Parents as Teachers (PAT)
About This Program
Target Population: Parents/Caregivers who are expecting a child or have a child who has not begun Kindergarten
For parents/caregivers of children ages: 0 – 5
Program Overview
Parents as Teachers™ is a home visiting model that promotes the optimal early development, learning, and health of children by supporting and engaging their parents and caregivers. The home visiting model can be offered prenatally through kindergarten and can be replicated by various types of organizations including health departments, nonprofit organizations, hospitals, and school districts.
The Parents as Teachers model offers a cohesive package of services for families with young children and is framed around four dynamic components: Personal Visits, Group Connections, Child Screenings, and Resource Network. These components are guided by explicit fidelity and quality standards that guide program service delivery and replication of the program.
Parents as Teachers home visiting professionals meet families where they are comfortable; each personal visit includes a focus on parent-child interaction, development-centered parenting, and family well-being.
Program Goals
The goals of Parents as Teachers for parents/caregivers receiving services are:
- Increase parent knowledge of early childhood development and improve positive parenting practices.
- Improve parent, child, and family health and well-being.
- Prevent child abuse and neglect.
- Increase children's school readiness and school success
- Improve family economic well-being.
- Strengthen connectedness to community services.
Logic Model
View the Logic Model for Parents as Teachers (PAT).
Essential Components
The essential components of Parents as Teachers include:
- Personal Visits:
- Home visitation is a key component of the Parents as Teachers model, with personal visits of approximately 60 minutes delivered at a minimum once a month, depending on family needs.
- Parent educators share research-based information and use practices to partner, facilitate, and reflect with families.
- Parent educators use the Parents as Teachers curriculum in culturally sensitive ways to deliver services that emphasize:
- Parent-child interaction which focuses on promoting positive parenting behaviors and child development through parent-child activities
- Development-centered parenting which focuses on the link between child development and parenting on the key developmental topics (e.g., attachment, discipline, health, nutrition, safety, sleep, transitions/routines, healthy births).
- Goal setting and a vision for the future is vital for family. Parent educators work collaboratively with families to identify, set, and achieve goals that lead to positive outcomes.
- Family well-being which includes a focus on family strengths, capabilities, skills, and the building of protective factors.
- Screenings:
- Annual child health, hearing, vision, and developmental screenings, beginning within 90 days of enrollment, are a component of the model. Child screenings:
- Assess developmental progress regarding cognitive, language, social-emotional, and motor skills
- Screen for delays or problems in vision/hearing/health
- Provide information about child's health and developmental progress through on-going tracking of developmental milestones
- Many programs also carry out adult screenings to identify parental depression, substance abuse, and intimate partner violence.
- Group Connections:
- Another component of the Parents as Teachers model is monthly or more frequent group connections
- Parents can attend with their child to obtain information and social support and share experiences with their peers.
- Group connections formats include family activities, presentations, community events, parent cafes, and ongoing groups.
- There are no set recommendations of the group size.
- Resource Network:
- Parents as Teachers maintains ongoing relationships with institutions and community organizations that serve families.
- Parent educators help families:
- Identify needs
- Set goals
- Connect with appropriate resources
- Overcome barriers to accessing services
Program Delivery
Parent/Caregiver Services
Parents as Teachers (PAT) directly provides services to parents/caregivers and addresses the following:
- Pregnant or parent/caregiver of a child prenatal through Kindergarten who may also be in possible high-risk environments:
- Teen parents
- Low income
- Parental low educational attainment
- History of drug abuse in the family
- Chronic health conditions effecting the child or parents
- Tribal communities
- Families with custody disruptions
- Military families
- Immigrant and refugee families
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Children in the family are included in the home visits that focus on parent-child interaction. Other family members in the home such as grandparents are also invited to take part in home visits. Parents are connected to other agencies in the community as the need arises.
