved their EPDS scores. Three moved from high to low, while the rest remained in the same categories. In the GAD-7, five mothers improved, and two in low categories showed slight deteriorations. Changes included improvements from severe to moderate/low, moderate to low, and low to minimal. Two mothers remained in the same category despite slight score deteriorations. Most of the PBQ subscales were mostly unremarkable initially.\u003c/p\u003e\n\u003ch3\u003eQualitative results from Tyrol and Vienna\u003c/h3\u003e\n\u003cp\u003eInterview and focus group results are reported below. The duration of the focus groups lasted an average of one hour. The individual interviews lasted 30 minutes on average, ranging from 14 to 70 minutes.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePsychological stressors at the start of the service\u003c/h2\u003e \u003cp\u003eIn the interviews at the start of the service, many mothers reported experiencing postpartum depression, psychosis, different anxiety disorders, obsessive thoughts, an emotionally unstable personality disorder, eating disorders, psychosomatic symptoms, or alcohol-related issues. Furthermore, mothers expressed struggles in mother-child-attachment and caring for the baby, as well as financial and relationship difficulties and critical life events.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInfluencing factors of utilization\u003c/h2\u003e \u003cp\u003eMothers and practitioners discussed aspects that influenced them, or they perceived influenced their clients, in seeking the support of Fr\u0026uuml;he Hilfen and ultimately participating in either the psychotherapy sessions (Tyrol) or mothers\u0026rsquo; group therapy sessions (Vienna). The main perceived influencing factors for utilization of the specific services cited by mothers and practitioners alike were low-threshold access and features (free of costs, anonymous etc.), the stigma associated with mental health problems, and difficulties in fulfilling the parental role, which runs counter to the mother\u0026rsquo;s and others' expectations and self-image. Lack of understanding of the illness - the mothers not knowing or not being able to admit that they are sick enough to use this service, the mother\u0026rsquo;s physical conditions as well as organizational hurdles (childcare etc.) also appear to contribute to their decision to participate in the programs. Mothers mentioned receiving good information about the service as well as the availability of the service at the necessary time, while therapists also report previous and current therapeutic experiences and language barriers as influencing factors. Additional support through personal contacts (family counsellor, midwife, etc.) also appears to play a role. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the main factors influencing the use of specific services, quotes are included to support interpretations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfluencing factors for utilization\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eCode\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eQuote\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBarrier\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFacilitator\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCosts associated with using the service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;The therapy hour is now around 95 euros or 105 euros on average. As a \u003cem\u003enormal\u003c/em\u003e person, I can afford maybe one hour a month and not four, as it should be.\u0026rsquo; (Family support worker FGT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;And of course, taking on the five sessions was also welcome in terms of money, financially speaking, because life becomes more expensive with a baby anyway.\u0026rsquo; (Mother #T33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability of the service when it was needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;My son was born at the end of April, and I contacted her in early summer. And she said: \u0026lsquo;There's no room.\u0026rsquo; And I could register for autumn. Which I did. But this waiting time is not good.\u0026rsquo; (Mother #VF1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;I didn't have to wait at all. I made an appointment and got an appointment the following week. The therapist lives in the same town as me. That was always very flexible with the children. It was great.\u0026rsquo; (Mother #T65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDealing with the fear of stigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;You feel a bit bad and think that there's something wrong with me. You often hear that; but many mothers don't talk about it because they think: \u0026lsquo;What kind of mum am I?\u0026rsquo; I can't just say that the feelings weren't there, otherwise people will think that maybe I don't love my child.\u0026rsquo; (Mother #T34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;I have the feeling that the name is also very, very well chosen. \u003cem\u003eMother soul group\u003c/em\u003e, because it simply doesn't involve illness or anything like that. And so, the medical, psychiatric and therapeutic context is not so strong. So, the inhibition threshold is lower.\u0026rsquo; (Family support worker FGV)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious experiences with psychosocial services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;You can just pick out any therapist with health insurance, yes, but that often backfires. Then you've gone to a lot of effort to overcome these inhibitions and then somehow you have your first one or two experiences, and it doesn't work at all. And then you don't just start again from scratch, but from minus ten, because you then have to overwrite this negative experience again.\u0026rsquo; (Family support worker FGV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;The fact that a mum I met at Vienna General Hospital had already gone there and said that it was great meant that my inhibitions were lower. So, I signed up straight away.\u0026rsquo; (Mother #V3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType and setting of the service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;I would say that this was largely due to the circumstances and partly to the administration, who said: \"No, we have to do this strictly according to the rules and you can only come from nine to ten and not from ten to eleven, even if there is actually space.\" I did not find that helpful. I think it would be better, in my opinion, if there was the option to offer this more often or to say: OK, if you can't come to the first 'slot', then you can come to another 'slot'. That would be helpful because sometimes it really is the case that if the child hasn't slept all night and he is asleep at eight o'clock in the morning, then I don't wake him up, no matter what happens. If I can't go to the group because I would be late.\u0026rsquo; (Mother #VF3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;That's why I was in such good hands in the group, because I simply realized: \u0026lsquo;Wow, there are also people who feel the same or similar.\u0026rsquo; It was just really nice, that environment too. The children played there. My son really liked it there too. [...]. It was just a nice setting. I also think the group size was right and the regularity. It was once a week. I really always looked forward to the appointment.\u0026rsquo; (Mother #VF2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychosocial health literacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;Then I thought: \u0026lsquo;Am I even eligible for this service? Am I allowed to take it? Am I \u003cem\u003ebad\u003c/em\u003e enough? Doesn't someone else need it more than me?