Design,Implementation,and Evaluation of a Preventive Intervention Program to Foster Social-Emotional Development and Attachment Security of Toddlers in Early Childhood Education and Care: The Papilio-U3 Program

Abstract

Due to an increasing number of children under the age of three attending early childhood education and care (ECEC), there is an increasing need for high-quality care settings. In addition to primary caregivers, ECEC teachers are important socializers of children’s emotional development and may become children’s attachment figures. Early preventive interventions bear the potential to reduce the risk for later maladaptive development in the social-emotional domain. The first objective of the present article is to introduce the Papilio-U3 program, a universal preventive intervention program to foster positive and sensitive teacher-child interactions, to foster children’s early social-emotional competence and secure child-teacher attachment relationships in ECEC, and to prevent children’s emotional and behavioral problems. Furthermore, we report the design and first results of the formative evaluation derived from the pilot evaluation study. The program was developed according to the Intervention Mapping Approach, and the present article describes the planning process comprising a needs assessment and description of the intervention context, the derivation of the logic model of change, a detailed account of the program design, production, implementation, and an overview of the program evaluation study (multi-centric, randomized-controlled trial). The total sample of the evaluation study comprised 125 teachers (age M= 34.0, SD = 10.1, 98.4 % female) from 55 ECEC centers. For the formative evaluation, teachers of the intervention group (n = 61) reported on training content, methods, material, organizational conditions, and potential challenges in the course of program implementation. Finally,we provide directions to revise the program and to guide future implementation of preventive intervention programs in the ECEC context.

Keywords

Early social-emotional development attachment early childhood education and care developmentally appropriate prevention intervention mapping approach

Social-Emotional Development in the First Three Years of Life

Sociocultural models of emotion research emphasize the importance of developmental context in the emergence of emotions. Holodynski (2005), for example, describes in the internalization model how fully functioning emotions emerge from innate precursor emotions by preschool age, and how the child’s caregivers in the early years of ontogeny facilitate this process through the repeated linkage of emotion occasion, expression, and response. Caregivers consciously or unconsciously expose their children to emotion-eliciting situations, interpret the children’s expression, and, ideally, respond to children’s needs. Thus, caregivers mirror children’s expression of the child’s presumed emotions based on social conventions highlighting that emotion socialization is culturally shaped.

As a caregiver (parent or teacher), orienting one’s behavior to the needs of the child is also a central aspect of attachment theory and research. Attachment is […] a relatively long-lived tie in which the partner is important as a unique individual, interchangeable with none other, from whom inexplicable involuntary separation would cause distress, and whose loss would occasion grief“ (Ainsworth, 1985, p. 799).

Multiple elements of the formation and presentation of early childhood attachment thereby exhibit conceptual intersections with social-emotional development: For example, attachment always emerges in a social system, most often the family microsystem (Bronfenbrenner, 1986); and individual differences in the caregivers’ responsiveness to infants’ emotions are related to the formation of different attachment qualities (Cassidy, 2016). Spangler and Zimmermann (1999) describe the inner working models (IWM) of attachment as control mechanisms in emotional regulation as they influence the perception, sensation, and interpretation of emotions. Moreover, individual differences in the IWM have been found to be associated with differences in the coherence of communication of emotions. Attachment security is associated with the development of social-emotional skills, whereas insecurity predicts social-emotional problems: Securely attached children, for example, show better emotion understanding and use more constructive emotion regulation strategies, demonstrate to a greater extent social competence with peers, and exhibit lower levels of externalizing and internalizing problems (Fearon et al., 2010; Groh et al., 2012; 2014; Thompson, 2016).

Aside from attachment relationships with their parents, children also form attachment relationships with secondary caregivers, such as early childhood education and care (ECEC) teachers (Ahnert et al., 2006; Howes & Spieker, 2016). While (dyadic) maternal sensitivity is a stable predictor of children’s attachment security to their primary caregivers (DeWolff & van Ijzendoorn, 1997), sensitive, group-oriented behavior has been shown to be predictive of the development of secure attachment relationships with teachers (Ahnert et al., 2006). Group-oriented sensitivity is characterized by an appropriate and prompt response to the needs of the individual child while taking into account the dynamics and needs of the entire group of children (Ahnert, 2014).

The transition to childcare is certainly the first major transition in the life of most children. Studies show that, although this transition can be accompanied by stress or emotional disturbances, teachers’ sensitivity and responsiveness can help children to cope with this challenge and foster secure child-teacher attachments (Ahnert et al., 2004; Ereky-Stevens et al., 2018).

Maladaptive child development pertains to clinically relevant disorders that may manifest as early as in the first years (ZERO TO THREE, 2016) as well as subclinical dysregulation, temperamental features, or social-emotional problems of varying intensity (Horwitz et al., 2013). The implementation of preventive interventions at an early stage of children’s development bears the potential to reduce the risk for later maladaptive development (see Izett et al., 2020, for a review of findings). Furthermore, a current meta-analysis demonstrated that attachment- and emotion-focused parenting interventions are effective in reducing children’s emotional and behavioral problems (Jugovac et al., 2022). Thus, the fostering of attachment security may be a promising framework for the design of early preventive interventions in other socialization contexts as well.

