HAMBURG, GERMANY -- In a small warren of offices upstairs from a family center in this port city, Gerhard Suess is working to make life easier for children in peril. On any given day, Suess, 47, may see a mother exhausted by an endlessly crying baby, or parents frantic to calm a toddler's violent tantrums. Instead of following standard German Child Welfare procedure -- not providing help until the child gets old enough to disrupt a preschool or school class -- Suess is experimenting with an early-intervention program he found 4,000 miles and one ocean away -- at the University of Minnesota.

The program, called STEEP, concentrates on children's fundamental need to have at least one secure, caring adult, normally a parent, for a healthy start to life. Without such a bond, or ``attachment,'' children are at great risk for a range of problems such as depression, anxiety disorder, volatile temperaments and antisocial tendencies. Extreme examples of attachment problems surfaced about 15 years ago, as children who had lived through long stays in East European orphanages were adopted by U.S. families. Many were behind intellectually, had hyperactivity and attention problems, and struggled to build bonds. While the importance of early attachment is well understood in the United States, the concept is coming slower to Germany and other parts of Europe. Suess was drawn to STEEP -- which stands for Steps Toward Effective, Enjoyable Parenting -- because of its practical remedies, he said. They include home visits and videotapes of families. Those videotapes allow parents to watch themselves connecting -- or not connecting -- with their children. ``With these families, you can quickly decide what needs to happen,'' Suess said. ``But the question is, `How?'''
A good fit

STEEP's reputation is growing. It is part of a program for families with seriously ill children at a hospital in Tacoma, Wash., and is part of another for mothers with postpartum depression in Sydney, Australia. Suess first heard of STEEP in Munich in 2000. Its authors at the University of Minnesota -- Martha Erickson, senior fellow at the Children, Youth and Family Consortium; and Byron Egeland, professor of child development -- described it at an international conference on parent-child attachment. It seemed a good fit for the clinic that Suess had started the year before. He had studied attachment, under Klaus and Karin Grossmann, Germany's first researchers in the field. He also spent a year of graduate school at the University of Minnesota in 1982. His small Hamburg clinic can't do the complete program, Suess said, because as part of a public health system it also needs to take all the other problems that walk in the door. Erickson said she hopes that all programs that adopt pieces of STEEP will carefully scrutinize the results, not assuming that the parts will achieve as much as the whole. ``But I am gratified to see this work take hold in such far-flung places,'' Erickson said, ``and I have great confidence in Gerhard's understanding of the core concepts. I'm very excited and optimistic about what he will achieve.'' Suess' staff consists of two psychologists and one social worker. They routinely concentrate on getting one dependable, supportive adult into the lives of children. That's the story with Eva Maria Biel, who is raising her grandson, Kevin, 4. Biel, 54, is a lively woman who still rides her bicycle on errands, enjoys an occasional cigarette -- a more common habit in Germany than in the United States -- and calls her loud-barking dog Herr Schroeder, after the current German chancellor. Kevin has lived with her since birth. He was a difficult baby, Biel said. He cried constantly and pulled away when anyone tried to hold him. When he was about a year old, Biel signed up for a playgroup at the family center below Suess' clinic. ``He came one day to talk to us,'' Biel remembers. ``He explained what a bond is and I immediately had this feeling: `I have to call him.' '' Biel had deliberately kept an emotional distance between herself and Kevin, hoping for a while that his mother -- her daughter -- would take over his care. ``I didn't want to get between a mother and her baby,'' Biel said. After hearing Suess, though, she decided that her approach could be hurting Kevin. ``I think he felt me holding back.'' Heiderose Holzapfel-Dantzer, the clinic's social worker, started regular home visits, which is one STEEP method for building close and supportive relationships with families. Biel told the social worker that she was worried that Kevin was out of control. He had tantrums so fierce that he sometimes stopped breathing. He was so fidgety that he never sat through a meal. Dantzer sympathized. They had long talks about boundaries being good for children, about limits as lessons, not criticism. Applying another STEEP principle, Dantzer played the role not of ``lecturer,'' but ``cheerleader'' for all that Biel does well. Dantzer also videotaped a family dinner, and Biel noticed that she often jumped up from the table herself, carrying dishes to and from the kitchen. She realized that her grandson might just be following her restless example at mealtimes. Gradually, as Biel felt more confident, she and Dantzer decided to put more time between visits. She still gets overwhelmed sometimes. On top of everything else, she cares for her husband, who has had a series of strokes. But she knows she can always call Dantzer. ``When there are problems, she's someone I call, someone I trust,'' Biel said.

Unusual challenges

The clinic's attachment work has taken it down unexpected paths, such as with the family of Peter Kwame Osei. Osei moved to Germany from Ghana in 1990, an illegal immigrant in search of work. He met and married Gisela Krautwurst, and they are raising two sons, Patrick, 4, and David, 5. Early on, The family had a series of health crises. Patrick was born more than three months early, and the parents were warned that he could die or develop any of a long list of handicaps. The stress triggered a bad episode for Gisela, who has a history of psychotic illness and hallucinations. Suess helped find a spot for her in a psychiatric clinic. She was gone about a year. Suess visited Osei and the boys in their apartment every other week. Osei remembers Suess' encouragement: ``He was happy I was a patient father.'' Then came the legal crisis: German immigration officials found Osei and sent him to prison, planning to deport him from there. Knowing how firmly attached the boys were to Osei, Suess scrambled to get a blood test for Osei, to prove paternity. He wrote regular appeals to family court and the immigration office, asking that they make an exception in Osei's case, for the children's sake. For about six weeks, while both Osei and Gisela were away, Dantzer and Suess even took the boys into their homes. The campaign worked, and the family is together again. ``What I learned from Dr. Suess is how good parents are good for children,'' Osei now says, ``and if not for the clinic, I wouldn't be here.''
`Admit we're helpless'

Suess, who is also a professor of child psychology at the Hamburg University of Applied Sciences, would like to see more STEEP-based programs across Germany. In some ways the timing is good. After a school shooting about a year ago in the German town of Erfurt -- an expelled student killed 13 teachers, two students, a policeman and himself -- Germans spoke in news accounts about losing their comfortable belief that such violence couldn't happen in their country. Also, Christiane Ludwig-Koerner, a staff member at a counseling center in Potsdam, said she expects serious attachment problems in the former Communist East Germany, where some working parents left babies, some as young as 12 weeks old, in child care centers from Monday morning to Friday night every week. Suess hopes to bring Erickson back to Germany this year to spread word of STEEP to a group of professionals who, like him, are more interested in prevention than cure. ``I got so tired of working with violent 14-year-olds,'' he said. ``I thought, `Why don't we just admit we're helpless by then and that we have to go in much earlier?' [With STEEP] we can inform parents about all the positive stuff, and I hope put more children on the right track.''

H.J. Cummins is at hcummins@startribune.com.

Parts of this article are translated from interviews conducted in German.