\u0026rsquo; Even though I was really rock bottom. I couldn't have been worse off.\u0026rsquo; (Mother #VF14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;There needs to be more psychoeducation about these stresses during pregnancy. When does it become critical? How does postpartum depression manifest itself? How can I get help? There is a relative lack of knowledge. If you start during pregnancy, you could probably prevent a lot of this. In my opinion, a lot could be done to prevent maternal burnout and postpartum depression.\u0026rsquo; (Family support worker FGT)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation about the features of the service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;I wasn't sure at the beginning whether it was all anonymous. That was very important to me.\u0026rsquo; (Mother #65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;I think it's a very valuable service, because it's very low threshold. The women receive the information via midwives or people [note: health professionals] who are in the families. This makes it much easier for them to access the practice.\u0026rsquo; (PT#4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiences with organizational support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;But you just have to drive to the place. It was quite far away from me. If there had been several locations, it would have been cool or easier for women who are extremely overwhelmed, like me. They'd think twice about whether they really want to make this journey around the world by public transport.\u0026rsquo; (Mother #VF15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;After talking to the woman [note: psychotherapist delivering the therapy], I had a slightly bad feeling because I wasn't sure whether it was the right thing to do. Then (name removed), who provides my family support, came to see me. She explained everything really well. Then I didn't feel so bad anymore. I'm now really glad that I took advantage of it.\u0026rsquo; (Mother #T34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompatibility with childcare responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;My partner is at work at that time. My parents-in-law are in the area, but they weren't always so quick or readily available at the time. [...] It would probably be easier with someone where the mum is in the house and says: \u0026ldquo;Give me the baby monitor for a moment and then you can go there relaxed\u0026rdquo;. I've often gone there stressed because you only have to keep to the times with a therapist. If you're a quarter of an hour late, you've lost 15 minutes. If you're late for any other meeting, it's not so bad. You're often not as flexible with children.\u0026rsquo; (Mother #T43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;I was supposed to come without the baby and therefore had to choose times when my partner could look after the baby. But that worked out quite well because she also was available later in the afternoon or on Friday afternoon. So, it was easy to organize.\u0026rsquo; (Mother #T23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaboration of the services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;I have also experienced that sometimes even the family support is perhaps almost an obstacle to seeking therapy. But if you have built up a good relationship and are regularly available as a contact person, then sometimes there is a need for them: \u0026ldquo;Yes, but I talk to you anyway. That's enough for me anyway.\u0026rdquo; And then they don't realize that it's not therapy and that we can't offer that. And then sometimes it takes a lot of persuasion.\u0026rsquo; (Family support worker FGW)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lsquo;I think it depends a lot on the degree of networking. It helps many families if the organizational process is relatively short and there aren't many small steps to take. For example, with our five units, the psychotherapy units, I have the impression that it's very easy and the hurdle is therefore incredibly small. Because the way it works is that we first ask the therapists whether they can accept someone and then we give the family the contact details of the relevant therapist. Then the family just has to call to make an appointment. Then that's already done. I have the impression that it's easier than having to fill out five forms and make five phone calls here and there. It's often more difficult.\u0026rsquo; (Family support worker FGT)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eFGV\u0026thinsp;=\u0026thinsp;Focus Group Vienna, FGT\u0026thinsp;=\u0026thinsp;Focus Group Tyrol, PT\u0026thinsp;=\u0026thinsp;Psychotherapist, GL\u0026thinsp;=\u0026thinsp;Group Leader, T\u0026thinsp;=\u0026thinsp;Tyrol Current Participant, V\u0026thinsp;=\u0026thinsp;Vienna Current Participant, VF\u0026thinsp;=\u0026thinsp;Vienna Former Participant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSatisfaction with evaluated services\u003c/h2\u003e \u003cp\u003eMothers were asked to indicate the extent to which they found the service helpful, 1 being the most helpful and 5 being the least helpful rating. In Tyrol, of the 14 parents who responded, eight gave the grade 1 (\"very good\"), five gave the grade 2 (\"good\"), and one gave the grade 2 to 3 (\"good to satisfactory\"). In Vienna, of the 22 mothers who were asked this question, half gave the service a 1, three others rated it 1\u0026ndash;2, five respondents gave it a 2, one respondent rated it 2\u0026ndash;3, and two respondents gave it a 3.\u003c/p\u003e \u003cp\u003eWhen asked about the general features, mothers rated the evaluated services very positively. In Tyrol, the psychotherapists, the geographical location, and rules/structures (e.g., flexibility in scheduling or rescheduling appointments) were very often highlighted positively. In Vienna, it was particularly the duration of the sessions, the premises, as well as the group size. In Tyrol, mothers reported varied views about the length of the support; for some, it was perceived as very suitable for a first, low-threshold introduction to psychotherapy, many others however believed that the service should be extended to up to 10 sessions, as five sessions are not suitable for more complex topics or situations. In Vienna, the fact that it consists of a fixed, limited group of members was often perceived as positive. The mothers mostly got on well with each other and there was a harmonious atmosphere.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSubjective reduction of psychological burden\u003c/h2\u003e \u003cp\u003eIn Tyrol, nine of the 14 respondents estimated the extent of the reduction in psychological stress as \u0026ldquo;a lot\u0026rdquo; and the remaining five as \u0026ldquo;a little\u0026rdquo;. In Vienna for 16 of the current or former participants in the group program, the psychosocial stress had reduced \u0026ldquo;a lot\u0026rdquo;, for two mothers it had reduced \u0026ldquo;a little\u0026rdquo; or \u0026ldquo;not at all\u0026rdquo; and for three mothers it was unclear.