Program Profile: Parents as Teachers

This is a parent education program that serves families from pregnancy until the child enters kindergarten to improve family relationships and child development. The program is rated No Effects. There were mixed findings for child social development but no statistically significant effects on cognitive development, communication development, physical development, parent/child interaction, or overall parenting behaviors.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative 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

Parents as Teachers is an early childhood, parent education, and family support program serving families from pregnancy until their children enter kindergarten. The program targets families from all socioeconomic backgrounds and from rural, urban, and suburban communities. It is not intended as an intervention for parents or families experiencing serious dysfunction.

The program is designed to improve child outcomes by working with the parents to increase parents’ knowledge of effective parenting practices and child development and to encourage parents to access community resources that support their activities as parents and the development of their children. Through increased knowledge of effective parenting practices and community support, parents are expected to experience positive attitudes toward their children and interact more effectively with them.

Though it is provided to parents, the ultimate intention of Parents as Teachers instruction is to improve child development. By improving the parenting skills of the parents, children are expected to experience enhanced wellness and development.

Program Components

Parents as Teachers offers four components:

• Parenting/child development information provided through home visits, telephone calls, group meetings, and so forth
• Parent support groups
• Child screenings/assessments
• Referral to services as appropriate

Certified parent educators conduct home visits, using a curriculum with the latest neuroscience research findings to offer practical ideas on ways to enhance parenting knowledge. The program is designed to be delivered over 17 visits, each lasting 60 to 90 minutes. The educators provide age-appropriate information as the child develops. The educators also work with parents to increase the parents’ skills as observers of their child.

Parents also meet in groups to discuss topics such as positive discipline, sleep, sibling rivalry, and toilet learning and to promote parent–child interaction through activities such as story reading and play.

During the home visits, the parent educators conduct periodic vision, hearing, and general developmental screenings. They also will refer parents to resources provided by their own agencies or others in the community.

Study

Wagner and colleagues (2001) employed an experimental design to assess the impact of PAT across three sites, including an Eastern Seaboard urban community, a mid-size Southern city, and a large Western city. A total of 667 families with infants up to 8 months of age were recruited from the communities and randomly assigned to a participant group or a control group. The participant group was offered monthly home visits and other PAT services. Families in the control group received services as usual in the community. Both groups received annual child assessments around the children’s birthdays.

Of the mothers recruited, 29 percent were White, 58 percent were Black, and 12 percent were Hispanic/Asian/Other. The average age of mothers was 24 years old at enrollment. Overall, 28 percent of recruited families included teen mothers, but the majority of mothers were in their 20s. Fifty-four percent of the families had a father living in the household, 29 percent had two married parents, and 31 percent had three generations living in the household.

The control and treatment groups did not differ statistically significantly in any measure at the start of the study or by the children’s first or second birthdays for families as a whole. The groups were virtually identical on all factors, although there were some differences between participant and control groups on a handful of factors in specific communities (for instance, at Site 1, the ethnic distribution differed between participant and control group mothers).

Attrition over the course of the study reached 56 percent. More than 20 percent of the families who responded positively to the initial enrollment invitation did not begin home visits when they were assigned to the participant group. Almost 35 percent of families began home visits, but discontinued them before their children were 2 years old. The dropout rate was almost twice as high between children’s first and second birthdays (23 percent) as before first birthdays (12 percent). About 44 percent of families were still participating as of their children’s second birthdays.

In-home assessments were conducted by trained field evaluators. Measurement instruments included the Knowledge of Infant Development Inventory, the Parents’ Sense of Competence Scale, the Child Maltreatment Precursor Scale from the Adult-Adolescent Parenting Inventory, Parent Observation Scale, the Developmental Profile II, a subscale of eight items from the Home Observation for Measurement of the Environment scale, and the Nursing Child Assessment Satellite Training teaching scale. Subgroup analyses were conducted to examine the impact that socioeconomic status had on outcomes.