Recommended Intensity:
At least 12 home visits annually to families with one or no high-needs characteristics. At least 24 home visits annually to families with two or more high-needs characteristics. In some cases, visit frequency may be gradually decreased as the family transitions out and into other services. Home visits last approximately 60 minutes. At least 12 group connections (or meetings) annually. Annual screening of children for developmental, health, hearing, and vision problems each year. Parent educators partner with families to establish goals, develop realistic action plans, and monitor progress on goals.
Recommended Duration:
At least two years
Delivery Settings
This program is typically conducted in a(n):
- Adoptive Home
- Birth Family Home
- Foster / Kinship Care
- Outpatient Clinic
- Community-based Agency / Organization / Provider
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
- Virtual (Online, Telephone, Video, Zoom, etc.)
Homework
Parents as Teachers (PAT) includes a homework component:
PAT includes parent-child activities that are chosen to reflect family needs and can be:
- Related to action steps for goals
- Related to resource connections
- Provide an opportunity for parents to focus on specific parenting behaviors that encourage their child's learning and the parent-child relationship
There are parent-child follow-up activities in the curriculum for the parent educators to choose from based on parenting behaviors or child development they want to encourage. Parent educators introduce a follow-up activity at the end of their visits and encourage parents to engage in it before the next personal visit. Families are also encouraged to read together between visits.
Languages
Parents as Teachers (PAT) has materials available in languages other than English:
Arabic, Burmese, Chinese, French, German, Greek, Kinyarwandan, Korean, Lingala, Mandarin, Nepali, Portuguese, Somali, Spanish, Turkish, Ukrainian
For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
Staffing Requirements - PAT programs have two primary staff positions: (1) parent educators who provide home visiting services and (2) their supervisors. It also is recommended that the affiliate identify staff to serve as the data entry specialist and to provide administrative support to the parent educators and supervisors.
Staff Ratio Requirements - The PAT program requires that a supervisor be assigned not more than 12 parent educators to supervise, regardless of whether the parent educators are full-time or part-time employees. The PAT program also requires that full-time parent educators complete no more than 60 visits per month, with new parent educators (those working for PAT less than one year) conducting no more than 48 visits per month. Fifty visits per month is the optimal number to be completed by full-time parent educators in their second year or beyond, and 40 visits per month is the optimal number to be completed by full-time parent educators in their first year.
Average Cost per Family and Purchase of Program Model or Operating License - On its website (see link at bottom of page), the PAT National Center provides a Budget Toolkit for programs to estimate basic program implementation costs (including affiliate fees), from which a per-family cost can be estimated. Curriculum materials are included in the cost of training and renewal. Some affiliates offer incentives to help retain families. The costs for family incentives vary by affiliate.
Data Systems/Technology Requirements - The PAT National Center has developed and offers a data management system, Penelope, and offers free access to it for PAT affiliates. Affiliates are not required to use Penelope, but affiliates should use a data-tracking or management information system.
Manuals and Training
Prerequisite/Minimum Provider Qualifications
The PAT program requires that, at a minimum, parent educators have a high school diploma or general equivalency degree (GED) and at least two years' previous supervised work experience with young children and/or parents. The PAT program prefers for parent educators to have at least a four-year degree in early childhood education or a related field, or at least a two-year degree, or 60 college hours in early childhood or a related field. It is recommended that parent educators have prior experience working with young children and/or parents.
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Three resources are used as manuals for the implementation of PAT:
- Parents as Teachers National Center, Inc. (2023). Affiliate implementation manual. Author.
- Parents as Teachers National Center, Inc. (2023). Parents as Teachers foundational curriculum: Prenatal to 3. Author.
- Parents as Teachers National Center, Inc. (2023). Parents as Teachers foundational curriculum: 3 Years to Kindergarten. Author.
These three model resources are available to model affiliates. Other CEBC users who are interested in learning more about PAT and its implementation can access resources such as the Parents as Teachers National Center (www.parentsasteachers.org)
Training Information
There is training available for this program.