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAreas of impact\u003c/h2\u003e \u003cp\u003eThe important of areas of impact differed between the two services, which is likely due to their different context. In Tyrol, understanding their mental illness and feeling more stable in their mental health, were common aspects reported by mothers. Others included reductions in their psychological symptoms and improvements in self-efficacy and self-confidence. In Vienna, the areas of impact that were mentioned by the largest proportion of mothers were mental relief, development of a network, and self confidence in parenting skills. Similar perceived areas of impact were described by practitioners (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAreas of impact\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCode\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eQuote\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving a better understanding of their mental illness and feeling more stable in their mental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;Mrs. N. N. said that I have mental exhaustion. In other words, you can just tell that I'm overloaded. By telling me that I have to look at it differently, she was able to help me a lot.\u0026rsquo; (Mother#T30)\u003c/p\u003e \u003cp\u003e\u0026lsquo;Hearing from someone that this is a phase, albeit a difficult one, but finding your way out of it together is very helpful. You've experienced this several times from the outside. You get the feeling that there is hope.\u0026rsquo; (Mother #VF13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived reduction in psychological symptoms through exchange and social integration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;I was happy to go. I think our appointments were every fortnight. It was a real time for me to talk, because I didn't have anyone in my neighborhood that I could talk to openly. That was really good for me. I also told the therapist a few times that I was looking forward to the appointments. I always had the impression that when I told my friends that I wasn't feeling so well or that I didn't feel fit, I sometimes got cold reactions, or they rolled their eyes. It wasn't the way I imagined it would be. I had the feeling that they didn't like listening to me. They didn't understand why I was imagining it all and dismissed it as nonsense. I didn't do it voluntarily and really got myself into it.\u0026rsquo; (Mother #T31)\u003c/p\u003e \u003cp\u003e\u0026lsquo;It's a huge relief to realize that you're not alone. My problems are recognized and I don't have to be afraid that they will be taken the wrong way in the group.\u0026rsquo; (Mother W #VF13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevelopment of a network (in Vienna)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;[...] this network that was created because you can now exchange more information. In the beginning, we set up this WhatsApp group, and in the first few weeks I thought to myself: \u0026ldquo;What do we need it for?\u0026rdquo; But now it's really very helpful, you can write something in there straight away if you have something [to share]. So, I wrote down the sore bum or the feeling I had when my parents were looking after the little one. Responses came straight away and then you feel better again, once you've told someone about it and someone responds straight away and writes: \u0026ldquo;I feel the same way when I'm at work and my little one isn't there\u0026rdquo;. Those two points have changed the most for me.\u0026rsquo; (Mother #V3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf confidence in parenting skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;The fact that I was able to get advice regarding my daughter's diet, for example, gave me more confidence. I learnt from the other women how they deal with the situation.\u0026rsquo; (Mother #V6)\u003c/p\u003e \u003cp\u003e\u0026lsquo;I've become a bit more relaxed in my dealings with N. N. [child], so I don't stress myself out so much anymore.\u0026rsquo; (Mother #T22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiencing improvements in relationship with child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;What has totally changed, however, is that I only felt safe when I was changing my child\u0026rsquo;s nappy, for example, and otherwise I didn't know how to fill the day with my child, or that the bond wasn't as strong. That is definitely very different.\u0026rsquo; (Mother #V3)\u003c/p\u003e \u003cp\u003e\u0026lsquo;We're harmonizing again now. I understand her now, and it just works.\u0026rsquo; (Mother #T40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprovement in self-efficacy and self-confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;What has improved is that I no longer completely lose my nerve on many topics, but I know that I can ask someone. If I don't ask on Monday, I can ask on Wednesday at the \u003cem\u003ebaby club\u003c/em\u003e. It also depends on the severity of the issues. But now I know which books I can look up.\u0026rsquo; (Mother #V8)\u003c/p\u003e \u003cp\u003e\u0026lsquo;Getting into action. Clients often say: \u0026ldquo;I'm glad that I'm here now, that I've arrived.\u0026rdquo; That's the first thing. The second is: \u0026ldquo;Then I dare to change something, to think about what is actually possible. What can I do? What options do I and my environment have?\u0026rdquo;\u0026rsquo; (Psychotherapist #PT3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-acceptance and self-awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;[...] take everything a little more calmly and appreciate it more. You often only see the negative things and what you didn't manage to do during the day. In the group, we also celebrated small things that we had achieved. It was also extremely important to reflect on that.\u0026rsquo; (Mother #VF15)\u003c/p\u003e \u003cp\u003e\u0026lsquo;Self-acceptance and understanding yourself more was also supported. Why is it like that for me? Clients were able to accept themselves more. It went more in the direction of self-love and acceptance.\u0026rsquo; (Psychotherapist # PT1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDealing with life changes due to the child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;[...] that I accept that my life has changed. I had serious issues accepting that my previous life was over, that I had gained something and that it had changed. Now, for example, I couldn't imagine my life without [child].\u0026rsquo; (Mother #T35)\u003c/p\u003e \u003cp\u003e\u0026lsquo;For me it was the issue of stress, I was simply overwhelmed by the situation itself and also because everything went so wrong. My stress reserves were simply at zero right from the start, and then having to fight the day with a new being was terrible. They gave me a few pointers to take the stress out.\u0026rsquo; (Mother #VF15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartnership/family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;[...] that it can simply be a help when my parents are there - to get new perspectives, to see that in other countries it is perhaps also quite different how other family members also look after the little one.\u0026rsquo; (Mother #V3)\u003c/p\u003e \u003cp\u003e\u0026lsquo;We are now much more of a unit as a family than before. That's how it feels to me now. That took half a year.\u0026rsquo; (Mother #T45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation of one\u0026rsquo;s own motherhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;We talked about motherhood at the second meeting. We collected flipcharts on what makes a good mother. We didn't realize how harshly you judge yourself as a mother - why I judge myself so harshly and where my insecurities come from. The exercise stayed with me in my mind for the whole semester. It opened my eyes.\u0026rsquo; (Mother #V8)\u003c/p\u003e \u003cp\u003e\u0026lsquo;That's easier too. But yes, being a mum has generally become easier, more stable, you could say. Things still happen. But everything around it is more stable. The group has certainly helped me to stabilize in my new role because I can reflect honestly. If I can't do that, then I can never find out or know who or how I want to be as a mum. That's more solidified now.