Program Profile: Adults and Children Together (ACT) Raising Safe Kids Program

This is an antiviolence program designed to prevent child maltreatment by providing education, resources, and support to parents to improve their parenting skills. The program is rated Promising. Treatment group parents reported a statistically significant reduction in using harsh discipline strategies and increase in appropriate developmental expectations, compared with control group parents at the 3-month follow up. However, there was no statistically significant difference in nurturing.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

The goal of the Adults and Children Together (ACT) Raising Safe Kids Program is to strengthen families and improve or change parenting skills and practices to prevent child maltreatment. The program provides education and resources and seeks to achieve the primary goal by (1) establishing partnerships with a variety of organizations and agencies, and (2) training professionals to take the program to families and caregivers in their communities. 

ACT emphasizes the important role that parents and other adults have in creating safe, nurturing, stable, and healthy environments for young children that help protect them from violence and trauma, and their consequences. The program also promotes community support and serves as a complement to existing interventions for children at high risk for maltreatment. The program is designed to be a universal approach to help groups of parents and caregivers from all backgrounds regardless of their risk level. It is also designed to be flexible so that a variety of community-based institutions and organizations can implement the program and integrate it into existing interventions and services for parents.

ACT is currently implemented in almost 100 communities in the United States and Puerto Rico, including Latino and Asian-American communities, and in Brazil, Colombia, Greece, Japan, and Peru.

Program Theory

The ACT Raising Safe Kids Program is based on research indicating that in the early years, violence, abuse, and neglect are mostly perpetrated by children’s own parents (Children’s Bureau 2010). Studies have also demonstrated that exposure to abuse and neglect early in life has long-term and serious emotional, cognitive, and behavioral trauma and consequences for children and youth. Therefore, ACT was designed to focus on the early years and the important role of parents and caregivers in shaping children’s early environment and experiences. In addition, it is based on the notion that lack of knowledge about child development and inadequate parenting skills are the primary causes of child maltreatment (Portwood, et al. 2011). Abusive parents often have inappropriate expectations about their child’s behavior and tend to react inappropriately. They are more likely to use harsh physical discipline and verbal aggression and less likely to use positive parenting strategies (Guttman, Mowder, and Yasik 2006). The framework for ACT is also informed by research related to violence prevention that shows that violence is the result of an individual’s lack of problem-solving skills to deal with conflict and can negatively affect the problem-solving abilities of children exposed to violence (Guttman, Mowder, and Yasik 2006). ACT seeks to teach caregivers how to model developmentally appropriate, non-violent social and problem-solving skills to children.

ACT is based on the Centers for Disease Control and Prevention’s (CDC) Best Practices of Youth Violence Prevention, which include social-cognitive interventions like didactic instruction, modeling, and role-playing. The CDC also suggests parent- and family-based interventions, which is why ACT was revised to address family violence and child abuse (Thorton, et al. 2002). The program is also grounded in components of social learning theory (Bandura 1973), proposing that children observe and imitate the adults in their lives. As such, parents participating in ACT are taught how to manage their anger in order to model appropriate behavior and conflict-resolution techniques for their children.

Program Activities
The ACT Program is delivered to groups of parents and caregivers by trained professionals (ACT Facilitators) with support from other organizations. The American Psychological Association (APA) established partnerships with institutions in the United States to create the ACT Regional Training Centers in various regions of the country (please see Implementation Information for additional information). 

The ACT curriculum is organized in eight 2-hour interactive group sessions and addresses:

• Understanding Children’s Behaviors: This component focuses on helping parents understand what to expect from children at various development stages and how to use skills to guide children’s behavior based on their developmental level, so that parents do not have unrealistic expectations of their children and do not resort to violence when dealing with misbehaviors.
• Young Children’s Exposure to Violence: The purpose of this session is to help parents understand (1) how children can be exposed to violence and its consequences; (2) that children learn by observation and imitation; and (3) that their behavior, actions and the environment they provide teach children lessons for life.
• Anger Management for Parents: This session is designed to help parents learn skills to understand, control, and manage their own feelings of anger.
• Understanding and Helping Angry Children: This session helps parents understand children’s angry feelings and how to teach them positive ways to express and control anger. The session also covers helping families teach social problem-solving skills in a home environment based on an understanding of the developmental stages through which children learn social skills.
• Children and Electronic Media: This part of the program emphasizes the relationship between time spent on screen and unhealthy behaviors, and between exposure to violent messages and images and aggressive behaviors so that adults can reduce the impact on their children.
• Discipline and Parenting Style: This session helps parents understand that their parenting styles have an impact on children’s behaviors. Distinctions are also made between punishment and discipline so that parents can respond effectively.
• Discipline for Positive Behaviors: This session teaches parents how to prevent challenging behaviors and how to use positive methods to discipline their children.
• Take the ACT Program with You: The final session encourages participants to use the learned tools at home and in the community.

Key Personnel

APA Violence Prevention Office staff coordinates the program including development of training and educational materials, and technical assistance to the ACT Regional Centers and program sites through e-mails and conference calls, organization of the annual leadership seminar and web-based seminars, and coordination of the program listserv. Organizations that host the program include community-based social service and mental health providers, hospitals, churches, childcare centers, prisons, and schools. Professionals conducting the program’s 8-week series in the communities include psychologists, early childhood professionals, social workers, social service agency staff, and nurses.

