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PUF 2018-19

More than 15 % of the child population suffer from mental health problems associated with social and emotional impairment and reduced possibilities of learning and functioning among peers. Resent research shows that most mental health problems have their onset in the early childhood and predictors of mental health problems can be identified in the first year of living.

To prevent mental health problems, it is necessary to target the whole range of mental health problems seen in infants: problems of language, communication, activity, attention and regulation of emotions, sleep and eating.

Community health nurses working in the municipality child health surveillance in Denmark have the potentials to identify early indicators of mental health problems in the first year of the child’s life, but they lack the measures necessary to a systematic and effective prevention.

The PUF (Psykisk Udvikling og Funktion) approach is therefore developed by community health nurses and child researchers to provide an instrument to evaluate infant mental health.


The PUF 2018-19 project aims to enhance the community health nurses’ opportunities to optimize infancy mental health development and functioning in close collaboration with the parents. The project is based on existing community health care and is grounded on a standardized method to identify vulnerable infants, which has been developed and validated in Denmark. PUF 2018-19 comprises a program including: 1) a manual for the PUF-assessment and for reporting the results of the assessment to the parents; 2) guidelines for the community health nurses’ intervention; 3) an educational program for the community health nurses focused on feed-back to the parents. Moreover, the program includes 4) the implementation and pilot testing of the PUF program; and among these 5) assessment of the feasibility; and 6) the parents and the health nurses overall evaluation of the program.


The PUF program is developed in a collaboration between community health nurses and experts into developmental psychology and mental vulnerability. The PUF-assessment will be adjusted, manuals will be created regarding the PUF-assessment and the reporting of the results to the parents. Likewise, guidelines will be developed for interventions within existing frame and possibility in the specific community. Overall both indicated and universal interventions towards vulnerable infants will be considered.

An educational program to prepare the community health nurses to use the PUF program will be developed.

The project will be pilot tested in 17 communities participating in the Child Health Database. Applicability and feasibility will be evaluated by survey and interviews among community health nurses and parents, before and after implementation of the program in the communities.

Period of project

The project runs from January 2018 to December 2019. The preliminary results will be presented in a workshop for the participating communities and other stakeholders in June 2019 and will be published in national and international journals at the end of 2019.


The project is running in collaboration with the community health services in the municipalities of Allerød, Dragør, Egedal, Fredensborg, Gladsaxe, Glostrup, Herlev, Hillerød, Høje-Taastrup, Ishøj, Kalundborg, Køge, Roskilde, Rudersdal, Tårnby, Vallensbæk and Vejle.


Ammitzbøll J., Wilms L., Skovgaard AM. (2018) PUF – En metode til at opruste sundhedsplejerskernes indsats over for mental sårbarhed hos små børn. Sundhedsplejersken;3:10-14.

Skovgaard AM., Wilms L., Johansen A., Ammitzbøll J., Holstein BE., Olsen EM. (2018) Standardiseret monitorering af spæde og småbørns helbred i de kommunale sundhedsordninger. Ugeskrift for læger;180:2-6.

Ammitzbøll J., Thygesen LC., Holstein BE., Andersen A., Skovgaard AM. (2017) Predictive validity of a service-setting based measure to identify infancy mental health problems – A population based cohort study. Journal of European Child & Adolescent Psychiatry;27(6):711-723.

Ammitzbøll J., Holstein BE., Wilms L., Andersen A., Skovgaard AM. (2016) A new measure for infant mental health screening: development and initial validation. BMC Pediatrics;16:197.

Last Updated 19.06.2020