Developmentally Appropriate Prevention in the ECEC Context

Approaches to developmentally appropriate prevention are based on findings on the interaction of risk and protective factors and aim to attenuate age-specific risk factors, promote protective factors, and provide support in coping with key developmental tasks and developmental transitions (Malti et al., 2009; Scheithauer & Scheer, 2022). The implementation of preventive interventions in ECEC centers offers numerous advantages, such as providing early support in a child’s life course, reaching large parts of the population independent of family background, and the potential for collaboration between settings or institutions (Zimmer, 2002).

During the last decades, a number of international and national prevention programs has been developed for the ECEC setting (Egert et al., 2018; Werner et al., 2016) with a small number of programs addressing sensitive teacher-child-interactions (e.g., Fukkink & Tavecchio, 2010; Gray, 2015; Groeneveld et al., 2011; Helmerhorst et al., 2017). However, there is a lack of theory-driven and evidence-based programs and approaches in German-speaking countries. To our knowledge, the existing programs lack published evaluation results, do not have a specific focus on child-teacher attachment, or are of lower intensity involving only a brief teacher training (e.g., Binationales Zentrum Frühe Kindheit, 2022; Heidelberger Präventionszentrum, 2022).

The Present Article

Papilio is a developmentally oriented prevention approach aiming at fostering social-emotional competence and preventing early emotional and behavioral problems. Originally developed for teachers of children between the ages of three and six (Mayer et al., 2015; Scheithauer & Peter, 2022), the prevention program has been expanded since 2016 to include the age groups of first- and second-graders (Braun et al., 2018; Lechner et al., 2020) and children under the age of three (Ortelbach et al., 2018).

The present article consists of two parts: In the first part, the Papilio-U3 program is introduced. We present the program design based on the Intervention Mapping Approach (IMA; Bartholomew Eldredge et al., 2016) and give an overview of the implementation process and the program evaluation study. In the second part, we describe the design and first results of the formative evaluation derived from the pilot evaluation study.

Design and Implementation of the Papilio-U3 Program

The IMA provides a framework for the theory-guided, evidence-based development and implementation of health promotion programs. In Fig. 1, an overview of the six intervention mapping steps is depicted. Although predominantly used to design health programs, an increasing number of ECEC programs designed to target a wider range of outcome areas have drawn on this framework throughout the last years (Blewitt et al., 2020; O’Connor et al., 2018).

Figure 1.

Overview of the Intervention Mapping Approach (IMA). Note. Adopted from Bartholomew Eldredge et al. (2016, p. 13).

Step 1 –Logic Model of the Problem

Tasks at step 1 of the IMA comprise the establishment of a planning group, a needs assessment, description of the intervention context, and description of program goals and aims. The planning group for the design and implementation of the Papilio-U3 program consisted of experts in early child development and prevention from universities Freie Universität Berlin and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, as well as Papilio gGmbH, Germany, a team of experts on implementing ECEC programs. During all steps, the planning group regularly consulted practitioners such as ECEC program implementers or teachers to ensure program practicability and benefits.

The needs assessment comprised two phases: Based on repeated requests of ECEC centers and teachers to extend the Papilio-3to6 program (Mayer et al., 2015; Scheithauer & Peter, 2022) to children under three years of age, an extensive review of the scientific literature was conducted, and the ECEC context in Germany was analyzed. Key topics that emerged in the course of the literature review were milestones of social-emotional development in the first three years, child temperament and self-regulation, attachment development and its application to the ECEC context (including sensitive teacher-child interaction and attachment-based transition to childcare), fostering constructive relationships with the children’s parents, and professional self-care.

To describe this intervention context, we provide a brief outline of the German ECEC context in the following paragraph. Usually, German ECEC centers provide groups for children under the age of three (“Krippe“) and between the ages of three and six (“Kindergarten“), although a growing number of centers form mixed aged groups (see Deutsches Jugendinstitut, 2022, for detailed information). In Germany, professionals working with children in ECEC are teachers with varying professional qualifications: The majority of ECEC staff are teachers who have at least three years of professional education. However, some teachers have a lower (two years of professional education), or a higher educational degree (e.g., bachelor degree in social work or childhood education). Currently, 35.5% of the children under the age of three in Germany are enrolled in nonparental care (Statistisches Bundesamt, 2022a). As the majority of those children spend a considerable amount of time, more than seven hours per day, in childcare (Statistisches Bundesamt, 2022b), the quality of care is crucial.