\u0026rsquo; (Mother #V7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperiencing less (self-) stigma after the support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;You just have images in your head that you don't want to correspond to or actually don't correspond to. And there are lots of mums sitting there who have had psychoses, then you see them and think to yourself: \u0026ldquo;What? Mums like \u003cem\u003ethat\u003c/em\u003e have had a psychosis?\u0026rdquo; [...] and then it's all totally put into perspective.\u0026rsquo; (Mother #VF1)\u003c/p\u003e \u003cp\u003e\u0026lsquo;I'm also very open about it now. If someone asks me how I am or have been, I talk about it openly and even if there's just a little spark and you're not quite sure whether it's normal or not normal: \u0026ldquo;Please get help\u0026rdquo;. I think I've already helped women, so that they know they're not alone. And I think that's a lot. You always read that it affects so many women, but once you actually know the women, it's something else.\u0026rsquo; (Mother #T29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eFGV\u0026thinsp;=\u0026thinsp;Focus Group Vienna, FGT\u0026thinsp;=\u0026thinsp;Focus Group Tyrol, PT\u0026thinsp;=\u0026thinsp;Psychotherapist, GL\u0026thinsp;=\u0026thinsp;Group Leader T\u0026thinsp;=\u0026thinsp;Tyrol Current Participant, V\u0026thinsp;=\u0026thinsp;Vienna Current Participant, VF\u0026thinsp;=\u0026thinsp;Vienna Former Participant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026lt;\u0026lt; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e should go here \u0026gt;\u0026gt;\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGiven the high demand for mental health services among perinatal women in Austria, and the limited availability of specialized care, the two evaluated services play a crucial role in the landscape of perinatal and infant mental healthcare (Zechmeister-Koss, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Zechmeister-Koss et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). They make an important contribution to improving the wellbeing of young mothers with psychological concerns.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAccess and reducing barriers\u003c/h2\u003e \u003cp\u003eDue to their features (e.g., low threshold access: being free of charge, no diagnosis of a mental illness required for participation), their specialization on mothers and close networking with family support, the two evaluated services help to reduce the barriers that frequently exist when using psychosocial services (Hadfield \u0026amp; Wittkowski, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Iturralde et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Millett et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Sagerschnig/Sator 2018; Sagerschnig et al. \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Schamschula/Paul 2024; Viveiros \u0026amp; Darling, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This support through family support workers, e.g., organizing or accompanying the mother to the first appointment is particularly important in a fragmented healthcare system as in Austria (Kern et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Simon et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Zechmeister-Koss, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). It was somewhat contrary to our expectations that the limited scope of the Tyrolean service was also seen in a positive context, by facilitating accepting help through conveying a \u0026lsquo;feeling of being able to try things out\u0026rsquo;. As expected, the \u003cem\u003eclosed\u003c/em\u003e group setting and the target group-specific orientation of the Vienna group program also encouraged participation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eProfessional support\u003c/h2\u003e \u003cp\u003eRegarding experiences of mothers with perinatal mental healthcare, a good relationship with qualified practitioners, feeling understood and treated \u0026lsquo;like ordinary people\u0026rsquo; by professionals (Hadfield et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Lever et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), as well as a treatment that is sufficiently tailored to the specific needs of this target group, proved to be important considerations for success and desired by mothers (Millett et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Regarding the evaluated services, the experience and expertise of the professionals, as well as their attitude (appreciative, empathetic, supportive, welcoming\u0026hellip;) were largely perceived positively. This was also found in Coates et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), where participants emphasized that supportive counselling provided a crucial safe space for self-reflection and personal growth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFlexible arrangements\u003c/h2\u003e \u003cp\u003eAs mothers described difficulties combining childcare and treatment (Hadfield et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Iturralde et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Millett et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and additionally often experience social pressure to prioritize their children's needs instead of their own mental health issues (Schamschula/Paul 2024), services like those evaluated - with flexible arrangements of appointments (Tyrol) or joint services for parents and children (mainly Vienna) - are especially appreciated and valued (Coates et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lever et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Rossiter et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePeer support\u003c/h2\u003e \u003cp\u003eAnother important factor influencing satisfaction with the group service in Vienna is the provision of peer support. One aim of the group service is to bring mothers out of possible isolation and connect them with peers. By being a \u003cem\u003eclosed\u003c/em\u003e group, the mothers could build trust in each other and internalize that they are not alone with their problems. Westgate et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) similarly emphasized the value of interventions that facilitate peer interactions among women experiencing perinatal depression. These interventions foster meaningful relationships, validate individual experiences, alleviate feelings of loneliness, and create opportunities for participants to connect with others who are further along in their recovery journey. Relief through exchange with peers and through the feeling of being socially integrated as well as development of a network are areas of impact that are mentioned most often in our study. This is in line with results from Hadfield et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) who found that peer support and social integration significantly reduced feelings of isolation and stigma, while enhancing mental health and parenting confidence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the services\u003c/h2\u003e \u003cp\u003eCurrently the services can only reach women with sufficient knowledge of German, so certain vulnerable groups cannot benefit from them. Iturralde et al. