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Program Profile: Parents as Teachers

Evidence Rating: No Effects - More than one study No Effects - More than one study

Date: This profile was posted on May 21, 2013

Program Summary

An early childhood parent education and family support program serving families from pregnancy until their children enter kindergarten. The program is rated No Effects. The preponderance of evidence suggests that the program had no effect on improving child or parent outcomes.

Program Description

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.

Evaluation Outcomes

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Although researchers detected a statistically significant positive impact on a small number of outcomes, the preponderance of evidence suggests that the Parents as Teachers (PAT) program had no effect on improving child or parent outcomes.

Study 1

Child Outcomes
Cognitive Development
Wagner, Cameto, and Gerlach–Downie (1996) found no differences on the cognitive development scale between the Parents as Teachers (PAT) and control groups at the children’s 2-year birthdays, though there was a slight positive difference for the PAT group for teens who received the expected level of intervention during the children’s second year.

Communication Development
There were no differences on the communication development scale between the PAT and control groups at the children’s 2-year birthdays, although there was a slight positive difference for the PAT group participants who received the expected level of intervention during the children’s second year.

Self-Help Development
There were no differences on the self-help scale between the PAT and control groups at the children’s 2-year birthdays.

Social Development
Compared with control group children, PAT group participants had significantly higher social development scores (p<.05).

Physical Development
There were no differences on the physical development scale between the PAT and control groups at the children’s 2-year birthdays, though there was a slight positive difference for the PAT group participants who received the expected level of intervention during the children’s second year.

Parent Outcomes
Knowledge of Child Development

Compared with control group mothers, mothers in the PAT group demonstrated significantly greater knowledge of child development as measured on the Knowledge of Infant Development Inventory at the children's 2-year birthdays (p<.05).

Attitudes Toward Parenting
There were no differences between the PAT and control groups on their attitude toward parenting as measured by the Parents' Sense of Competence Scale.

Parenting Behavior
There were no differences between the PAT and control groups on parenting behavior as measured by the Home Observation for Measurement of the Environment (HOME) scale. No effects were noted for the incidence of child abuse.

Study 2

Child Outcomes

Cognitive Development

Wagner and colleagues (1999) found no differences on the cognitive development scale between the PAT and control groups at the child’s 3-year assessment.

Communication Development
There were no significant differences on the communication development scale between the PAT and control groups on the two tests of communication development at the children’s 3-year assessments.

Self-Help Development
Compared with the control group, the PAT group scored significantly higher on mean month differentials on the self-help scale (p<.05), with the effect stronger for children of Latina mothers.

Social Development
There were no differences between the PAT and control groups on the social development scale at the children’s 3-year assessments, though there was a significant effect for children of Latina mothers (p<.01).

Physical Development
There were no differences on the physical development scale between the PAT and control groups at the children’s 3-year assessments.

Parent Outcomes
Parenting Behavior

There were no differences between the PAT and control groups on parenting behavior as measured by the total Home Observation for Measurement of the Environment scale at the children’s 3-year assessments.

Acceptance of Behavior Subscale
The PAT group scored significantly lower than the control group on the Acceptance of Behavior Subscale (p<.01) at the children’s 3-year assessments.

Appropriate Play Materials Subscale
There were no differences between the PAT and control groups on the Appropriate Play Materials Subscale at the children’s 3-year assessments.

Parental Involvement Subscale
There were no differences between the PAT and control groups on the Parental Involvement Subscale at the children’s 3-year assessments.

Opportunity for Stimulation Subscale
There were no differences between the PAT and control groups on the Opportunity for Stimulation Subscale at the children’s 3-year assessments.

Study 3

Child Outcomes
Child Development
Wagner and colleagues (2001) found there were no significant differences between the participant and control groups on any of the developmental domains measured by the Developmental Profile II.

Adaptive Social Behavior
At the 2-year assessment, the Adaptive Social Behavior Inventory scores showed a small, positive effect on the PAT group (effect size = 0.21). However, this effect was not statistically significant.

Parent Outcomes
Parent–Child Interaction
There was a small positive effect (effect size = 0.22) for the PAT group on the HOME Parent-Child Interaction Subscale score. However, this effect was not statistically significant.

As measured by the overall Nursing Child Assessment Satellite Training scale there were no differences between the treatment and control groups on parent-child interaction. A small positive effect for the parent scale was noted (effect size = 0.19), with the largest effect for parents relating to responses to children’s distress (effect size = 0.23). However, no meaningful effect was noted for the child scale or subscales.

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Evaluation Methodology

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Study 1
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.

Equivalence of groups was achieved by random assignment, with three exceptions. First, the control group had a smaller proportion of members who were dropouts at the time of assignment (25 percent) than other groups, significantly so when compared with the PAT group (35 percent; p<.05). 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 African American, 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 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 included the Knowledge of Infant Development Inventory, the Parents’ Sense of Competence Scale, and the Home Observation for Measurement of the Environment scale. 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.

Study 2
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 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 2, 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.

Study 3
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 Caucasian/white, 58 percent were African-American, 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 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 (CMPS) from the Adult-Adolescent Parenting Inventory, Parent Observation Scale, the Developmental Profile II (DPII), a subscale of eight items from the Home Observation for Measurement of the Environment (HOME) scale, and the Nursing Child Assessment Satellite Training (NCAST) teaching scale.

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Cost

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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. Aos and colleagues (2004) estimated that the cost per participant totaled $3,500.
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Evidence-Base (Studies Reviewed)

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

Study 1
Wagner, Mary M., Renée Cameto, and Suzanne Gerlach–Downie. 1996. Intervention in Support of Adolescent Parents and Their Children: A Final Report on the Teen Parents as Teachers Demonstration. Menlo Park, Calif.: SRI International.
http://policyweb.sri.com/cehs/publications/TeenParentFinalReport.pdf

Study 2
Wagner, Mary M., Serena Clayton, Suzanne Gerlach–Downie, and Mary McElroy. 1999. An Evaluation of the Northern California Parents as Teachers Demonstration. Menlo Park, Calif.: SRI International.
http://policyweb.sri.com/cehs/publications/EvalNorthCAPATDemonstration.pdf

Study 3
Wagner, Mary M., Donna Spiker, Frances Hernandez, Julia Song, and Suzanne Gerlach–Downie. 2001. Multisite Parents as Teachers Evaluation: Experiences and Outcomes for Children and Families. Menlo Park, Calif.: SRI International.
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Additional References

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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.

Parents as Teachers Website. N.d.
http://www.parentsasteachers.org/

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

———. 1995. The Effects of the Parents and Children Together Program on School Achievement. Binghamton, N.Y.: Community Resource Center.

———. 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.

———. 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.
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Program Snapshot

Age: 0 - 3, 14 - 44

Gender: Both

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White, Other

Geography: Urban

Setting (Delivery): Home

Program Type: Parent Training

Targeted Population: Families

Current Program Status: Active

Listed by Other Directories: National Registry of Evidence-based Programs and Practices

Program Developer:
Parents as Teachers
2228 Ball Drive
St. Louis MO 63146
Phone: 314.432.4330
Fax: 314.432.8963
Website