Training Contact:
- Parents as Teachers National Office
TrainingBusiness@ParentsasTeachers.org
phone: (866) 728-4968
Training Type/Location:
- Requirements for Program Certification: To become an approved PAT model affiliate, all applicants must (1) contact the PAT National Center or state PAT office to review expectations for fidelity and quality and to assess their fit with the PAT model; (2) submit an affiliate plan that covers program design and services, funding sources, service population, leadership, recruitment and retention, public awareness efforts, and evaluation; (3) receive approval of a final affiliate plan; (4) send parent educators to pre-service training; and (5) have parent educators undergo professional development to renew certification annually.
- Pre-Service Staff Training: The PAT National Center requires all parent educators implementing the PAT model to attend and successfully complete a three-day foundational training and a two-day model implementation training. Affiliates that offer services to families with children age 3 years through kindergarten must attend a second foundational training. The PAT National Center also requires that supervisors complete the two-day model implementation training and recommends that they attend the foundational training. Additional training might be needed to administer assessments or outcomes measures required by a funder or sponsoring agency. In addition to the trainings, the PAT National Center offers professional development opportunities for professionals who work with special populations. The trainings are one- or two-day sessions taught by instructors experienced with working with the special populations.
- In-Service Staff Training: To renew certification, the PAT National Center requires that parent educators complete a minimum of 20 hours of professional development during the first year, 15 hours the second year, and 10 hours per year thereafter.
- Training Materials: Training materials, including the foundational training guides, PAT Toolkit Cards, and Model Implementation Guide, are available to parent educators and supervisors through the PAT National Center.
- Qualified Trainers: All training sessions are taught by experienced, certified PAT national trainers with backgrounds in education, human development, or social services; most trainers have delivered PAT or are actively involved in doing so.
- Technical Assistance: Technical assistance and implementation support are available to PAT affiliates through the National Center's Affiliations and Program Support department, which includes PAT state offices and approved regional technical assistance specialists.
Number of days/hours:
At least 5 days of initial training and more for supervisors and those working with special populations (see above for more information)
Implementation Information
Pre-Implementation Materials
There are pre-implementation materials to measure organizational or provider readiness for Parents as Teachers (PAT) as listed below:
Prior to sending home visitors to attend a training, new organizations must complete an Affiliate Plan that details their implementation plan. Information on how to start and implement a program is available in the Quality Assurance Guidelines posted at www.parentsasteachers.org.
Formal Support for Implementation
There is formal support available for implementation of Parents as Teachers (PAT) as listed below:
The PAT National Center provides ongoing technical assistance to any organization who is implementing the Parents as Teachers model and requests assistance. Each state is assigned a National Center technical assistance provider who provides statewide information as well as one-on-one work with the programs. Technical assistance is provided on a variety of topics with a focus on meeting the 17 Parents as Teachers essential requirements. These essential requirements focus on staffing and staff oversight, visit frequency, delivering home visits, using the require forms, screenings and participating in model fidelity reviews. The National Center also provides technical assistance to those programs using the Penelope database.
Fidelity Measures
There are fidelity measures for Parents as Teachers (PAT) as listed below:
To help achieve fidelity to the PAT model, the PAT National Center requires that affiliates provide annual data on their fidelity to the program model through an Affiliate Performance Report. In addition, affiliates are expected to participate in the affiliate quality endorsement and improvement process in their fourth year of implementation and every fifth year thereafter.
Fidelity Measure Requirements:
Fidelity measures are required to be used as part of program implementation.
Implementation Guides or Manuals
There are implementation guides or manuals for Parents as Teachers (PAT) as listed below:
The Parents as Teachers Quality Standards are comprised of 20 essential requirements and 81 additional standards for high quality implementation. Parents as Teachers also provides the Quality Assurance (QA) Guidelines to assist organizations in understanding the expectations for model implementation. The QA Guidelines incorporate information that supports the implementation the Parents as Teachers quality standards. Finally, staff members attending Model Implementation training are also provided with the Model Implementation Guide which provides additional resources for model implementation. The Data in Motion manual helps affiliates to understand how, when and why to collect data and encourages them to use data to improve their programs and services.