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) emphasizes that it is important to consider cultural differences when developing programs and to respond to specific needs and values of different ethnic groups. This can be achieved through the involvement of culturally competent professionals and the provision of information in different languages. In addition, the limited scope of the service in Tyrol means that it is not sufficient for mothers with more complex problems, and the limited capacity of the service in Vienna leads to waiting times. Another limitation is the low involvement of fathers in the services. When involvement of the partner was reported, it was perceived as useful by mothers in our study. Literature also shows that the involvement of the family and male partners/fathers is very important in the treatment of women with perinatal mental health problems (Lever et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Noonan et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Walton et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and often desired by the patients, (Millett et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Powell et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and their partners (Feeley et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In addition, fathers with young children often experience perinatal illnesses themselves (Anding et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Kim \u0026amp; Swain, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; O\u0026rsquo;Brien et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), are often undiagnosed due to limitations of screening tools (Sch\u0026ouml;ch et al. \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and are especially confronted with stigma. Galasinski (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) highlights in this context the stigma arising from conflicting discourses about masculinity and mental illnesses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations of the evaluation\u003c/h2\u003e \u003cp\u003eThe use of different qualitative and quantitative approaches and the inclusion of different perspectives made it possible to obtain a comprehensive picture. The applied screening instruments are tried and tested for their application in this target group. The EPDS and GAD-7 questionnaires proved to be very suitable for this evaluation, the suitability of the PBQ questionnaire, however, can be critically questioned. It was selected to investigate the topic of attachment, but most results were already unremarkable at the first measurement. Due to the relatively short-term follow-up, only statements on short-term benefits can be made based on the screening results. The qualitative interviews with participating mothers and specialists were all conducted using guidelines to ensure better comparability and to improve rigor. As the interviews and the online survey were based on voluntary participation, a self-selection bias in the group of respondents is possible. Furthermore, social desirability bias in response behavior cannot be ruled out. Retrospective questions (interviews with mothers who used the service in the years before), could be affected by recall bias. In addition, mostly mothers who had already received support from Fr\u0026uuml;he Hilfen took part. It can therefore be assumed that these mothers are generally open to psychosocial services.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eImplications for policy and practice\u003c/h2\u003e \u003cp\u003eBased on the evaluation results, the following implications for policy and practice can be summarized (see Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The findings highlight the importance of embedding psychosocial services within existing early childhood intervention systems. The close integration with Fr\u0026uuml;he Hilfen facilitated access to support for mothers experiencing psychological stress while enabling coordination between family support services and therapeutic care. Such integrated models may strengthen preventive approaches to maternal and infant mental health within public health systems. Flexible service delivery formats, including adaptable scheduling, language-sensitive provision, and practical support such as childcare, appear important for ensuring equitable access to psychosocial support for mothers experiencing psychological stress.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTopic\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRecommendations\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eExpansion of Services\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is recommended to tailor service duration to mothers\u0026rsquo; needs. In Tyrol this would mean a base of five sessions, expandable to ten if necessary. In Vienna, offering multiple groups at different locations and times (morning/afternoon) with varying focuses (e.g., pregnant women, single parents, fathers) is suggested. To better integrate mothers with migration backgrounds, group leaders from similar backgrounds should be involved.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTarget-Specific Design\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo ensure equal access, therapy in foreign languages should be offered. Due to mothers\u0026rsquo; psychological burdens, online sessions or home visits could be considered. Arranging external childcare would help mothers access therapy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eStructure and Communication\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe close connection between the evaluated services and Fr\u0026uuml;he Hilfen is seen as beneficial for both families and those providing treatment and should therefore be maintained. It might be useful to establish clear communication and networking structures to support the exchange. Maintaining flexible scheduling in an individual setting helps accommodate childcare and work hours. Rules and expectations, like bringing children to sessions, need to be clearly communicated to mothers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAwareness of the service\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClear and broad information about the services should be provided, especially to healthcare professionals and families, focusing on who can access the services. To reduce stigma and fear, details about anonymity and confidentiality should be emphasized.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eContent and Interventions\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBased on mixed feedback, participants of group services should be more involved in selecting session content. Regular feedback should be sought to adjust as needed. Sessions should end with a review, and individual follow-up meetings should be offered after emotionally intense sessions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026lt;\u0026lt; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e should go here \u0026gt;\u0026gt;\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch question\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTARG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReflexive Thematic Analysis Reporting Guidelines\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEDPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGAD-7\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneralized Anxiety Disorder Scale 7\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePBQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostpartum Bonding Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMAXQDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMax Qualitative Data Analysis \u0026ndash; computer assisted data analysis software program\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFR\u0026Uuml;DOK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFr\u0026uuml;he Hilfen Dokumentation: Online Documentation System for National Centre for Early Chilhood Support, Fr\u0026uuml;he Hilfen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFGV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocus Group Vienna\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFGT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocus