Program

Dec 17, 2010

OVERVIEW

The Parents as Teachers (PAT) program is an early childhood parent education program. The program focuses on positive child development by providing monthly home visits and group meetings.  PAT uses trained parent educators to work with families with children who have not yet entered school. Random-assignment evaluations of PAT have been conducted.

OUTCOMES

Some evaluations have found that the program is effective in increasing several measures of parents’ knowledge of children’s needs and interactions with children. For example, PAT participants had increases in parenting knowledge and were more likely to engage in reading activities with their children.  PAT was also effective in influencing several child outcomes such as being fully immunized and free from injuries.

 DESCRIPTION OF PROGRAM

Target population: The program recruits parents of children who have not yet entered school. Once in the program, participants can remain in the program as long as they would like; however the program officially ends when children enter kindergarten. Services were offered up to the child’s third birthday.

The goal of the PAT program is to increase parent knowledge of early childhood development, improve parenting practices, prevent child abuse and neglect, increase children’s school readiness, and detect developmental delays and health issues.

The program consists of monthly home visits by trained parent educators, parent education group meetings, and other services. The home visits last from 45 to 60 minutes. Participants can receive program services as long as they remain in the program. In the home visits, parent educators share age-appropriate child development information, help parents learn to observe their children, address parenting concerns, and facilitate activities that provide parent/child interaction. In parent education group meetings, parents interact with other parents to share information and support one another. The other services the PAT program provides include developmental screenings, a “drop in and play” session, and referral to resources.

 EVALUATION(S) OF PROGRAM

Wagner, M. M., & Clayton, S. L. (1999). Parents as Teachers Program: Results from two demonstrations. The Future of Children, 9(1, Home visiting: Recent program evaluations), 91-115.

SITE 1: SALINAS, CA

Evaluated Population: The sample consisted of a predominately Hispanic group of individuals living in an agricultural area with bouts of high unemployment due to seasonal farm labor needs. Many of the families in the sample primarily spoke Spanish and were low-income households; and almost 50 percent were single-mother families. About 20 percent received Aid to Families with Dependent Children (AFDC) and over 50 percent received Medi-Cal.

Approach: Parenting knowledge, attitudes, and behaviors/home environment were assessed. Parenting attitudes included a total scale consisting of parent satisfaction and parent efficacy. Parenting behaviors/home environment consisted of the following: acceptance of child’s behavior, opportunity for stimulation, organization of the environment, parental involvement, parental responsivity, and appropriate play materials. Child development measured by the DPII included cognitive, communication, social, self-help, and physical development subscales. This measure is based on parent reports and field evaluator observations. The BSID is another measure used here and is a direct assessment of the child, as is the vocabulary test. The BSID analyses presented in the article are based on only 42 to 54 percent of the baseline sample because of drop out and missing data. Parents also reported on child immunizations and use of health care services. In the multivariate analyses, demographic variables taken into account were mother’s education, age, primary language, self-reported experience with infants at baseline, household income, and the child’s gender.

 Results: One of the parenting behaviors were significant: parents in the control group had a significantly higher acceptance of child’s behavior (effect size: 0.28) compared with the treatment group. The treatment group children had a significantly higher score on self-help development (DPII) compared with the control group children (effect size: 0.25).

Multivariate analyses, controlling for demographic variables, found that the treatment group had higher scores on three separate outcomes compared with the control group: cognitive, social, and self-help development.

Subgroup analyses were done as well. Latina mothers and English-speaking or bilingual Latinas had higher scores on the parent efficacy attitude subscale compared with their respective control groups. Non-Latina mothers in the control group had significantly higher scores on acceptance of child’s behavior subscale and on discipline, compared with the treatment group. For the control group, children of non-Latina mothers had higher scores on the physical development index compared with the treatment group. Children of Latina mothers in the treatment group scored higher on DPII-measured cognitive development, social development, and self-help development, compared with the control group. Children of Spanish-speaking Latinas in the treatment group also scored higher than the control group on significant outcomes: DPII-measured cognitive development, vocabulary communication development, and social development.

Parenting knowledge, parenting attitudes, other parenting behaviors and HOME, child’s cognitive development, communication development, social development, physical development, and child health and health care were nonsignificant. Multivariate analyses found no impacts on parenting outcomes or most child development outcomes. For the Spanish-speaking Latina subgroup, no significant impacts were found, and no significant findings were found for the other three subgroups on parenting knowledge.

Wagner, M. M., & Clayton, S. L. (1999). Parents as Teachers Program: Results from two demonstrations. The Future of Children, 9(1, Home visiting: Recent program evaluations), 91-115.

SITE 2: Southern California, Teen Parents as Teachers

Evaluated Population: Teens were less than 19 years old, with an average age of about 16 years, and were either pregnant or had a child less than six months old. About half of the participants were Hispanic, and around one in five spoke mostly Spanish. Around one in three received AFDC benefits.