Research shows that ECEC quality is associated with positive child development (Cadima et al., 2022; NICHD Early Child Care Research Network, 2002; Slot, 2018). To operationalize childcare quality, mainly two domains are subject to investigations: structural features of childcare (“structural quality“) on the one hand and process quality on the other hand, defined as “proximal processes of children’s everyday experiences […that] involve the social, emotional, physical, and instructional aspects of staff-child and peer interactions while being involved in play, activities or routines“ (Slot, 2018, p. 8). While studies indicate low to moderate quality of care in German ECEC centers (Tietze et al., 2013), prevention and intervention research show potential benefits of specific programs to foster sensitive teacher-child interactions and positive child development (Egert et al., 2018; Werner et al., 2016). Additionally, recent research discussed the need to consider teacher attributes such as job-related stress, resources, or beliefs as targets for intervention or mediators to enhance process quality (e.g., Blewitt et al., 2020; Sottimano et al., 2018; Tanaka et al., 2020).

As a result of the needs assessment and analysis of the intervention context, the following main aims for the preventive intervention program were elaborated:

Fostering of children’s social-emotional development and early social-emotional competence,

Fostering of sensitive teacher-child interactions and promotion of secure child-teacher attachment relationships,

Prevention of children’s emotional and behavioral problems (distal goal),

Enhancing teacher resources and knowledge related to, for example, social-emotional and attachment development, as well as fostering positive attitudes and beliefs,

Supporting the collaboration among teachers and between teachers and parents.

Step 2 –Program Outcomes and Objectives –Logic Model of Change

Step 2 of the IMA comprises tasks to select detailed intervention outcomes and specify personal determinants and performance objectives to build a logic model of change.

Drawing on important theories of early social-emotional development such as attachment theory or the internalizing model of emotional development, crucial targeted proximal child developmental outcomes were emotion perception and emotion understanding, emotional and verbal emotional expression, support of emotional and behavioral regulation, and secure attachment relationships to the teachers. Ultimately, these skills can promote early prosocial behavior and can prevent emotional and behavioral problems (defined as distal developmental outcomes). Targeted proximal and distal outcomes on the teacher level were the reduction of job-related stress and the promotion of job satisfaction and teacher self-efficacy, as well as the prevention of mental health problems (e.g., burnout, depression). A detailed list of all targeted outcomes can be found in Table 1.

Table 1

Targeted Outcomes of the Papilio-U3 Program

Main outcomes/intervention levels	Detailed outcomes
Fostering of children’s social-emotional development and early social-emotional competence	• Fostering of emotion perception and emotion understanding
	• Differentiation of emotional and verbal emotional expression
	• Support of emotional and behavioral regulation
	• Fostering of early prosocial behavior
	• Prevention of emotional and behavioral problems
Fostering of sensitive teacher-child-interactions	• Fostering of emotion talk
	• Fostering of dyadic sensitivity
	• Fostering of group-centered sensitivity
Fostering of secure child-teacher attachment relationships	• Fostering a smooth attachment exploration balance reflecting a secure attachment
	• Fostering that the child can use the caregiver as both a secure base (from which a child ventures out and explores new environments) and a safe haven (to which the child can return when feeling scared, uncertain etc.)
	• Fostering effective emotion regulation by the caregiver
	• Fostering the caregiver’s delight in the children
	• Implementation of an attachment-based transition to the ECEC center
Promotion of teacher resources, knowledge, attitudes, and beliefs	• Promotion of teachers’ self-efficacy
	• Reduction of job-related stress and promotion of job satisfaction
Promotion of collaboration among teachers and between teachers and parents	• Strengthening communication and collaboration in the ECEC center team
	• Collaboration between teachers and parents
	• Transfer of important program elements (e.g., fostering of early social-emotional competence) to the families

As ECEC teachers are crucial for establishing attachment relationships and serve as important socializers of children’s emotional development (Ahnert et al., 2006; Mortensen & Barnett, 2015), we chose the teachers as primary target persons of the program. For this reason, we primarily focused on teacher determinants and performance objectives when we created the logic model of change for the program (see Fig. 2).

Figure 2.

Logic Model of Change for the Papilio-U3 Program. Note. Aspects not specifically targeted in the program are in dashed boxes; further examples for the elements are described in the text.

We considered emotion talk, dyadic and group-centered sensitivity, and attachment-based transition practices as examples of crucial “environmental [i.e., teacher] outcomes” as potential predictors for children’s social-emotional development and attachment security (Ahnert et al., 2006; Tietze et al., 2013). Crucial personal (teacher) determinants comprise knowledge (e.g., about child social-emotional and attachment development), skills (e.g., self-reflection, basics of behavior analysis), self-efficacy (e.g., personal or teacher efficacy), resources (personal resources, e.g., coping strategies, or organizational resources, e.g., support from staff), and perceived barriers (e.g., structural features such as teacher-child-ratio or group size) (Blewitt et al., 2020; McDonald Connor et al., 2005; Slot, 2018; Tietze et al., 2013). Important performance objectives (i.e., specific behaviors to facilitate changes) comprise that the teachers observe children’s behavior and interactions, focus on children’s emotions and attachment behavior, create opportunities for sensitive teacher-child interactions, and take time for reflection and self-care. The complete logic model of change is depicted in Fig. 2.