Implementation Cost
There have been studies of the costs of implementing Parents as Teachers (PAT) which are listed below:
Corso, P. S., Ingels, J. B., & Walcott, R. L. (2022). Costs of evidence-based early childhood home visiting: Results from the mother and infant home visiting evaluation. OPRE Report 2022-01. https://www.acf.hhs.gov/opre/report/costs-evidence-based-early-childhood-home-visiting-results-mother-and-infant-home
Research on How to Implement the Program
Research has not been conducted on how to implement Parents as Teachers (PAT).
Relevant Published, Peer-Reviewed Research
Child Welfare Outcomes: Safety and Child/Family Well-Being
The CEBC reviews all of the articles that have been published in peer-reviewed journals as part of the rating process. When there are more than 10 published, peer-reviewed articles, the CEBC identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Parents as Teachers (PAT) are summarized below:
Wagner, M. M., & Clayton, S. L. (1999). The Parents as Teachers Program: Results from two demonstrations. The Future of Children, 9(1), 91–115. https://doi.org/10.2307/1602723
Type of Study:
Randomized controlled trial
Number of Participants:
SV PAT: 497; Teen PAT: 704
Population:
- Age — SV PAT: Control: Average=25.9 Years; Intervention: Average=25.3 years; Teen PAT: Control: Average=16.8 Years; PAT: Average=16.6 years; CM: Average=16.6 years; PAT+CM: Average=16.6 years
- Race/Ethnicity — SV PAT: C: 77% Latina, 23% Cauc; Inter: 84% Latina, 17% Cauc; Teen PAT: C: 55% Latina, 24% Afr. Am., 19% Cauc, 2% Oth; PAT: 57% Latina, 20% Cauc, 18% Afr. Am., 5% Oth; CM: 53% Latina, 25% Cauc, 18% Afr. Am., 4% Oth; PAT+CM: 59% Latina, 21% Cauc, 18% Afr.
- Gender — 100% Female
- Status — Participants were families recruited from community services, including WIC, medical clinics, and school districts.
Location/Institution: Salinas Valley, CA and sites in Los Angeles, San Bernardino, San Diego, and Santa Barbara counties.
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the impact of two randomized trials of Parents as Teachers (PAT): (1) the Northern California (Salinas Valley) PAT Demonstration, which served primarily Latino parents in the Salinas Valley of California’s Monterey County; and (2) the Teen Parents as Teachers Demonstration, which served adolescent parents in four counties in Southern California. Participants in the Salinas Valley PAT study were randomly assigned to receive the PAT program or to a comparison group, while participants in the Teen PAT study were randomly assigned to PAT, a control group, a case management group, or a combined PAT + case management group. Measures utilized include the Knowledge of Infant Development Inventory (KIDI), the Parenting Sense of Competence Scale, and the Home Observation and Measurement of Environment (HOME) Inventory, along with use of health care services and immunizations. Results indicate that there were few effects of the PAT intervention on parenting knowledge, attitudes or behavior. The Teen PAT group showed improvement on the HOME Inventory subscale measuring acceptance of children’s behavior, but the same subscale showed a negative effect for the Salinas PAT group. The teen PAT only group also showed a negative effect for availability of appropriate play materials. There were benefits shown for PAT on children’s outcomes. PAT children in Salinas showed significant improvement in self-help and both groups showed smaller positive effects on social development. Finally, in the Teen PAT study, children in the combined PAT-plus-case-management group were less likely to be subjects of child abuse investigations. Limitations include high attrition rates, gaps in service delivery, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Pfannenstiel, J. C., Seitz, V., & Zigler, E. (2002). Promoting school readiness: The role of the Parents as Teachers program. NHSA Dialog, 6(1), 71–86. https://doi.org/10.1207/s19309325nhsa0601_6
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
2,375 children
Population:
- Age — Entering Kindergarten (approximately 4–6 years)
- Race/Ethnicity — 83% Nonminority
- Gender — Not specified
- Status — Participants were families with children entering public school.