Approach: Participants were randomly assigned to one of four groups: PAT alone, case management alone, PAT plus case management, and the untreated control group. For measures, see site 1’s approach section. Attrition for this group was high, with only 52 percent of families assessed after the child’s second birthday.

 Results: The control group’s average scale for an environment with appropriate play materials subscale (effect size: 0.35) was higher than the score for the treatment group. For the combined intervention, PAT plus case management, parents in the control group had a significantly lower acceptance of child’s behavior (effect size: 0.30). Combined group children had a significantly fewer number of opened case of child abuse or neglect, compared with the control group.

 Parenting knowledge, parenting attitudes, other parenting behaviors and HOME, child’s cognitive development, communication development, social development, self-help development, physical development, and child health and health care were nonsignificant. Multivariate analyses controlling for demographic variables found no significant impacts on parenting outcomes or child development outcomes.

 Wagner, M., Iida, E., & Spiker, D. (2001, August). The multisite evaluation of the Parents as Teachers home visiting program: Three-year findings from one community. Menlo Park, CA: SRI International.

 Evaluated population: Because of the high attrition in the other two sites, the three-year evaluation was only conducted in one site. Families (N=206) were recruited to participate in the evaluation.  Participant mothers were on average 24 years old and the sample was mostly Caucasian. The average educational attainment of mothers was 12th grade and most participants were from low-income households.

Approach: Parents with infants up to 8 months of age were randomly assigned to either a participant or control group. Participants varied in the number of home visits they received, with an average of 20 home visits.

Data were collected from participants using the family enrollment form, the Mothers’ Previous Experience with Infants questionnaire, a family survey, parenting knowledge items, Parenting Sense of Competence Scale, Maternal Social Support Index, Adult-Adolescent Parenting Inventory, Language- and literacy-promoting behavior items, Home Observation for Measurement of the Environment, Nursing Child Assessment Satellite Training, Developmental Profile II, Adaptive Social Behavior Inventory, Immunization Status, and program records. Assessments were conducted around the time of children’s birthdays and data were collected from participants in in-home assessments.

Results: Results of the study showed parents in the PAT program increased their knowledge of child development and methods to stimulate children’s development. For overall parent knowledge, there were small to medium impacts (w2 ranging from 0.01 to 0.23). There were also significant differences on measures of attitudes towards parenting (effect size was 0.12 at year 3 assessment). Parents in PAT were also more likely to engage in reading activities with their children (effect size of 0.21 at 3 year assessment). Impacts were greater among teen parents.

With regard to child outcomes, children in the PAT program experienced several non-significant gains.  Specifically, they showed gains in the self-help domain of child development at the 3-year assessment (effect size=0.26).  They also were more likely to be fully immunized (effect size=0.81) and less likely to be treated for injury (effect size=0.36) at the 3-year follow up.

The researchers concluded that PAT was effective in influencing outcomes but the effects were small. Also, since only one of the three sites participated, they caution about generalizing from these findings.

Wagner, M. M., Spiker, D., Hernandez, F., Song, J., & Gerlach-Downie. (2001). Multisite Parents as Teachers evaluation: Experiences and outcomes for children and families. Menlo Park, CA: SRI International.

Evaluated Population: Families (N=665) from three communities participated in the evaluation. Site 1 had 205 families, Site 2, 247, and Site 3 had 213 families. Average age of mothers was 24 years and most were African American (58 percent). About one in every six families had a mother enrolled in school, while 30 percent had some education after high school and 37 percent had less than a high school diploma. One in five mothers was working full-time, and 45 percent were not working or they were seeking work. Sixty percent of the families lived in households with an annual income of less than $15,000. The mothers rated their homes as a positive place to be, 21 out of 24, based on whether the home is calm, a good place to relax, and whether the new child is seen as a positive or puts a strain on the household. One in ten of the children born were low birth weight, and slightly over half of mothers reported “excellent” health. Twenty-four percent reported “very good” health.

Approach: Participants were randomly assigned to the PAT program (N=275) or to a control group (N=390) at baseline. Parenting and child outcomes were measured at the child’s first and second birthdays. Subgroups of income were examined also. Parents’ knowledge, attitudes, and behaviors were assessed. Knowledge included subscales of general child development, language/cognitive development, emotional development, discipline, and child care and safety. Attitudes referred to parenting efficacy and satisfaction. Risk of maltreating the child and happiness while caring for the child were also assessed. Promoting language and literacy development was the behavior outcome. Such development included talking to the child, reading aloud to the child, counting, singing, or saying counting rhymes with the child, telling stories or singing to the child, looking at books or reading to the child, and asking the child questions while reading. Home visitors also observed the language promotion environment of the home as well as parent-child interactions.