Step 3 –Program Design

For step 3 of the IMA process, we derived change methods and applications to influence personal (teacher) determinants as predictors of performance objectives and outcomes as defined in our logic model of change.

As described above, the broad theoretical foundations of the program were the developmentally appropriate approach (Malti et al., 2009; cf., Scheithauer & Scheer, 2022), attachment theory (Ahnert et al., 2006; Ainsworth, 1985), and the internalization model of emotions (Holodynski, 2005). The Papilio-U3 program contains a 7.5 days training for ECEC teachers over a course of approximately eight months. The structure of the training, its topics, content, and examples of program elements are depicted in Table 2. The training was designed to contain recurring features (such as introductory and concluding/feedback sessions or mindfulness exercises) to facilitate a positive group atmosphere and cohesion. Additionally, recurring training applications included theoretical inputs, video demonstrations, group discussions, role play, and self-reflection exercises. Finally, driven by attachment research indicating that video feedback interventions enhance positive parenting skills (Bakermans-Kranenburg et al., 2003), we also included a video-feedback session to foster positive teacher-child-interactions. Each teacher provided videotapes of a teacher-child interaction in their ECEC center. The trainer reviewed all tapes and selected for each teacher a short sequence to be shown during the supervision session. Afterwards, all edited video clips were discussed with the trainer and the group members providing positive feedback on each sequence. The core process was to reflectively engage teachers.

Table 2

Overview of Sessions and Content of the Teacher Training

Session	Content	Program elements (examples)	Duration
1	Theory &Overview of the Program	• Becoming acquainted with the trainer and training group.	1/2 day
		• Information about risk and protective factors, developmentally appropriate prevention.
		• Reflection on emotions and emotional competence.
2	Social-Emotional Development	• Information about early social-emotional development, social-emotional competence, prosocial behavior, and early peer relationships.	1 day
		• Role-plays for emotion talk/ emotional verbalization and mirroring of children’s signals.
		• Discussion of age-appropriate emotion regulation strategies and behavior regulation via principles of positive teacher behavior.
		• Presentation of games/activities to foster early social-emotional skills.
3	Temperament	• Information about child temperament traits, goodness of fit, and their relevance for the ECEC context.	1 day
		• Reflections on children’s unique temperament features and needs.
		• Discussion of how to promote goodness of fit between children’s (temperamental) characteristics and the ECEC environment.
4	Attachment	• Information about attachment development, attachment patterns, and their relevance for ECEC.	1 day
		• Reflection on attitudes on child rearing and education and children’s attachment behavior.
		• Video analyses of attachment-related situations in ECEC and secure/insecure attachment patterns.
5	Sensitive Interactions	• Information about dyadic and group sensitivity.	1 day
		• Videotape reviews of sensitive and less sensitive teacher behavior, and sensitive discipline.
		• Reflecting that the own attachment experiences and representations influence caregiving behavior.
6	Attachment &Transition to Childcare	• Reflection of attachment relationships with specific children (attachment diary).	1/2 day
		• Discussion of transition practices and benefits/drawbacks of different transition approaches, and attachment-based transitions to childcare.
7	Collaboration with Parents	• Background information about close collaboration with parents.	1/2 day
		• Reflection of attitudes towards the collaboration with parents.
		• Analysis of relationships with parents of the children and approaches to promote positive relationships.
		• Preparing a workshop for parents to inform on topics addressed in the program.
8	Self-Care	• Information about stress, relaxation, mindfulness, and opportunities for mindfulness in daily ECEC routines.	1/2 day
		• Reflection of the self-image as a ECEC teacher.
		• Implementation of mindfulness practices and strategies of problem-focused coping.
Super-vision	Video Feedback	• Providing resource-oriented feedback to the other participants.	2× 1/2 day
		• Receiving resource-oriented feedback from the other participants and trainer.
Booster	Recapitulation & Sustainability	• Summary of the core program elements and discussion of teachers’ remaining questions.	1/2 day
		• Discussion of problem-solving strategies to overcome implementation barriers.

Note. In the table, the revised version of the teacher training is depicted; see the discussion section for details on the revision process.

Throughout the training, numerous exercises or reflection activities were designed as partner activities, meaning that teachers were encouraged to discuss the tasks or topics with a colleague from the same ECEC center. For example, the teachers were asked to reflect if the routines in the center meet the needs of children with diverse temperamental traits or to provide mutual feedback on the use of emotion vocabulary during daily routines. Partner activities are assumed to facilitate the implementation of program components and to stimulate discussions with team members who did not attend the training.

Step 4 –Program Production

During step 4 of the IMA, we produced the Papilio-U3 program materials on three levels:

Materials for activities to be conducted in the ECEC centers (recipients: children, conducted by teachers; level 1),

Activities and materials for the teacher training (recipients: teachers, conducted by trainers, see below; level 2),

Train-the-trainer workshop (recipients: trainers, conducted by program developers; level 3).

