The results suggest that interactional issues between a mother and her infant are related to the child's subsequent physical health. Children with recurrent or chronic health problems may have relationship difficulties with which they need help. Also, early avoidant behaviour of the infant should be regarded as an indicator of the infant's distress with possibly adverse outcomes in the child's physical health, among other consequences.

The number of children in Europe with significant psychologic and social problems is large and increasing. This article describes an innovative crosscultural method of working with families to This project has been financially supported by the European Union (Leonardo da Vinci Programme, EL 98/98/1/ 68123/P1/1.1.1.b/FPC), the Ministry of Social Welfare and Health in Finland, the Medical Research Fund of Tampere University Hospital, the Greek General Secretariat of Research and Technology and the Greek Ministry of Health (Cofunding programme 96SYN103), The Gatsby Charitable Foundation, The South London and Maudsley NHS Trust, and the Community Health South London NHS Trust. We should like to thank all the primary health care professionals involved in the project for their commitment and care, all the research staff, and of course the families and children. Direct correspondence to: Kaija Puura, Assistant Chief of Child Psychiatry, Medical School, 33014 University of Tampere, Finland; e-mail: puura@sci.fi. The European Early Promotion Project • 607promote the psychosocial well being of children and prevent the development of psychologic and social problems. A study designed to evaluate the effects of the service is also presented. Primary health care workers in five European countries have been trained to conduct promotional interviews with all prospective mothers in their area one month before and one month after birth. They have also been taught to work with mothers identified as in need of support as a parent by using a specific counselling model to try to prevent the onset of child mental health difficulties. Effects of the intervention on children's psychologic development and family adaptation are being evaluated at two years in comparison with matched groups not receiving the intervention.RESUMEN: El número de niños en Europa con problemas sicológicos y sociales significativos es grande y va en aumento. Este ensayo describe un método innovador e intercultural de trabajar con familias para promover el bienestar sicológico de los niños y prevenir el desarrollo de problemas sicológicos y sociales. También se presenta un estudio diseñado para evaluar los efectos del servicio prestado. Los trabajadores que prestan los servicios de salud esenciales en cinco países europeos han sido entrenados para llevar a cabo entrevistas promocionales con todas las futuras madres en sus áreas un mes antes y un mes después del parto. A ellos se les ha enseñado también a trabajar con madres identificadas como personas con necesidad de apoyo en su papel de madre, por medio de un modelo específico de consejería para tratar de prevenir el comienzo de las dificultades de salud mental del niño. Los efectos de la intervención en el desarrollo sicológico de los niños y la adaptación familiar están siendo evaluados a los dos años en comparación con grupos similares que no están recibiendo tal intervención.RÉ SUMÉ : Le nombre d'enfants en Europe qui ont d'importants problèmes psychologiques et sociaux est élevé et grandit sans ce...

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The importance of an economic dimension in the planning, delivery and evaluation of care and support for children and families is widely recognised. We report a cost analysis of a primary prevention programme using primary health care professionals trained to promote the psychosocial adaptation of children from birth. The programme was established in five European centres. We estimated the cost of the intervention in training and supervision for each country, and measured the impact of the intervention on service use and cost two years after the birth of the index child. Total costs incurred by families at comparison sites where no such training was provided were also calculated, and were compared with total costs at intervention sites. Cost differences between countries were also explored. Differences in total costs between the Intervention and Comparison treatment groups were small and did not reach statistical significance. However, total costs varied substantially between countries. Training primary health care professionals in the primary prevention of child mental health problems is found to be inexpensive, and does not appear to affect total costs in the years immediately following the intervention. Given the outcome findings from the study (see other chapters in this special issue), the cost evaluation provides encouragement for the wider establishment and examination of this preventative intervention.