Headshot of Ashoka Fellow in Austria Katharina Kruppa. Person with lighter skin and light brown dark blonde hair tied up with a hair tie smiling at the camera. Dressed in light grey jacket. Background of a white wall
Ashoka Fellow since 2022   |   Austria

Katharina Kruppa

Grow Together
Katharina Kruppa founded Grow Together to transform early childhood development support for families from high-risk backgrounds through a holistic approach guided by scientific methods and deep…
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This description of Katharina Kruppa's work was prepared when Katharina Kruppa was elected to the Ashoka Fellowship in 2022.

Introduction

Katharina Kruppa founded Grow Together to transform early childhood development support for families from high-risk backgrounds through a holistic approach guided by scientific methods and deep empathy. Through her work, Katharina is improving a new-born's experience in life and healing deeply rooted trauma of parents from high-risk environments.

The New Idea

Katharina empowers the sector of early childhood development to support mothers and their new-born babies to overcome adverse conditions in high-risk environments. Grow Together’s programme offers a thorough proof of concept for prevention by creating conducive living conditions through intensive developmental measures that ensure a healthy development of children within the first three years of life.

She has developed an approach and mindset that enables young families to develop a stable and close relationship with secure attachment figures, the key element of a child’s early development. Katharina, a psychotherapist and paediatric by education, realised the importance of intervening already before childbirth to have tremendous outcomes on a baby’s future and the wellbeing of the family. Her approach, hence, stands in contrast to the majority of interventions for families from highly stressed environments. These currently start at a later stage of a child’s development and often lead to children being taken away from their mothers. Grow Together, however, becomes already involved at the time of pregnancy. For this, Katharina has built a high-frequency, long-term, and high-quality care approach that ensures that parenting patterns and attitudes, sometimes ingrained over generations, are broken and children develop according to the norm.

Instead of stigmatising parents for being responsible for the circumstances they find themselves in, Grow Together’s approach is based on the assumption that these parents do everything they can for their children and starts by empowering and supporting mothers. This attitude of acceptance and empathy, instead of blame, empowers mothers to learn to trust themselves again, and to listen to and rely on their instincts. A capacity that mothers from high-risk environments and with low levels of self-confidence have learned to not rely on anymore leading to the believe that they do not actually have it in them to know what is best for their babies Through Grow together’s approach, however, they break with the prejudices they have against themselves and recognize their own strengths. Grow Together’s combination of different interventions, therefore, directly tackle the root causes of them being locked in a high-risk environment.

Katharina is now following a clearly defined strategy to spread Grow Together’s attitude and approach to influence (future) professionals in the sector. She does so by setting up educational programmes with academic institutions as well as shifting the structures of the sector by lobbying for more coordinated baby-care work and funding to let similar initiatives emerge. At the same time, Katharina is working on media campaigns to spread the Grow-Together attitude far beyond high-risk families.

The Problem

The emerging field of social neuroscience has shown that without a secure setting and attachment figure children cannot properly learn and develop. Attachment patterns build the ground for every relationship formed in life and are shaped through experiences in the first years of a child’s life. These patterns influence a person’s wellbeing, social competency, future development, and life opportunities. One central success factor for a happy and fulfilled life is to have at least one secure attachment figure to base the attachment patterns on. In most cases for children that is a parent.

Children, however, that are born into a multi-risk family constellation and have remained in this environment without external, protective interventions show developmental delays, as well as emotionally and physically neglect. In the worst case, severe signs of maltreatment. There is an empirical correlation between massive adverse childhood experiences and extensive personal impairments such as psychological disorders, chronic illnesses, limitations in cognitive abilities and higher incidence of delinquent behaviour. In Austria 5% of the population have experienced extreme negative childhood experiences.

In the case of Austria, societal culture does not have the mindset of shared parental responsibilities for up-bringing. A lot of pressure is put on a mother to properly take care of her child. If a mother cannot live up to it, society’s overall reaction is to blame mothers for neglect. If mothers are struggling with never having had a secure attachment figure, traumata or other risk factors, they often find themselves in a vicious cycle of their own guilty conscience of not being a good mother and society’s disapproval. The latter is reinforced by the youth welfare system’s current working logic. As the systemic contact point for families in highly stressed environments, the youth welfare system does not have the capacity to recognize the need nor is able to provide the extensive support needed for parents to learn to be a secure attachment figure to prevent passing on their trauma. To avoid endangering the welfare of children and due to a lack of knowledge around the support needed, children are often taken away from their families. The risks and consequences of psychological and emotional deprivation in children whose development has been disrupted by public interference in the family structure are widely known. All of this denies a child a stable attachment pattern and reinforces a mother’s individual and societal stress factors.

The Strategy

With Grow Together, Katharina ensures that parents and children at risk are given the opportunity to carry on within the family structure by empowering families to address their own problems and face their domestic situations. Katharina’s work enables troubled families to meet their children's needs, and even collaborate with state agencies instead of working against them.

As a first step in this process, Katharina identifies parents in need even before their children are born. For this, Katharina is closely collaborating with primary (e.g. hospitals) and secondary (e.g. youth welfare offices) care providers, to source those cases, where many high-risk factors are present without any counterbalancing protective factors. For this, she has developed a screening process which the care providers are trained to use. Through trainings and easy to use information material provided by Grow Together, the providers are enabled to uncover high-risk factors when interacting with families in their regular routines. Once a need for a Grow Together intervention is identified within a family, they are matched with a specifically trained staff member of Grow Together and are obliged to participate in Grow Together’s programme.