Examples of level 1 materials were a collection of games and activities teachers are provided to foster early social-emotional competence of the children (e.g., cards with basic emotion characteristics) or worksheets to reflect on children’s temperament traits. Materials for level 2 (teacher training) were PowerPoint presentations, flipcharts, videotapes (e.g., videos of daily ECEC routines including more or less sensitive teacher behavior), and leaflets compiling “best practice” strategies for daily routines (e.g., emotion regulation strategies or sensitive group-oriented teacher behavior, see Fig. 3). The trainers conducting the teacher training also received detailed protocols for every workshop day including a timetable as well as a description of the aims, activities and tasks, phrasing specifications, and additional notes. Further, the trainers received detailed background information and further reading advice for the PowerPoint presentations. Materials for level 3 (train-the-trainer) comprised PowerPoint presentations, flipcharts, videotapes, and literature on early social-emotional development or attachment for self-study.

Figure 3.

Examples of the Papilio-U3 Program Material.

Additionally, dissemination materials for communication, public relations, and recruitment were designed. For public relations purposes, we created fact sheets and guidelines for presenting the program, and released a press statement that informed on the program.

Step 5 –Program Implementation Plan

After developing the program, details of implementation were defined and are delineated in the following.

General Aspects of Program Implementation

We deliberately chose an implementation plan that reflects the circumstances under which the program would later (after the pilot implementation and evaluation will be completed) be delivered. Thus, the program implementation follows a train-the-trainer approach. Potential implementers of the program are recruited on two levels: Teachers implement the program in their ECEC centers, and trainers are responsible to deliver the training for the teachers. Primary users or recipients of the Papilio-U3 program are early ECEC teachers who work with children under three years of age. The training is implemented in fixed groups of at most twelve participants. In the maintenance phase following the pilot implementation, trainers would offer training regularly which would provide opportunities for teachers to catch up on one or several modules they might have missed.

Implementation in the Pilot Study

To become a Papilio-U3 trainer of the pilot phase, nine practitioners with a psychological or educational degree and professional experience in delivering the Papilio-3to6 program received a 4-day intensive training plus additional supervision meetings. To recruit teachers for the pilot study, ECEC centers were addressed via telephone, press release, and based on established networks of Papilio gGmbH. ECEC centers received detailed information about both the prevention program and the evaluation study and were screened for the following inclusion criteria: Enrollment of at least two ECEC teachers for the program who exclusively care for children under the age of three in their group(s), and at least two children remaining in the group from the planned wave 1 to wave 3 assessments of the evaluation study. Additionally, ECEC centers were excluded from the study if they already implemented the prevention program Papilio-3to6 for children between three and six years of age (Mayer et al., 2015; Scheithauer & Peter, 2022) to avoid any bias (e.g., spillover effects).

To ensure a sufficient training dosage, the trainers additionally offered brief catch-up sessions for teachers who missed training sessions (approximately a half-day catch-up per missed training session).

Step 6 –Evaluation Plan

Evaluation Design

In order to evaluate the Papilio-U3 program, we designed an evaluation study 1 , adopting a multi-centric, randomized intervention and waiting-control group design with three assessment waves (waves 1 to 3). The study targeted 120 teachers and approximately 600 toddlers from 60 ECEC centers in Germany. ECEC centers enrolled at least two ECEC teachers for the program and were then randomly assigned to an intervention or waiting-control group (IG and WCG, respectively). IG teachers participated in the pilot intervention (program implementation and pilot evaluation study) whereas WCG teachers received the intervention after completion of the pilot evaluation.

The pre- and post-intervention assessments (waves 1 and 3) encompassed the collection of observational data at the ECEC centers (videotaped teacher-child interactions, developmental tests with a subsample of the children) and questionnaires that were administered to the teachers. At wave 2, during the intervention period of the IG, only questionnaire (but no observational) data were collected.

Indicators and measures for the summative and formative evaluation are presented in the subsequent paragraphs. Important control variables or covariates assessed in the evaluation study comprised information on the ECEC centers and teachers, information on transition practices of the centers, information on children’s family background (based on Lorenz et al., 2020), and children’s temperament (Putnam et al., 2006), cognitive, and language developmental status (Bayley, 2005).

Summative Evaluation

The main teacher outcomes targeted in the evaluation study were dyadic and group sensitivity, self-efficacy, and job-related stress. Outcomes were assessed using the following measures:

Dyadic sensitivity (Gerlach et al., 2022),

Caregiver Interaction Scale (Arnett, 1989),

Support for group processes (van Schaik et al., 2018),

Classroom Assessment Scoring System, Toddler (La Paro et al., 2012),

Teacher self-efficacy (adapted from Schwarzer & Jerusalem, 1999),

Job-related stress (Enzmann & Kleiber, 1989),

Psychosomatic conditions (Mohr & Müller, 2014).