Location/Institution: Missouri
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to utilize the Parents as Teachers (PAT) program to assess children’s school readiness. Participants were families who had received the PAT program, or a group who had not. Measures utilized include the School Entry Profile and the Parent/Guardian Survey. Results indicate that parents in the PAT program reported reading to their children more often and were more likely to enroll them in a preschool program. Statistical analysis also indicated direct effects of the program on school readiness, suggesting that parenting practices had changed. Finally, impoverished children whose families received PAT and who attended preschool had readiness scores equivalent to those of children from nonimpoverished homes. Limitations include lack of randomization of participants.
Length of controlled postintervention follow-up: 2–3 years.
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(2), 67–81. https://doi.org/10.1177/02711214020220020101
Type of Study:
Randomized controlled trial
Number of Participants:
665
Population:
- Age — Children: 0–3 years; Adults: Mean=24.1–24.3 years
- Race/Ethnicity — Children: Not specified; Adults: 58% African American, 29% White, and 12% Hispanic/Asian/Other
- Gender — Children: Not specified; Adults: 100% Female
- Status — Participants were families in Parents as Teachers (PAT).
Location/Institution: Large urban programs serving a large proportion of low-income families
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effectiveness of the Parents as Teachers (PAT) program with low-income families. Participants were randomly assigned to receive the PAT program or to a comparison group. Measures utilized include the Knowledge of Infant Development Inventory, the Parenting Sense of Competence Scale, the Child Maltreatment Precursor Scale, the Home Observation and Measurement of Environment (HOME) Inventory, the Developmental Profile II, and the Adaptive Social Behavior Inventory. Results indicate that lower scores on parent knowledge, attitude toward parenting, and parenting behaviors were noted for lower-income families. Few measures were affected by participation in the PAT program. These included higher self-reported happiness when caring for the child, greater acceptance of child behavior (2nd year) among moderate-income parents, and a greater tendency to read aloud or tell stories to the child among low-income parents. There was also a moderate effect on prosocial behavior among low-income children. Limitations include a high drop-out rate for the sample, inability to fully examine site differences due to the small sample sizes at the outcome assessment points, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Zigler, E., Pfannenstiel, J., & Seitz, V. (2008). The Parents as Teachers program and school success: A replication and extension. Journal of Primary Prevention, 29, 103–120. https://doi.org/10.1007/s10935-008-0132-1
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
5,721 kindergarten children
Population:
- Age — Assessed in third grade (approximately 7–9 years)
- Race/Ethnicity — 15% Minority
- Gender — Not specified
- Status — Participants were public school students.
Location/Institution: Missouri
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to use path analysis to test how the Parents as Teachers (PAT) program affected children's school readiness and subsequent third-grade achievement. Participants were students whose families had undergone PAT compared to those who had not. Measures utilized include the Student Observation Record, the Parent/Guardian Survey, and the Missouri Assessment Program (MAP) Communication Arts Assessment. Results indicate that parents in PAT read to their children more often and were more likely to enroll them in preschool, which are predictors of school readiness. Statistical analysis also showed direct effects of PAT participation on school readiness, through better parenting practices. Length of PAT participation also predicted third grade achievement. Children of low-income families who received PAT and also attended a preschool program showed achievement levels approaching those of nonimpoverished families who did not attend preschool. Limitations include lack of randomization of participants, and reliance on self-reported measures.
Length of controlled postintervention follow-up: 4–5 years.
Drotar, D., Robinson, J., Jeavons, L., & Kirchner, H. L. (2009). A randomized, controlled evaluation of early intervention: The Born to Learn curriculum. Child: Care, Health & Development, 35(5), 643–649. https://doi.org/10.1111/j.1365-2214.2008.00915.x
Type of Study:
Randomized controlled trial
Number of Participants:
459
Population:
- Age — 0–9 months at recruitment
- Race/Ethnicity — 66% White, 29% African American, and 5% Hispanic/Asian/Other
- Gender — Not Specified
- Status — Participants were families recruited by announcements in local papers and through outreach in pediatric clinics, day care practices and health fairs.