Group Tyrol\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePsychotherapist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGroup Leader\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTyrol Current Participant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVienna Current Participant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVienna Former Participant\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInformed Consent Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was performed in line with the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Medical Universities in Innsbruck (EK Nr: 1243/2022) and Vienna (EK Nr: 1636/2022). Participants provided informed consent, and ethical guidelines were strictly followed throughout the study. Each participant was assigned a unique five-digit code to ensure anonymity, and all documents were securely stored - access to raw data was restricted to the evaluation team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe Additional Files contain the interview guidelines, screening instruments employed in the study, and the analytical code system developed for data analysis. Further deidentified research materials can be obtained from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The research leading to these results received funding from the Austrian Ministry of Social Affairs, Health, Care and Consumer Protection. This research was also funded in part by the Austrian Science Fund (FWF) [grant DOI\u0026nbsp;10.55776/cm6]. For open access purposes, authors have applied a CC BY public copyright license to any author accepted manuscript version arising from this submission. The funders had no role in the study design, data collection, analysis or interpretation, manuscript preparation, or the decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e Conceptualization, T.O., S.S., F.S., P.S., J.L.P.; methodology, T.O., S.S., F.S., P.S., J.L.P.; validation, T.O., S.S., F.S., P.S.; formal analysis, T.O., S.S., F.S., P.S.; investigation, T.O., S.S., F.S.; resources, J.L.P.; T.O.; data curation, T.O., S.S, F.S.; writing\u0026mdash;original draft preparation, T.O., S.S., F.S., P.S., J.L.P.; writing\u0026mdash;review and editing, T.O., S.S., F.S., P.S., J.L.P.; visualization, F.S.; supervision, J.L.P.; project administration, T.O., P.S. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to express our sincere gratitude to all individuals and institutions involved in this evaluation. Our thanks go to the initiators and implementation partners of \u0026ldquo;Netzwerk Gesund ins Leben\u0026rdquo; (Tyrol) and \u0026ldquo;gut begleitet \u0026ndash; Fr\u0026uuml;he Hilfen Wien\u0026rdquo;, and to independent collaborator Martina Glatz-Grugger for her valuable contributions. We appreciate the early input from Dr. Sabine Haas (Nationales Zentrum Fr\u0026uuml;he Hilfen (NZFH.at)) and Dr. Zechmeister-Koss (Director, Austrian Institute of Health Technology Assessment) who provided insight on the study design. We are especially grateful to all participants who took part in the interviews, focus groups, and online survey\u0026mdash;your openness and time made this research possible. We thank our colleagues at Gesundheit \u0026Ouml;sterreich GmbH for their constructive feedback and advice throughout the project. The personal commitment of everyone involved was essential to the successful implementation of this study. Finally, we gratefully acknowledge all those who provided administrative and organizational support, as well as the project\u0026rsquo;s funding bodies.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnding JE, R\u0026ouml;hrle B, Grieshop M, Sch\u0026uuml;cking B, Christiansen H. Couple comorbidity and correlates of postnatal depressive symptoms in mothers and fathers in the first two weeks following delivery. J Affect Disord. 2016;190/:300\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2015.10.033\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2015.10.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnding J, R\u0026ouml;hrle B, Grieshop M, Sch\u0026uuml;cking B, Christiansen H. Early detection of postpartum depressive symptoms in mothers and fathers and its relation to midwives\u0026rsquo; evaluation and service provision: a community-based study. Front Pead. 2015;3/:62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fped.2015.00062\u003c/span\u003e\u003cspan address=\"10.3389/fped.2015.00062\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntony G, Bengough T, Marbler C, Sagerschnig S. The Austrian Early Childhood Intervention Programme: Support for families with young children in burdened life circumstances to improve relational health and well-being. Perspect Infant Mental Health. 2021;29/1:16\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBauer A, Parsonage M, Knapp M, Iemmi V, Adelaja B, Hogg S. The costs of perinatal mental health problems. London: Centre Mental Health Lond School Econ. 2014;44/:1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://eprints.lse.ac.uk/598\n85/1/__lse.ac.uk_storage_LIBRARY_Seconda\nry_libfile_shared_repository_Content_Bauer%2\nC%20M_Bauer_Costs_perinatal_%20mental_20\n14_Bauer_Costs_perinatal_mental_2014_author\n.pdf\u003c/span\u003e\u003cspan address=\"https://eprints.lse.ac.uk/59885/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_Bauer%2C%20M_Bauer_Costs_perinatal_%20mental_2014_Bauer_Costs_perinatal_mental_2014_author.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. (2024). Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: A review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). \u003cem\u003ePalliative medicine\u003c/em\u003e, 38(6), 608\u0026ndash;616. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/02692163241234800\u003c/span\u003e\u003cspan address=\"10.1177/02692163241234800\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoates D, Davis E, Campbell L. The experiences of women who have accessed a perinatal and infant mental health service: a qualitative investigation. Adv Mental Health. 2016;15/1:88\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/18387357.2016.1242374\u003c/span\u003e\u003cspan address=\"10.1080/18387357.2016.1242374\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Clark VLP. Designing and conducting mixed methods research. Sage; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodge KA, Goodman WB, Murphy RA, O\u0026rsquo;Donnell K, Sato J, Guptill S. Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting. Am J Public Health. 2014;104/S1:S136\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2105/ajph.2013.301361\u003c/span\u003e\u003cspan address=\"10.2105/ajph.2013.301361\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeeley N, Bell L, Hayton B, Zelkowitz P, Carrier ME. Care for Postpartum Depression: What Do Women and Their Partners Prefer? Perspect Psychiatr Care. 2016;2016/52:120\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ppc.12107\u003c/span\u003e\u003cspan address=\"10.1111/ppc.12107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/1475-6773.12117\u003c/span\u003e\u003cspan address=\"10.1111/1475-6773.12117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalasinski D. Fathers, Fatherhood and Mental Illness. Palgrave Macmillan; 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadfield H, Glendenning S, Bee P, Wittkowski A. Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis. J Child Fam stud. 2019;2019/28:3519\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10826-019-01535-0\u003c/span\u003e\u003cspan address=\"10.1007/s10826-019-01535-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHadfield H, Wittkowski A. Women\u0026rsquo;s Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature. J Midwifery Women\u0026rsquo;s Health. 