The main child outcomes were attachment security, social-emotional competence, and children’s well-being. Outcomes were assessed using the following measures:

Attachment Q-Sort (Waters & Deane, 1985),

Brief Infant-Toddler Social-Emotional Assessment (BITSEA, Briggs-Gowan et al., 2004),

Infant-Toddler Social-Emotional Assessment (ITSEA), selected competence scales (Carter & Briggs-Gowan, 2006),

Leiden Inventory for the Child’s Well-being in Daycare (De Schipper et al., 2004).

Statistical analyses for main outcomes on the teacher and child level will include longitudinal analysis of covariance with the respective wave 2 or wave 3 variables as outcomes. Due to the nested data structure (children nested in groups), multilevel modeling will be carried out for child-level outcomes. To elucidate treatment mechanisms, mediation hypotheses will be tested, that is if changes in teacher behavior (e.g., dyadic or group sensitivity) mediate changes in child outcomes (e.g., attachment security or social-emotional competence). Additionally, explorative moderation analyses are planned to assess whether intervention effects differ between particular groups of teachers or children (e.g., between children with different numbers of risk factors). Results of the summative evaluation will be presented in subsequent publications (e.g., Ortelbach et al., in preparation).

Formative Evaluation

The formative evaluation consisted of three parts: First, to ensure an adequate training dosage, trainers provided information on the attendance of participants and indicated to what extent they offered catch-up sessions for their group of teachers. Second, the teachers of the intervention group were asked to report on the frequency of selected skills and topics covered in the training to their daily routines. Third, after finalizing the training, a questionnaire covering feedback on training content, methods, material, organizational conditions, and implementation challenges was administered. The questionnaire was handed out by the trainer during the concluding training session. The questionnaire sheets did not contain any information that could identify the teacher or ECEC center, but only a numerical code. This code was used later to combine the formative evaluation information with data from the summative evaluation. Pilot evaluation results presented in the present article focus on the latter element of the formative evaluation with selected results to be presented in the following.

Formative Evaluation Results of the Pilot Evaluation Study

Recruitment and Sample

The recruitment of the convenience sample was conducted at four study sites spread across Germany covering a broad range of rural and urban areas (in the federal states Bavaria, Berlin, Brandenburg, and North Rhine-Westphalia). All participants (i.e., ECEC teachers and the children’s parents) were provided detailed information on the procedures and gave written consent to participate in the study. At baseline, the sample comprised 125 ECEC teachers (n = 61 IG, n = 64 WCG) working at 55 ECEC centers, and 652 children. The baseline characteristics of the sample are displayed in Table 3.

Table 3

Sample Characteristics at Baseline

	M (SD)	n (%)
ECEC Center Characteristics
N		55 (100)
# of employed teachers	15.2 (8.6)
# of children	84.6 (50.7)
ECEC Teacher Characteristics
N		125 (100)
Group
intervention group		61 (48.8)
waiting-control group		64 (51.2)
Gender
female		123 (98.4)
male		0
other		2 (1.6)
Age	34.0 (10.1)
Qualification
ECEC teacher¹		104 (83.2)
childcare worker²		20 (16.0)
Professional Experience (years)	10.4 (9.8)
Group size	13.6 (5.2)
Child Characteristics
N		652 (100)
Gender
female		289 (44.9)
male		355 (55.1)
Age (months)	26.8 (7.7)

Note.¹ECEC Teacher: higher qualification, at least 3 years of professional education, ²Childcare Worker: lower qualification, 2 years of professional education.

Data were collected between July 2018 and December 2019. ECEC teachers who completed all measurements (wave 1 to wave 3) received a 10 € gift voucher. The participants received no further payments or incentives.

Results

In Figs. 4 to 6 and Tables 4 and 5, results of the formative evaluation are depicted. More than 90 % of the IG teachers were satisfied or very satisfied with the training contents of the main program topics social-emotional competence, temperament, attachment, and sensitivity. Feedback on secondary topics was somewhat mixed but still positive (see Fig. 4). Teacher ratings of the training methods were positive as well, with most favorable ratings for the trainers’ theoretical input (100 % liked it well or very well) and video feedback (98 % liked it well or very well). Teachers were more critical with their ratings of role-play activities and the “best practice” leaflets. Twenty-four percent liked the role-play activities little or not at all, 15 % were indifferent, and 4 % liked the “best practice” leaflets little, 14 % were indifferent (Fig. 5). The usability of the “best practice” leaflets was rated as adequate by most teachers. However, some perceived them as too brief or too limited (Fig. 6). When asked for feedback on the implementation process and potential implementation barriers, the majority of teachers (72 %) stated that the implementation was possible without major difficulties. Though, a substantial number of teachers (31 %) endorsed the current political situation as a factor hindering the implementation. When asked for their self-perceived changes related to program participation, teachers endorsed their increasing job satisfaction (63 %), children’s increasing social-emotional competence (94 %), and reduction of children’s behavioral problems (54 %) (Table 4). In sum, 87 % of teachers stated that their expectations regarding the Papilio-U3 program had been mostly or completely met (Table 5) and 98 % would recommend the program to others.

Figure 4.

Teachers‘ Perception of Program Contents.

Figure 5.