The central success factor of Grow Together is the direct work with children and a targeted empowerment of the mothers/parents to regain their intuitive parenting skills whilst overcoming own trauma. Based on empirical evidence including long-term studies of other adjacent programs and the medical experience of Katharina and her team, Grow Together has been developed as a complex in-depth intervention program. It combines various levels of intervention that have proven their positive (long-term) effects on early childhood development and the resolution of transgenerational trauma. The assistance contains home visits 2-3 times a week, mother-child groups once a week, psychotherapy for parents once a week, and childcare and babysitting as required. To break the transgenerational transmission of pathological relationship patterns, Katharina has put a unique focus on attachment-based psychotherapy for the parents. This starts in the last trimester of pregnancy or at the birth of the children and aims to strengthen the parent-child relationships and attachment patterns conducive to development through close social pedagogical support for the families. As a consequence a long-term psychosocial stabilization of the families occurs, in which the regaining of believing in a mother’s own intuitive parental skills is a key factor.

Of the 50 cases that Grow Together has accompanied so far, more than one-third of the families treated did not need any further support after three years. Whilst there are a few cases where separation between children and parents was inevitable right at the beginning of the treatment, the majority of the families, needed only remote support after three years. By its early intervention, Grow Together’s programme is also reducing the long-term costs of curative treatment of parents and children, for insurers and the state, as it is reducing the negative long-term consequences of adverse childhood experiences and traumatic experiences for parents. In an effort to attach a concrete value to this, Grow Together has been measured to have a SROI of 22.16.

The thorough proof of concept allows Katharina to apply several leverage points to achieve long-lasting systemic change in the medical system for early childhood support for socially disadvantaged families.

Katharina is creating targeted collaborations with the Austrian Youth Welfare Department and an insurance company, to ensure that key health care institutions gradually adapt to her new concept.

Furthermore, to shift the mindsets of (future) practitioners, she has been instrumental in the setting up an academy in collaboration with the Paracelsus Medical University Salzburg. Here she trains practitioners of early childhood health care to change their attitude and decision-making towards the target patient group. At the same university, Katharina has been instrumental in the creation of an “Early Life Care” Master programme, the first one to exist in Europe, focused on trans-disciplinary, holistic approach towards early childhood development in which she acts also as a lecturer.

To enable students to practice the new attitude and approach, Grow Together is an officially recognized provider for internships for students of propaedeutics, psychology, psychotherapy and social work by the Federal Ministry of Education. So far, more than 130 interns have been trained in a one year-long traineeship who are now all taking positions in the social sector, spreading the Grow Together attitude.

Leveraging on her position of being recognized and highly respected by the Austrian health care representatives for her expert opinions, Katharina positively influences political decision-making processes to focus on prevention in early childhood support. Just recently, she has been collaborating with the government of Vienna to build a holistic care plan for children from the ages of 0-3. Additionally, she is active on many professional platforms around early life care (e.g. child psychology, child protection,…) to connect actors across disciplines and spread the Grow Together approach.

Through targeted campaigning with stakeholders who have a wide reach into overall society, she showcases success stories of the program to break with the negative reinforcing feedback loops of stigmatization of socially disadvantaged mothers and their children leading to lower-self-esteem and surrender of the target group leading again to lower societal expectations. Making stories visible does not only help the women in the program to see how they have changed but also encourages other women in similar situations as well as influence societal perception of the target group. She has, for example, just collaborated in a campaign with a major bank under the name #glaub an dich (believe in yourself). She also publishes interviews with mothers on the radio and the television achieving national scale.

The Person

Katharina was born in Vienna, Austria, into a family with very high academic standards and a strong work ethic. Her father was editor in chief of a famous conservative newspaper her mother was one of the first women to do her PhD in economics and to work for the UN later on although she came from a very simple home. Her grandmother raised Katharina as her mother was always gone for work. Whilst Katharina was expected to perform very well and use the opportunities she was given, she made her own decisions about her life from an early stage. At the same time, equality and standing up for the less fortunate was highly valued by the whole family. While her older brother went into politics (Green Party), Katharina saw her strengths and opportunity to make the world a better place as a doctor.

During her studies, she became increasingly interested in the relationship between mothers and young children and what impact the relationship has on a child’s development. At the same time, she became increasingly interested in spirituality and non-verbal communication. She decided to specialize in psychology and paediatrics and started working in a hospital with urgent and difficult cases (Brennpunkt-Spital). During her time at the hospital, she continuously went beyond her duty in her role. Realising that there was no formalised desk for mothers and their new-borns to come and be treated for psychosomatic problems, she established Austria’s first so-called “Baby Care Clinic” in her hospital. Through this work, Katharina, was able to work with families from different “risk categories” and learn about the complexity of their situations. One of the outcomes of her work was that she created a project around changing the attitude of nurses towards drug-addicted mother’s whose children were suffering from drug withdrawal symptoms right after birth. By training staff to adapt a positive attitude and overcome prejudices towards mothers with a substance addiction problem, she was able to reduce the time babies needed for their drug withdrawal period by a third. For this work she received a social innovation award in 2011 by the City of Vienna and saw the attitude change scale to many other stations and hospitals across Austria afterwards.

With increasing experience working on the parents’ attachment towards their new-borns, she realised that early intervention are the most crucial factors in many catastrophes and complex unhealthy relationships. Therefore, it increasingly, hurt her to see cases, from high-risk backgrounds, come into the clinic where she could not make a difference anymore, as the parents had come seeking help at a stage, where often separation as the only option.

With her background as a paediatric and psychologist for individuals and families and specialization in systemic therapy for individuals, couples, and families, she decided to look further into a potential concept that she could implement into the system that she knew very well.

Once she understood how it could be done in practice and had her concept, she felt the strong urge to go through with it. She knew that in the hospital itself she could not test her theory to the extent she wanted to and decided to start Grow Together with the idea to integrate it as much as possible into the system.