Study

Wagner and colleagues (1999) assessed the effectiveness of PAT as implemented by a consortium of school districts in the Salinas Valley of California from 1992 to 1996. Families with infants up to 6 months were recruited and randomly assigned either to the PAT group or to a control group. The control received services as usual. Both groups received annual child assessments around the child’s birthday until children were 3 years old.

Four hundred ninety-five mothers were recruited; 400 were Latina and 95 non-Latina. Most fathers (77 percent) also were Latino. The sample of Latinas included approximately equal numbers of English-speaking or bilingual mothers and primarily Spanish-speaking mothers. The sample ranged from 14 to 44 years old at enrollment, with the average age being 25. Fathers were 3 years older, on average. Fifty-six percent of the families had two married parents living with the child at enrollment; 16 percent had two unmarried parents living with the child.

The control and treatment groups did not differ statistically significantly from each other in any measure at the start of the study, though the evaluators note a pattern of small difference that might favor positive outcomes for the control group (e.g., compared with PAT parents, control group parents were somewhat better educated). Group equivalence was largely maintained through the project, although the difference in the rate of Latina enrollment in the treatment and control groups reached statistical significance at the first assessment (PAT group was 84 percent Latina, the control group was 74 percent at the first assessment).

In-home assessments were conducted by trained field evaluators. Measurement instruments included the Knowledge of Infant Development Inventory, the Parents’ Sense of Competence Scale, Developmental Profile II, the Home Observation for Measurement of the Environment scale, the Bayley Scales of Infant Development, and the Peabody Picture Vocabulary Test. Sixty-four percent of control parents participated in all three assessments, compared with 58 percent of PAT parents. Eleven percent of control parents participated in none of the assessments, compared with 17 percent of PAT parents. Forty-three percent of PAT participants dropped out of the study.

Descriptive statistics were used to compare the characteristics of the groups and their outcomes; multivariate analysis was used to identify independent relationships. Subgroup analyses were conducted to examine the impact that ethnicity had on outcomes.

Study

Wagner, Cameto, and Gerlach–Downie (1996) assessed the impact of Parents as Teachers (PAT) on parent and child outcomes using a randomized control design where a group of teen parents were randomly assigned to one of three intervention groups (PAT; comprehensive case management; PAT plus case management) or the control group. The control group received no direct services through the demonstration, though they did receive assessments of the children’s development and regular mailings of children’s toys. The CrimeSolutions review of this study focused on the difference between both treatment groups combined and the control group.

Equivalence of groups was achieved by random assignment, with three exceptions. First, the control group had a statistically significantly smaller proportion of members who were dropouts at the time of assignment (25 percent) than other groups, compared with the PAT group (35 percent). Control teens who were not pregnant at enrollment were more likely to be using contraceptives at least some of the time than were teens in some intervention groups. PAT group members had more frequent experience with infants than any other group, even though they were not significantly more likely than other groups to rate their knowledge of infants as “high.”

Four agencies in Southern California participated in the study, recruiting a total of 717 clients. The average age of the participants was 16.7 years; 56.3 percent of the participants were Latina, 20.8 percent were White, 20.3 percent were Black, and 2.6 percent were “other.” Most (68.2 percent) were enrolled in high school programs, 30.3 percent were dropouts, and 1.5 percent had graduated or had achieved a GED.

Data came from a variety of sources, including enrollment interviews by agency staff, agency records maintained by staff, participant interviews, Children’s Protective Services data on opened cases of child abuse/neglect, comparison data from California’s Adolescent Family Life Program state database, and focus groups with service providers and with teen parents in intervention groups.

Attrition was significant: 402 teens dropped out of the demonstration between enrollment and the child’s second birthday, for an overall dropout rate of 56 percent. The rate at which teens dropped out was fairly evenly distributed among the four groups (PAT dropout rate was 58 percent; PAT plus case management 63 percent; combined intervention 53 percent, and the control group 54 percent). There were no statistically significant differences between participants and dropouts, except that 35 percent who dropped out of the study had also dropped out of school, while only 24 percent of intervention participants had dropped out of school.