Teachers‘ Perception of Program Methods and Activities.

Figure 6.

Teachers‘ Perception of Practice Materials (“How do you Rate the ‘Best Practice’ Leaflets (e.g., on Emotion Talk or Sensitivity)?”).

Table 4

Teachers‘ Perception of the Implementation Process and Effectiveness of the Program

	Does not apply at all	Predominantly does not apply	Neither / nor	Applies predominantly	Applies completely	Missing (n)
1. The implementation of Papilio-U3 measures in my institution is taking place without major difficulties.	1.9 %	5.6 %	20,4 %	63.0 %	9.3 %	11
2. I will increasingly need the support of the trainer for the implementation.	47.2 %	35.8 %	17.0 %	0 %	0 %	12
3. Due to the current political situation for childcare, implementation is a challenge.	28.8 %	25.0 %	15.4 %	17.3 %	13.5 %	13
4. With Papilio-U3, my job satisfaction is increasing.	9.3 %	3.7 %	24.1 %	46.3 %	16.7 %	11
5. The children are increasingly showing social-emotional competences.	0 %	2.0 %	3.9 %	54.9 %	39.2 %	14
6. The children do not change their behavior.	58.5 %	30.2 %	7.5 %	3.8 %	0 %	12
7. The children are showing fewer behavioral problems (such as frequent hitting, biting, kicking).	1.9 %	11.5 %	32.7 %	51.9 %	1.9 %	13

Note. N = 65. The cells reflect valid percent.

Table 5

Teachers‘ Concluding Evaluation of the Training

Conclusion: To what extent were your expectations regarding the Papilio-U3 training met?
Not at all	Little	Partly	Mostly	Completely	Missing (n)
0 %	1.9 %	11.5 %	53.8 %	32.7 %	13

Note. N = 65. The cells reflect valid percent.

Discussion

Discussion of the Program Design and Implementation

As delineated in the needs assessment, in Germany there is a lack of evaluated, ready-to-implement programs for children under the age of three in childcare. Papilio-U3 closes this gap by implementing an intensive, multilevel preventive intervention program rooted, for example, in attachment theory and models of early social-emotional development. It integrates fundamental topics such as fostering sensitive teacher-child interactions and early social-emotional competence, reflecting on children’s temperament, promotion of teacher job satisfaction and reduction of job-related stress. Innovative aspects of Papilio-U3 include:

The focus on attachment in ECEC: Existing programs are designed to address parent-child-attachment (e.g., Pillhofer et al., 2015; Walter et al., 2019), or, if implemented in the ECEC context, they do not specifically use attachment theory as a basis (Binationales Zentrum Frühe Kindheit, 2022; Heidelberger Präventionszentrum, 2022).

The focus on scientifically sound methods for program development and evaluation: To our knowledge, there are no empirical evaluation studies for any of the existing German ECEC programs for children under the age of three available.

The unity of evidence-based foundation and user applicability: The program was evaluated under circumstances that reflect the later implementation of the program.

Strengths and Limitations

A core strength of the present article is the comprehensive record of theory and discussions behind program development and implementation utilizing the IMA. By providing extensive, accessible background information on implemented programs, we enable practitioners to compare and evaluate various approaches and may furthermore stimulate other researchers to develop a comparable program.

The results of the formative evaluation were generally positive concerning the topics of the training, the methods used, and the implementation in the ECEC centers. These positive ratings indicate that the program proved acceptable, feasible, and can be implemented in its current design. A limiting factor for the formative evaluation’s validity is the fact that the teachers answering the questionnaire in the presence of the trainer may be leading to socially desirable responses. Moreover, the current results of the formative evaluation are merely descriptive and permit no conclusions about the effectiveness of the program. Nevertheless, we consider teachers’ attitudes towards the program as an important contribution to its effectiveness and the existent positive evaluation results as promising with regard to the summative evaluation that will follow. Further limitations predominantly relevant for the summative evaluation (e.g., the structure of the sample, dropout rates, the strong focus on teacher reports, or a lacking follow-up measurement) will be addressed in the respective publications. Finally, the results of the formative evaluation laid the foundation for the revision of the program.

Revision of the Program and Future Directions

Following the detailed feedback of the formative evaluation, and supported by further feedback and protocols provided by the trainers of the pilot implementation, the Papilio-U3 planning group worked on the revision of the program. Minor changes covered the reduction of repetitive elements and adaptations of single sessions to enhance the comprehensibility for the teachers. Examples include the goodness of fit model in the child temperament session (we designed a clearer conceptual derivation and added further examples and a discussion of how to apply the goodness of fit model in ECEC routines), or further discussions of how to implement emotion talk. A crucial change was the addition of a second supervision session with another video feedback. Teachers are asked to submit a second videotape containing interaction sequences in their group of children, and we decided to focus not only on positive video examples but also included video examples displaying limited/underdeveloped caregiving capacities of the teachers. Finally, we improved the quality of the materials, for example, we designed a stable stand-up display for use in the ECEC center group room (Fig. 3), and we produced a folder containing chapters with the theoretical background on the covered topics, notes on the practical implementation of the diverse program components, and impulses for further reflection (Pfalzgraf et al., 2020).