2017;62/6:723\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jmwh.12669\u003c/span\u003e\u003cspan address=\"10.1111/jmwh.12669\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026ouml;lzle L, Sch\u0026ouml;ch P, H\u0026ouml;rtnagl C, Buchheim A, Lampe A, Zechmeister-Koss I, Paul JL. Identifying and synthesizing components of perinatal mental health peer support \u0026ndash; a systematic review. Front Psychiatry. 2024;20/15:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoward LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384/9956:1775\u0026ndash;88. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0140-6736(14)61276-9\u003c/span\u003e\u003cspan address=\"10.1016/s0140-6736(14)61276-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIturralde E, Hsiao CA, Nkemere L, Kubo A, Sterling SA, Flanagan T, Avalos L. Engagement in perinatal depression treatment: a qualitative study of barriers across and within racial/ethnic groups. BMC Pregnancy Childbirth. 2021;2021/21:512. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12884-021-03969-1\u003c/span\u003e\u003cspan address=\"10.1186/s12884-021-03969-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med. 2021;18/5:e1003602. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pmed.1003602\u003c/span\u003e\u003cspan address=\"10.1371/journal.pmed.1003602\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKern J, Edlinger M, Zechmeister-Koss I. (2024). Uptake of Mental Health Benefits in Women Before and During the Perinatal Period - An Analysis of Austrian Health Insurance Data. \u003cem\u003eAIHTA Project Report\u003c/em\u003e. ISSN online 1993\u0026thinsp;\u0026ndash;\u0026thinsp;0496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim P, Swain JE. (2007). Sad dads: paternal postpartum depression. \u003cem\u003ePsychiatry (Edgmont)\u003c/em\u003e 4/2:35. PMID: 20805898; PMCID: PMC2922346.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKowalenko N, Barnett B, Fowler C, Matthey S. The Perinatal Period: Early Intervention for Mental Health. Clinical Approaches to Early Intervention in Child and Adolescent Mental Health. Austrlian Early Intervention Network for Mental Health in Young People; 2000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLever BT, Kandiah A, Johnson S, Howard LM, Morant N. A qualitative investigation of models of community mental health care for women with perinatal mental health problems. J Mental Health. 2020;30/5:594\u0026ndash;600. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638237.2020.1714006\u003c/span\u003e\u003cspan address=\"10.1080/09638237.2020.1714006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLever TB, Billings J, Morant N, Bick D, Johnson S. Experiences of how services supporting women with perinatal mental health difficulties work with their families: a qualitative study in England. BMJ Open. 2019;9/7:e030208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2019-030208\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2019-030208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons-Ruth K, Todd Manly J, Von Klitzing K, Tamminen T, Emde R, Fitzgerald H, Paul C, Keren M, Berg A, Foley M. The worldwide burden of infant mental and emotional disorder: Report of the task force of the world association for infant mental health. Infant Mental Health J. 2017;38:695\u0026ndash;705. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/imhj.21674\u003c/span\u003e\u003cspan address=\"10.1002/imhj.21674\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahoney G, Filer J. How responsive is early intervention to the priorities and needs of families? Top Early Child Special Educ. 1996;16/4:437\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/027112149601600405\u003c/span\u003e\u003cspan address=\"10.1177/027112149601600405\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarbler C, Sagerschnig S, Scolik F, Winkler P. Fr\u0026uuml;he Hilfen. Zahlen, Daten und Fakten 2023. Wien: FR\u0026Uuml;DOK Jahresbericht. Gesundheit \u0026Ouml;sterreich; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMillett L, Taylor BL, Howard LM, Bick D, Stanley N, Johnson S. Experiences of Improving Access to Psychological Therapy Services for Perinatal Mental Health Difficulties: a Qualitative Study of Women\u0026rsquo;s and Therapists\u0026rsquo; Views. Behav Cogn Psychother. 2017;46/4:421\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/s1352465817000650\u003c/span\u003e\u003cspan address=\"10.1017/s1352465817000650\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoonan M, Jomeen J, Doody O. A review of the involvement of partners and family members in psychosocial interventions for supporting women at risk of or experiencing perinatal depression and anxiety. Int J Environ Res Public Health. 2021;18/10:5396. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18105396\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18105396\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Hara MW, Swain AM. Rates and risk of postpartum depression\u0026mdash;a meta-analysis. Int Rev psychiatry. 1996;8/1:37\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/09540269609037816\u003c/span\u003e\u003cspan address=\"10.3109/09540269609037816\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Brien AP, McNeil KA, Fletcher R, Conrad A, Wilson AJ, Jones D, Chan SW. New fathers\u0026rsquo; perinatal depression and anxiety\u0026mdash;Treatment options: An integrative review. Am J Men's Health. 2017;11/4:863\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1557988316669047\u003c/span\u003e\u003cspan address=\"10.1177/1557988316669047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeacock S, Konrad S, Watson E, Nickel D, Muhajarine N. Effectiveness of home visiting programs on child outcomes: a systematic review. BMC Public Health. 2013;13/:1\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2458-13-17\u003c/span\u003e\u003cspan address=\"10.1186/1471-2458-13-17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowell C, Bedia S, Nathab S, Pottsa L, Trevilliona K, Howard L. Mothers' experiences of acute perinatal mental health services in England and Wales: a qualitative analysis. J Reproductive Infant Psychol. 2020;40/5:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02646838.2020.1814225\u003c/span\u003e\u003cspan address=\"10.1080/02646838.2020.1814225\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossiter C, Fowler C, Mcmahon C, Kowalenko N. Supporting depressed mothers at home: Their views on an innovative relationship-based intervention. Contemp Nurse. 2012;41/1:90\u0026ndash;100. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5172/conu.2012.41.1.90\u003c/span\u003e\u003cspan address=\"10.5172/conu.2012.41.1.90\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagerschnig S, Grabenhofer-Eggerth A, Kern D. Modell f\u0026uuml;r einen verbesserten Zugang zur psychosozialen Versorgung f\u0026uuml;r Kinder und Jugendliche. Wien: Gesundheit \u0026Ouml;sterreich; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagerschnig S, Ofner T, Scolik F. Psychosoziale Angebote und Fr\u0026uuml;he Hilfen. Evaluation spezifischer Angebote bei psychischen Belastungen im Rahmen der Fr\u0026uuml;hen Hilfen; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSagerschnig, Sophie; Grabenhofer-Eggerth, Alexander; Kern, Daniela;; Sator, Marlene;Zuba, Martin (2018): Inanspruchnahme von Psychotherapie und psychiatrischer Rehabilitation im Kontext der Angebote. Gesundheit \u0026Ouml;sterreich, Wien.