Location/Institution: Cleveland, Ohio
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to address the need for studies of the efficacy of the Born to Learn (BTL) curriculum [now called Parents as Teachers (PAT)]. Participants were randomized into the BTL curriculum or general child development education only. Measures utilized include the Bayley Scale of Mental Development, Second Edition (BSMD), the Bayley Behavioural Rating Scale (BBRS), the Q-Sort measure of Security of Attachment, the Child Behaviour Rating Scale (CBRS), the Kaufman Assessment Battery (KAB), the Bracken Basic Concept Scale - Revised, the Test of Early Reading Ability-2 (TERA-2), and the Social Skills Rating System (SSRS). Results indicate that the BTL curriculum resulted in higher mastery motivation (task competence) at 36 months and greater effects for children from low versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes. Limitations include program intensity as defined by frequency of visits was less than optimal, especially for the third year and for low-SES families, level of attrition in the sample, especially among low-SES families, was relatively high, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Chaiyachati, B. H., Gaither, J. R., Hughes, M., Foley-Schain, K., & Leventhal, J. M. (2018). Preventing child maltreatment: Examination of an established statewide home-visiting program. Child Abuse & Neglect, 79, 476–484. https://doi.org/10.1016/j.chiabu.2018.02.019
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
7,386
Population:
- Age — Not specified
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were socially high-risk families involved with child welfare services.
Location/Institution: Connecticut
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the impact of voluntary participation in Parents as Teachers (PAT) for socially high-risk families on child maltreatment as identified by child protective services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008, and December 31, 2011, who participated in Connecticut’s home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. Measures utilized include three CPS-related outcomes: 1) investigated reports of maltreatment, 2) substantiated reports of maltreatment, and 3) out-of-home placements. Results indicate that in the unmatched sample, families who participated in home-visiting had significantly higher median risk scores. After matching families on measured confounders, the percentages of families with CPS investigations were similar between the two groups. However, there was a 22% decreased likelihood of CPS substantiations (hazard ratio [HR] 0.78, 95% confidence interval) for families receiving home visiting. First substantiations also occurred later in the child’s life among home-visited families. There was a trend toward decreased out-of-home placement. Limitations include nonrandomization of participants, reliance on self-reported measures, use of administrative data for research purposes which has limitations, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Jonson-Reid, M., Drake, B., Constantino, J. N., Tandon, M., Pons, L., Kohl, P., Roesch, S., Wideman, E., Dunnigan, A. & Auslander, W. (2018). A randomized trial of home visitation for CPS-involved families: The moderating impact of maternal depression and CPS history. Child Maltreatment, 23(3), 281–293. https://doi.org/10.1177/1077559517751671
Type of Study:
Randomized controlled trial
Number of Participants:
122
Population:
- Age — Mean=26 years
- Race/Ethnicity — 69% Black, 19% White, and 12% Mixed
- Gender — 100% Female
- Status — Participants were families involved with child welfare services.
Location/Institution: Not Specified
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the impact of participation in Parents as Teachers (PAT) in reducing recurrent maltreatment. Participants were randomized to either the PAT program or to usual care services from child protection. Measures utilized include the Center for Epidemiologic Studies Depression Scale (CES-D), the Parenting Stress Index, the Family Support Scale, and official re-reports to child protective services (CPS) as a maltreatment measure. Results indicate that no significant changes were found in maternal outcomes by group. Among nondepressed mothers or families without multiple CPS reports prior to study enrollment, PAT was associated with a significantly lower likelihood of CPS report recidivism. Limitations include small sample size, high attrition, lack of generalizability due to region, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Matone, M., Kellom, K., Griffis, H., Quarshie, W., Faerber, J., Gierlach, P., Whittaker, J., Rubin, D. M., & Cronholm, P. F. (2018). A mixed methods evaluation of early childhood abuse prevention within evidence-based home visiting programs. Maternal and Child Health Journal, 22(Suppl 1), 79–91. https://doi.org/10.1007/s10995-018-2530-1
Type of Study:
Other quasi-experimental
Number of Participants:
PAT cohort=3,780 (PAT=851; Control Group=2929)
Population:
- Age — Control: 6.5% less than 18 years; Intervention: 6.0% less than 18 years
- Race/Ethnicity — Control: 77% White, 13% Hispanic, 8% Black, and 2% Other; Intervention: 78% White, 13% Hispanic, 9% Black, and 1% Other
- Gender — 100% Female
- Status — Participants were clients enrolled in Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funded Parents as Teacher programs between 2008–2014, along with a matched group of non-client comparisons.