Measurement instruments for parental outcomes included the Knowledge of Infant Development Inventory, the Parents’ Sense of Competence Scale, and the Home Observation for Measurement of the Environment scale. Child outcomes (cognitive development, social development, self-help development, communication development, and physical development) were measured by five subscales of the Developmental Profile II. Descriptive statistics were used to compare the characteristics of the groups and their outcomes; ordinary least squares regression analysis and logit analysis were used to identify independent relationships. No subgroup analyses were conducted.

Montgomery and Duenas (1997) conducted an independent cost analysis of the Parents as Teachers (PAT) model as implemented in the Northern California PAT demonstration. The study was conducted between 1995 and 1997. According to the study, the average monthly cost of the PAT program per family was estimated at $170. Forty-eight percent of the cost was attributable to parent educator time, 18 percent was for nonpersonnel supplies and materials, and 34 percent went to administrative overhead costs (Wagner et al. 1999). The cost of the program for a family served for the expected time period (30.1 months) totaled $5,125, on average.<br/><br/> Aos and colleagues (2004) estimated that the cost per participant totaled $3,500.

Information about the program can be found on the Parents as Teachers website.

Subgroup Analysis

Wagner and colleagues (1999) also examined the impact that ethnicity had on outcomes. Children with Latina mothers in the treatment group had higher scores in cognitive development, self-help development, and social development, compared with children with Latina mothers in the control group, at the child’s third birthday. These differences were statistically significant. There were no statistically significant differences between children with Latina mothers in the treatment group and children with Latina mothers in the control group in communication development or physical development.

Finally, Wagner and colleagues (2001) conducted subgroup analyses to examine the impact socioeconomic status had on outcomes. Treatment group children from low-income families had greater Adaptive Social Behavior scores, compared with control group children from low-income families, at the child’s second birthday. This difference was statistically significant. There were no statistically significant differences between treatment group moderate-income families and control group moderate-income families.

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

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

Aos, Steve, Roxanne Lieb, Jim Mayfield, Marna Miller, and Annie Pennucci. 2004. Benefits and Costs of Prevention and Early Intervention Programs for Youth. Olympia, Wash.: Washington State Institute for Public Policy.

Drazen, Shelley M., and Mary Haust. 1994. Increasing Children’s Readiness for School by a Parental Education Program. Binghamton, N.Y.: Community Resource Center.

Montgomery, D.L., and X.E. Duenas. 1997. Parents as Teachers Cost Analysis: Phase 1 Report. Palo Alto, Calif.: American Institutes for Research.

Pfannenstiel, Judy C, Theodora Lambson, and Vicki Yarnell. 1991. Second Wave Study of the Parents as Teachers Program. Overland, Kan.: Research and Training Associates.

Pfannenstiel, Judy C, Theodora Lambson, and Vicki Yarnell. 1995. The Effects of the Parents and Children Together Program on School Achievement. Binghamton, N.Y.: Community Resource Center.

Pfannenstiel, Judy C, Theodora Lambson, and Vicki Yarnell. 1996. Lasting Academic Gains From a Home Visitations Program. Binghamton, N.Y.: Community Resource Center.

Pfannenstiel, Judy C., and Dianne A. Seltzer. 1985. Evaluation Report: New Parents as Teachers Project. Overland, Kan.: Research and Training Associates.

Wagner, Mary M. 1992. Home the First Classroom: A Pilot Evaluation of the Northern California Parents as Teachers Project. Menlo Park, Calif.: SRI International.

Wagner, Mary M. 1993. Evaluation of the National City Parents as Teachers Programs. Menlo Park, Calif.: SRI International.

Wagner, Mary M., Donna Spiker; and Margaret Inman Linn. 2002. “The Effectiveness of the Parents as Teachers Program With Low-Income Parents and Children.” Topics in Early Childhood Special Education 22(2):67–81.

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

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