Study

Using an experimental design, Portwood and colleagues (2011) examined whether participation in the Adults and Children Together (ACT) Raising Safe Kids Program increased positive parenting skills, improved partner conflict management skills, increased the use of supportive networks, and decreased parenting stress. A total of 162 intervention group participants and 109 comparison group participants were recruited from social service agencies and parenting programming in three sites: Chicago, IL; Newport News, VA; and Milwaukee, WI. Parents over the age of 18 were randomly assigned to ACT (treatment group) or to continue in current programming without ACT as a supplement (control group). Treatment and control conditions were present at all sites, and parents in control groups were offered the opportunity to participate in subsequent ACT classes.

The treatment group was 89.3 percent female, 68.4 percent married, and the average age was 32.9 years. Participants were 70.7 percent Hispanic, 17.8 percent white, 8.3 percent Black, 0.6 percent Asian/Pacific Islander, 0.6 percent American Indian/Alaska/Native, and 1.9 percent other race/ethnicity. Approximately 40 percent of the participants had obtained their GED or high school diploma, and 35.8 percent reported annual household incomes below $20,000. Parents most commonly had one child living in the home (30.2 percent), followed by two children (28.2 percent). There were no statistically significant differences between treatment and comparison groups in the demographic characteristics of participants.

A traditional pretest-posttest study design was employed, with all participants in both treatment and control groups asked to complete a Parenting Survey at three time periods: (1) within 10 days preceding the ACT program start date; (2) at the conclusion of the ACT program; and (3) three months following the program's completion. Several measurement scales were used to assess positive parenting skills, family conflict, social support, and parenting stress.

• The Parenting Behavior Checklist (PBC), a 32-item measure, was used to assess levels of Discipline, Nurturing Behaviors, and Expectations. 
• The Conflict Scale of the Family Environment (FES) scale, a 9-item true/false inventory, was used to produce a summary score reflecting aggression and conflict among family systems.
• The Perceived Social Support (PSS) scale, a 40-item scale, was used to assess support from family and friends.
• The Parenting Stress Index-Short Form (PSI-SF), a 36-item Likert scale, was used to assess stress levels in families with young children, including parent distress, parent-child dysfunctional interaction, and parents’ views of children’s oppositional behavior.

Four types of analysis of variance models and Tukey post-hoc comparisons were also used to examine program outcomes. Group comparisons across pretests and posttests were conducted, as well as a separate analysis of the 3-month follow-up results. The study authors conducted subgroup analyses on intervention completers and noncompleters (i.e., participants who attended six or fewer sessions) and across groups on participants whose pretest scores were below the normal, clinical range (i.e., abnormally low).

Participating agencies must complete the American Psychological Association (APA) training protocol and obtain Adults and Children Together (ACT) Raising Safe Kids Program materials from the APA. Training workshops are free and conducted through a train-the-trainer model with community service providers. The APA established partnerships with institutions in the United States to create the ACT Regional Training Centers (RC) in various regions of the country. The RCs coordinate the 2-day training workshops for ACT Facilitators, and provide assistance to those implementing ACT in their communities. The RCs are: ACT Midwest RC at Pillars, a major mental health agency in the Chicago area; ACT Great Lakes RC at the University of Toledo; ACT Southeast RC at The Melissa Institute in Miami, FL; ACT Northeast RC at Brandeis University; and the ACT Mid-Atlantic at APA in Washington, DC.

The ACT curriculum is offered in English and Spanish, and has also been translated into Greek, Japanese, and Portuguese. ACT is also designed to be implemented alongside existing parental training programming in participating communities. More information is available at: https://www.apa.org/pi/prevent-violence/programs/act

Subgroup Analysis

Portwood and colleagues (2011) conducted subgroup analyses on Adults and Children Together (ACT) Raising Safe Kids Program completers and noncompleters (i.e., participants who attended six or fewer sessions) and across groups on participants whose pretest scores were below the normal, clinical range (i.e., abnormally low). The authors found that program completers were more likely to report a reduction in harsh discipline strategies, compared with noncompleters, at the 3-month follow up. This difference was statistically significant. However, there were no statistically significant differences between completers and noncompleters in expectations, nurture, or parent stress.

ACT parents who reported abnormally low expectations at baseline showed a greater improvement in the level and appropriateness of their developmental expectations for their children and in parent stress, compared with low-scoring control group parents, at the 3-month follow up. These differences were statistically significant. However, there were not enough participants with sufficiently low scores to conduct an analysis for harsh discipline or nurturing.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Preventive Child Maltreatment Programs

Preventive child maltreatment programs are designed to prevent physical child abuse or neglect by educating expectant and new parents in parenting skills, coping with stressors, and stimulating child development. This practice is rated Effective for preventing child abuse, neglect, and maltreatment.

Evidence Ratings for Outcomes

Victimization - Child abuse/neglect/maltreatment

Parent-Involved Antibullying Programs for Youth

This practice includes programs that offer a parent-involved component to reduce bullying perpetration and victimization. This practice is rated Promising for reducing bullying victimization and perpetration, reducing negative parenting, and improving positive parenting skills but is rated Ineffective for reducing youth depression.

Evidence Ratings for Outcomes

	Victimization - Bullying victimization
	Family Functioning - Parenting skills
	Family Functioning - Negative parenting skills
	Juvenile Problem & At-Risk Behaviors - Bullying
	Mental Health & Behavioral Health - Internalizing behavior

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?