Location/Institution: Pennsylvania
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the impact and context of early childhood home visiting on rates of child abuse-related injury. Participants were a propensity score matched cohort of Parents As Teachers (PAT) enrollees and Pennsylvania Medicaid eligible women. Measures utilized include administrative data, such as abuse-related injury episodes identified from medical assistance claims. Results indicate that the odds of a healthcare encounter for early childhood abuse among PAT clients were significantly greater than comparison children. Qualitative data illustrated the circumstances of and program response to client issues related to child maltreatment, highlighting the role of non-client caregivers. All stakeholders described curricular content aimed at prevention (e.g., positive parenting) with little time dedicated to addressing current or past abuse. Clients who reported a lack of abuse-related content supposed their home visitor’s assumption of an absence of risk in their home but were supportive of the introduction of abuse-related content. Limitations include the lack of randomization, the observational study design, the lack of information on PAT service use, and possible surveillance bias.
Length of controlled postintervention follow-up: Not specified.
Schaub, S., Ramseier, E., Neuhauser, A., Burkhardt, S. C. A., & Lanfranchi, A. (2019). Effects of home-based early intervention on child outcomes: A randomized controlled trial of Parents as Teachers in Switzerland. Early Childhood Research Quarterly, 48, 173–185. https://doi.org/10.1016/j.ecresq.2019.03.007
Type of Study:
Randomized controlled trial
Number of Participants:
248
Population:
- Age — Not specified
- Race/Ethnicity — Not specified
- Gender — Not specified
- Status — Participants were families involved with parent-counseling offices, pediatricians, midwives, social counseling, and psychological and psychiatric services who volunteered to participate in the study.
Location/Institution: Switzerland
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of the Parents as Teachers (PAT) programing in the German-speaking part of Switzerland. Participants were randomly assigned to PAT or a control group. Measures utilized include the Heidelberg Stress Scale (HBS), the Bayley Scales of Infant and Toddler Development (BSID III), the Snijders-Oomen Non-verbal Intelligence Test (SON-R 2½) and the Child Behavior Checklist (CBCL 1½–5). Results indicate that PAT improved children’s adaptive behavior, developmental status, and language skills at the age of 3 years. Problem behavior was reduced in families with the highest risk. Limitations include high attrition, reliance on self-reported measures, lack of generalizability due to region, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Guastaferro, K., Felt, J. M., Font, S. A., Connell, C. M., Miyamoto, S., Zadzora, K. M., & Noll, J. G. (2020). Parent-focused sexual abuse prevention: Results from a cluster randomized trial. Child Maltreatment, 27(1), 114–125. https://doi.org/10.1177/1077559520963870
Type of Study:
Randomized controlled trial
Number of Participants:
110
Population:
- Age — Parents: 19–73 years (Mean=31 years)
- Race/Ethnicity — Parents: 96% White
- Gender — 95% Female
- Status — Participants were referred to PAT through community-level pipelines, including through schools, word of mouth, or voluntarily
Location/Institution: A large Mid-Atlantic state
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test whether a child sexual abuse (CSA) prevention program, Smart Parents–Safe and Healthy Kids (SPSHK), could be implemented as an additional module in evidence-based parent training and whether the added module might detract from the efficacy of the original program. Participants were randomized to deliver Parents as Teachers (PAT) with SPSHK (PAT+SPSHK) or PAT as usual (PAT-AU). Measures utilized include the Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST-10), the Center for Epidemiologic Studies Depression Scale (CESD), and the Interpersonal Support Evaluation List (ISEL). Results indicate that there were significant group by time interactions for both awareness and behaviors, indicating the PAT+SPSHK group had significantly greater awareness of CSA and used protective behaviors more often (which were maintained at follow-up) compared to the PAT-AU group. No differences were observed in general parenting behaviors taught by PAT suggesting adding SPHSK did not interfere with PAT efficacy as originally designed. Limitations include sample was likely at lower risk than most parents who are receiving public services and may not be representative to the target SPSHK population; given that SPSHK was added to a home-visiting based parenting program delivered to individuals, it is unknown how these findings might generalize to other programs; and length of follow-up.