Child outcomes were development and health care assessed at the child’s second birthday. Subscales of child development included cognitive, self-help, social, physical, and communication development. Health insurance coverage, well-child care visits in the six months prior to the child’s second birthday, full immunization by age two, treatment for injury since the child’s first birthday, and emergency room visits since the child’s first birthday were assessed. Subgroup impacts were also examined: very low income and moderate income.

Results: 

Mothers

Mothers in the PAT group had a significantly higher score compared with the control group mothers on their reports of being “very happy” while caring for their child in the last year. When separating mothers into very low income and more moderate income subgroups, only this happiness variable at the two-year assessment was significant for the moderate income group. All over variables at one-year and other two-year assessments were nonsignificant. When looking at the mothers in very low income and moderate income subgroups, reading aloud to the child as well as telling stories/saying nursery rhymes/singing with the child were significant. Very low income mothers in the PAT group had higher self-reported instances of doing these two types of activities with their child.

Overall, the program was not found to have any significant impacts on parenting knowledge (general child development, language/cognitive development, emotional development, discipline, child care and safety), attitudes (efficacy, satisfaction, maltreatment risk), ease of remembering details about the child’s abilities (e.g. whether the child picks objects up with two fingers or in their whole fist), promoting language and literacy development (talking to child, reading aloud questions, counting, singing, saying counting rhymes, telling stories or singing to the child, looking at books or reading to child, talking to or asking child questions while reading), home-visitor observation of language promotion, or parent-child interaction.

Children

No significant impacts were found for any child development or health care variables, overall or subscales. Subgroup impacts were also not found.

Wagner, M., Spiker, D., & Linn M. I. (2002).  The effectiveness of the Parents as Teachers program with low-income parents and children.  Topics in Early Childhood Special Education, 22, 67-81.

 Evaluated population: Parents of 665 young children from 8 months to 3 years of age.  60% of families had incomes less than $15,000 per year and 18% received Temporary Assistance for Needy Families incentives.

Approach: Families were selected only from PAT sites which had been running for at least two years, served at least 100 families, had high rates of low-income families, had monthly home visits, and agreed to participation in the study.  Families were then randomly assigned to PAT and control group treatments.  The control group received free annual assessments and free children’s books several times a year.  Parents were assessed using measures designed to test parent knowledge of child-rearing/educating and parent reports of child behavior.  In addition, children were assessed on their second birthdays on the Developmental Profile II (DPII) which is designed to collect data on child behavior and health.

Results: Researchers found that children in the PAT treatment groups performed only slightly better than the control group, and then only in a few areas.  Treatment groups received higher parent ratings of happiness when caring for the child as well as acceptance of the child’s behavior.  There were no differences between controls and treatment groups with respect to the DPII measure administered to children.

SOURCES FOR MORE INFORMATION

Link to PAT eStore: http://patnc.login.rboinc.com/login.aspx

Website: http://www.parentsasteachers.org

Contact information:

Karen Guskin, Ph.D.

Parents as Teachers National Center

2228 Ball Drive

St. Louis, MO 63146

314-432-4330 or 866-PAT-4YOU (phone)

314-432-8963 (fax)

info@parentsasteachers.org

References

Wagner, M. M., & Clayton, S. L. (1999). Parents as Teachers Program: Results from two demonstrations. The Future of Children, 9(1, Home visiting: Recent program evaluations), 91-115.

Wagner, M., Iida, E., & Spiker, D. (2001, August). The multisite evaluation of the Parents as Teachers home visiting program: Three-year findings from one community.Menlo Park, CA: SRI International.

Wagner, M., Spiker, D., Gerlach-Downie, S., & Hernandez, F. (2000, February). Parental engagement in home visiting programs: Findings from the Parents as Teachers multisite evaluation. Menlo Park, CA: SRI International.

Wagner, M., Spiker, D., & Linn M. I. (2002).  The effectiveness of the Parents as Teachers program with low-income parents and children.  Topics in Early Childhood Special Education, 22, 67-81.

Program categorized in this guide according to the following:

Evaluated participant ages: younger than 8 months old at start and were followed through 3 years of age / Program age ranges in the Guide:  0-5

Program components: child care/early childhood education; clinic-based, provider-based, or miscellaneous; home visiting; parent or family component

Measured outcomes: education and cognitive development; physical health

KEYWORDS: Infants (0-12 months), Toddlers (12-36 months), Adolescents (12-17), Adolescent Mothers, Males and Females (co-ed), Female-only, Clinic/Provider-based, Parent Training/Education, Home Visitation, Other Mental Health, Health Status/Conditions, Child Maltreatment, Parent-child Relationship, Academic Achievement/Grades.

 

Program information last updated 12/17/10.