In contrast, there are some aspects addressed by the teachers in the course of the formative evaluation we did not consider for the present revision of the program. Some teachers stated that they felt uncomfortable with the role-play activities during the training sessions. We decided to retain these activities as we consider them vital for acquiring and practicing new behavioral strategies (e.g., emotion talk). Moreover, teachers asked for further information on and material for the collaboration with parents. However, we are currently working on a program particularly targeting the teacher-parent relationship with the aim to further transfer knowledge and skills of the teachers on attachment and early social-emotional development to the families.

There are two additional aspects of program design which are associated with program effectiveness as indicated by meta-analyses (Egert et al., 2018; Fukkink & Lont, 2007; Werner et al., 2016) that we discussed in the course of the revision process: The use of a defined curriculum and individual “coaching” sessions for teachers. Due to mixed findings referring to the question whether or not to use a defined curriculum, we retained the program focus on teacher-child interactions and imparting strategies to, for example, foster children’s social-emotional development to be implemented in daily routine, but we consider fixed curriculum components with more structured games and exercises for potential future revisions of the program. Both recent meta-analyses (Egert et al., 2018; Werner et al., 2016) indicated that coaching individual teachers may result in greater program effects. Although we acknowledge the potential benefits of integrating individual coaching of teachers by trainers, we found it not feasible for our program due to time and financial restrictions. Nevertheless, the two supervision sessions with video feedback, though taking place in a group setting, include an individual training component.

Conclusion

The present article documents the theory-guided development of the preventive intervention program Papilio-U3. Papilio-U3 proved as a feasible program to be implemented by ECEC teachers in their daily routines. A vital strength of the Papilio approach is its sustainability: Teachers are equipped to implement the program by the time they attend the first training session and continue to integrate the acquired knowledge and skills in their daily routines and interactions with the children.

As described in the program evaluation plan, the next steps involve analyses and publications of the pilot evaluation results. Currently, due to the first promising evaluation results (Ortelbach et al., in preparation), the roll-out of the program in different regions in Germany is ongoing.

Future research will also aim at integrating other levels involved in fostering early social-emotional competence of children in childcare, namely the children’s parents and the whole ECEC center. As parents and ECEC staff are important program target persons as well as “moderators” of treatment effects, we strive to direct future studies to further investigate these influences.

To conclude, Papilio-U3 is the first component in a series of programs designed to foster social-emotional competence of children in ECEC up to early elementary school settings. Further common features of the subsequent programs Papilio-3to6 (Scheithauer & Peter, 2022) and Papilio-6to9 (Lechner et al., 2020) are the strong emphases on fostering of positive or sensitive teacher-child relationships and the focus on developmentally appropriate practices (Scheithauer & Peter, 2022).

Footnotes

Acknowledgments

The program was developed and evaluated from 2017 to 2020 by the German health insurance provider BARMER as development partner, Papilio gGmbH as program provider, Freie Universität Berlin (Univ.-Prof. Dr. Herbert Scheithauer, expert for prevention, and team) and Friedrich-Alexander-Universität Erlangen-Nürnberg (Dr.in Ina Bovenschen, expert for attachment, and team). We would like to thank all staff members of Papilio gGmbH, as well as Dr. Markus Hess, former team member at Freie Universität Berlin.

Bio Sketches

Niklas Ortelbach, Dipl.-Psych., is a researcher at the unit “Developmental Science and Applied Developmental Psychology” at Freie Universität Berlin, Berlin, Germany. His research interests are children’s social-emotional development during the first years of life and the development and evaluation of preventive interventions for children up to the first school years.

Dr. Ina Bovenschen works as researcher at the Friedrich-Alexander-Universität Erlangen-Nürnberg and the German Youth Institute in Munich, Germany. Her research interests comprise attachment development in children at risk, the development of attachment-based interventions, and the development of children in foster care and adoptive families.

Dr. Jennifer Gerlach works as a researcher and clinical psychologist at the Department of Child and Adolescent Mental Health, University Hospital Erlangen, Germany. Her research interests include early child development under risk exposure (e.g., prenatal or family-related risks) with a focus on attachment, self-regulation, and parent-child-interactions.

Dr. Charlotte Peter, psychologist, heads the area of responsibility of “Science and Development” at the non-profit, limited company Papilio, Augsburg, Germany. Her professional interest centers mainly around the development and evaluation of evidence-based, developmentally appropriate preventive intervention programs.

Dr. Herbert Scheithauer is Professor for Developmental and Clinical Psychology at Freie Universität Berlin, Berlin, Germany, and Head of the Unit “Developmental Science and Applied Developmental Psychology". His research interests are on bullying, cyberbullying, and the development and evaluation of preventive interventions.

The study was approved by the ethics committee of the Department of Education and Psychology, Freie Universität Berlin (207/2018).

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