Length of controlled postintervention follow-up: 1 month.
Pais, J. & Sexer, L. P. (2023). The Effectiveness of a Parents as Teachers home visitation program on school readiness: An application of complier average causal effect analysis. Journal of Evidence-Based Social Work, 20(5), 637–652. https://doi.org/10.1080/26408066.2023.2201233
Type of Study:
Randomized controlled trial
Number of Participants:
268 families
Population:
- Age — Between 3–4 years at time of study enrollment
- Race/Ethnicity — 67% Hispanic, 18% Non-Hispanic Black, 8% Non-Hispanic White, and 7% Asian/Other
- Gender — 51% Male
- Status — Participants were all immigrant families with children born in 2015 that were involved with Family Centers in the region.
Location/Institution: An urbanized area in the Northeast United States
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate an encouragement trial of the Parents as Teachers (PAT) home visitation intervention on the school readiness of preschool children using an innovative analysis to address issues of selective enrollment. Participants were given the opportunity to enroll in a PAT program through a randomized lottery and randomized into treatment and control groups. Measures utilized before and after the two-year program include the Connecticut Documentation and Observation for Teaching System. A comparison of three different analyses is used to evaluate the program – Average Treatment Effect (ATE) analysis, Intent-to-Treat (ITT) analysis, and Complier Average Causal Effect (CACE) analysis. Results indicate that the PAT program is effective at increasing school readiness, regardless of which analytic technique was used. However, the effect sizes for the CACE analysis are over twice as large as the other two analyses. Limitations include the modest sample size and the lack of post-intervention follow-up.
Length of controlled postintervention follow-up: None.
Additional References
Sama-Miller, E., Akers, L., Mraz-Esposito, A., Zukiewicz, M., Avellar, S., Paulsell, D., & Del Grosso, P. (2017). Home visiting evidence of effectiveness review: Executive summary. https://www.acf.hhs.gov/sites/default/files/documents/opre/HomVEE_Executive%20Summary%20August%202017.pdf
Burwick, A., Zaveri, H., Shang, L., Boller, K., Daro, D., & Strong, D. (2014, January). Costs of early childhood home visiting: An analysis of programs implemented in the supporting evidence-based home visiting to prevent child maltreatment initiative: Final report. https://www.mathematica.org/publications/costs-of-early-childhood-home-visiting-an-analysis-of-programs-implemented-in-the-supporting
Institute of Medicine and National Research Council. (2014). New directions in child abuse and neglect research. The National Academies Press. https://pubmed.ncbi.nlm.nih.gov/24757747/
Contact Information
- Allison Kemner, MPH
- Title: Senior Vice President and Chief Research Officer
- Agency/Affiliation: Parents as Teachers
- Website: www.parentsasteachers.org
- Email: Allison.Kemner@parentsasteachers.org
- Phone: (314) 866-8569
Date Research Evidence Last Reviewed by CEBC: August 2023
Date Program Content Last Reviewed by Program Staff: February 2024
Date Program Originally Loaded onto CEBC: May 2008