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchachner A, Hesse N, Rappauer A, Stadler-Vida M. Umsetzung von regionalen Fr\u0026uuml;he-Hilfen-Netzwerken in \u0026Ouml;sterreich - Endbericht der summativen Evaluation. queraum. Wien: kultur- und sozialforschung; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchamschula M, Paul JL. Deconstructing stigmatising narratives: a qualitative analysis of contrast devices in interviews with mothers with a mental illness. BMC Psychol. 2024;12/1:433.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSch\u0026ouml;ch P, H\u0026ouml;lzle L, Lampe A, H\u0026ouml;rtnagl C, Zechmeister-Koss I, Buchheim A, Paul JL. (2024): Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps. In: frontiers in Public Health 2024/12:1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon J, Boyer P, Caldas-de-Almeida JM, Knapp M, McCrone P, Gorwood P, Oertel W, Arango C, Treasure J, Young AH, Destrebecq F, Quoidbach V. Viewpoint: Assessing the value of mental health treatments in Europe. Eur Psychiatry. 2023;66/1:3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/j.eurpsy.2023.2419\u003c/span\u003e\u003cspan address=\"10.1192/j.eurpsy.2023.2419\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanLandeghem K, Curtis D, Abrams M. (2002). Reasons and strategies for strengthening childhood development services in the healthcare system. Natl Acad State Health Policy Portland \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2002\n_oct_reasons_and_strategies_for\n_strengthening_childhood_devel\nopment_services_in_the_healthcare_\nsystem_vanlandeghem_nashp_630_\npdf.pdf\u003c/span\u003e\u003cspan address=\"https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2002_oct_reasons_and_strategies_for_strengthening_childhood_development_services_in_the_healthcare_system_vanlandeghem_nashp_630_pdf.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViveiros CJ, Darling E, K. Barriers and facilitators of accessing perinatal mental health services: The perspectives of women receiving continuity of care midwifery. Midwifery. 2018;2018/65:8\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.midw.2018.06.018\u003c/span\u003e\u003cspan address=\"10.1016/j.midw.2018.06.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalton GD, Ross LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S. Decisional conflict among women considering antidepressant medication use in pregnancy. Archives Women\u0026rsquo;s Mental Health. 2014;17/6:493\u0026ndash;501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00737-014-0448-1\u003c/span\u003e\u003cspan address=\"10.1007/s00737-014-0448-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestgate V, Manchanda T, Maxwell M. Women\u0026rsquo;s experiences of care and treatment preferences for perinatal depression: a systematic review. Archives Women\u0026rsquo;s Mental Health. 2023;2023/26:311\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00737-023-01318-z\u003c/span\u003e\u003cspan address=\"10.1007/s00737-023-01318-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZechmeister-Koss I. (2023). Perinatal and infant mental health care in Austria. A mapping report of existing prevention, screening and care structures, with a specific focus on Tyrol. \u003cem\u003eAIHTA Project Report\u003c/em\u003e. ISSN online 1993\u0026thinsp;\u0026ndash;\u0026thinsp;0496.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZechmeister-Koss I, H\u0026ouml;rtnagl C, Lampe A, Paul JL. (2024): Perinatal and infant mental health care in Austria. In: Neuropsychiatrie 2025/39:11\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"early childhood intervention, maternal mental health, psychosocial services, family support, access barriers, mixed methods evaluation","lastPublishedDoi":"10.21203/rs.3.rs-9136961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9136961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePsychological stress during pregnancy and early motherhood is a major public health concern with significant implications for maternal wellbeing and early child development. Persistent stress during this period can adversely affect maternal mental health, parent\u0026ndash;child interactions, and the developmental trajectories of infants. Early childhood intervention programs aim to provide preventive support to vulnerable families; however, systematic evaluations of psychosocial services embedded within these programs remain limited. Understanding how such services meet maternal needs and contribute to health outcomes is essential for informing service delivery and policy. This study evaluates two psychosocial services offered to mothers experiencing psychological stress in Tyrol and Vienna as part of the Austrian Early Childhood Intervention Program \u0026ldquo;Fr\u0026uuml;he Hilfen\u0026rdquo;. The study aimed to explore the needs of mothers participating in early childhood interventions and to assess the perceived benefits and challenges of two psychosocial services from the perspectives of both mothers and healthcare providers.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA summative evaluation using a mixed-methods design was conducted. Data were collected through focus groups and individual interviews with participating mothers and healthcare providers, complemented by standardized screening instruments to assess maternal mental health and wellbeing. Qualitative data were analyzed using content analysis to identify recurring themes, perceptions, and experiences, while quantitative screening data were analyzed descriptively to examine changes in maternal outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipating mothers valued the services for their low-threshold access, professional support, and flexibility. In Tyrol, mothers reported improvements in mental health and self-efficacy following participation in short-term psychotherapeutic interventions. In Vienna, group therapy sessions facilitated peer support, reduced feelings of isolation, and strengthened parenting confidence. The group setting enabled mothers to share experiences, build trust, and develop supportive networks. Improvements were also reflected in screening scores. At the same time, barriers such as language limitations and limited service capacity were identified.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePsychosocial services embedded within early childhood interventions can make an important contribution to perinatal and infant mental healthcare. The findings highlight the value of accessible psychosocial support for mothers experiencing psychological stress while identifying structural barriers that should be addressed to improve access and service capacity within the public health systems.\u003c/p\u003e","manuscriptTitle":"Psychosocial support for mothers experiencing psychological stress in early childhood interventions: a mixed-methods evaluation in Austria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 05:28:10","doi":"10.21203/rs.3.rs-9136961/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-02T03:31:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-24T17:18:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T17:18:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Public Health","date":"2026-03-16T10:56:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aoph","sideBox":"Learn more about [Archives of Public Health](http://archpublichealth.biomedcentral.com/)","snPcode":"13690","submissionUrl":"https://submission.nature.com/new-submission/13690/3","title":"Archives of Public Health","twitterHandle":"@Archpubhealth","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2b7e5661-e98c-4306-af60-4088e887a205","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T05:28:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 05:28:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9136961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9136961","identity":"rs-9136961","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}