positive parent-child interactions: supported and supportive … · 2020-02-28 · through a better...

NC Pathways to Grade-Level Reading: WORKING DRAFT – AUGUST 2017

What Works for Third Grade Reading NC Pathways to Grade-Level Reading Working Paper

Positive Parent-Child Interactions: Supported and Supportive Families and Communities Table of Contents

I. Pathways Measure of Success

II. Definitions

III. Positive Parent-Child Interactions: Why They Matter

IV. Positive Parent-Child Interactions: Connections to Other Pathways Measures of Success

V. Context Matters: Positive Parent-Child Interactions

VI. Policy Options to Support Positive Parent-Child Interactions • FederalFundingforPositiveParent-ChildInteractions• AccesstoMaternalMentalHealthScreeningandTreatment

VII. Research-Informed Practice Options to Support Positive Parent-Child

Interactions • Streamliningtheapplicationprocessforfamilysupportsandbundlingservicestoreduce

additionalstressonfamilies• Includingpracticesshowntoimproveparent-childinteractionsinstate-andcommunity-

fundedparentingsupportprograms

VIII. Evidence-Based Program Options to Support Positive Parent-Child Interactions

Appendix A. BUILD Initiative: Integrating Family Engagement to Support Positive

Parent-Child Interactions Appendix B. Evidence-Based Program Descriptions

NC Pathways to Grade-Level Reading: WORKING DRAFT – AUGUST 2017 2

I. Pathways Measure of Success AveragenumberofminutesperdaythatparentstalkorplaywiththeirchildrenII. Definitions Thefollowingtermsarereferencedinthisbrief:

ParentingInterventionshelpparentsandothercaregiversovertimelearnandusepositiveapproachestosupportchildren’soptimaldevelopment.Interventionscanandareusedinthehome,childcareandprekindergartenclassrooms,schoolsandothercommunitysettings.iChildoutcomesincludeimprovedsocial-emotionalhealth,languageandcognitivedevelopment,andareductioninproblematicbehaviors.Parentoutcomesincludemorepositiveparentingattitudes,practices,andparent-childattachmentthroughabetterknowledgeofchilddevelopmentandthereductionofstress.ii

PositiveParent-ChildInteractionsarethephysical,social,andemotionalback-and-forthactionsbetweenparentsorcaregiversandyoungchildrenthatallowchildrentoestablishsecureexpectationsthattheirneedswillbemet.Positiveparent-childinteractionsbuildsafe,stable,responsiverelationshipsbetweenparentsandchildren,whichhelpchildren’sbrainsdevelopandhelpthembuildsocial-emotionalskills.Whenparentsorcaregiversrespondnegatively,inconsistentlyornotatalltochildren’sexpressedneeds,theirdevelopingbrainscanbeimpacted,resultinginphysical,mentalandemotionalhealthissues.iii

Self-regulationistheprocessofproperlymanagingfeelings,thoughtsandbehaviors.Self-regulationinvolvescognitiveandsocial-emotionalskills,includinggoal-setting,impulsecontrolandproblemsolving.Self-regulationbeginstoemergeduringachild’sfirstfiveyearsbutisnotcompletelydevelopeduntilearlyintoadulthood.iv

SocialandEmotionalDevelopmentreferstothedevelopmentofskillsnecessarytointeractpositivelywithpeersandadults,regulateemotionsandbehavior,anddevelopsocialcompetenceandself-identity.vToxicStresscanoccurwhenchildrenoradultsexperiencelong-lastingstressorslikechildmaltreatment,domesticviolence,familysubstanceabuse,parentalincarceration,and/orchronicpoverty,withoutbeingbufferedbyneededsupports.Forveryyoungchildren,toxicstresscannegativelyimpactthedevelopmentofbrainarchitectureandfunctioning,resultinginahigherriskofsocial-emotionalandcognitiveimpairment,andthedevelopmentovertimeofchronichealthconditions.viIII. Positive Parent-Child Interactions: Why They Matter Positive,responsiveinteractionsbetweenparentsorotherprimarycaregiversandyoungchildrenarethefoundationofchildren’scognitive,language,andsocial-emotionaldevelopment,allofwhichareessentialforearlyliteracy.Startingatbirth,positiveparent-childinteractionspromoteattachmentandasenseofsecurityforchildren—parentsrespondtobabies’cries,andbabieslearntoexpectasoothingresponsewhentheyexpresstheirneeds.viiPositiveparent-childinteractionscanbufferchildrenfromnegativepsychologicalandhormonalimpactsoftoxicstress.viiiHowever,familystressalsocanresultin


parent-childinteractionsthatarelesspositiveand/orlessfrequent,whichimpactschilddevelopmentandlong-termoutcomes.ix

Parent-childinteractionscanlookdifferentindifferentfamilies—thereisno“rightway”toparent—andmothersandfatherstendtoinfluencechildren’sdevelopmentindifferentways.xParent-childinteractionalsoisinfluencedbydifferencesinchildren’stemperaments.xiSingleparentsfaceadditionalstressors,oftenstrugglingtohandlefinancial,workforce,andchildcareissuesalone.Thislevelofstresscanresultinreducedoraggravatedparent-childinteractions,negativelyimpactingboththeparentandthechild.xiiIV. Positive Parent-Child Interactions: Connections to Other Pathways Measures of

Success Justlikethedomainsofchilddevelopment,thePathwaysMeasuresofSuccessarehighlyinterconnected.ThetableandtextbelowoutlinethemeasuresthatinfluenceorareinfluencedbyPositiveParent-ChildInteractions.

HealthandDevelopmentonTrack,BeginningatBirth

SupportedandSupportiveFamiliesandCommunities

EarlyIntervention FormalandInformalFamilySupports

Social-EmotionalHealth SafeatHome

ReadingwithChildrenEarlyIntervention.Childrenlivinginfamiliesstrugglingwithbothlowincomeandmaternaldepressionareparticularlyatriskfordevelopmentaldelaysinlanguageandcommunication,xiiipartlybecauseoffewerpositiveparent-childinteractions.Oneintwolow-incomemotherswithyoungchildrenmayexperiencedepression.xivHigh-qualityparent-childinteractionsimprovechildren’soutcomeswithearlyintervention.xvHigh-qualityearlyinterventionprogramsprovideneededsupportsforfamilies,educateandempowerparentstoadvocatefortheirchildren,xviandhelptoimprovethequalityofparent-childinteractions.xviiSocial-EmotionalHealthistheprocessofchildrendevelopingtheskillsnecessarytobuildstrongattachmentswithadults,maintainpositiverelationshipswithpeersandadults,developempathy,constructhealthypersonalidentities,andmanagetheirownbehaviorsthroughself-regulation.xviiiForyoungchildren,theseskillsarebuiltlargelythroughpositiveparent-childinteractions.xixSocial-emotionaldevelopmentisoftendescribedintermsofachild’stemperament,attachment,socialskillsorsocialcompetence,andemotionalregulation.xxFormalandInformalFamilySupports.Manyfactorsinthelivesofchildrenandtheiradultcaregiversimpactthedevelopmentofpositiveparent-childrelationships.Parentswhoexperiencedsignificantadversityintheirownchildhoods,liveinpoverty,sufferfromdepression,and/orexperienceadifficultseparationfromaparentingpartner(includingdivorce,incarcerationordeath)mayhavemoretroubledevelopingpositiverelationshipswiththeirchildren.xxiTheseadverseexperiencesincreasethestressoncaregiverswho,withoutwell-functioningnetworksofsupport,finditdifficulttosupportchildren’slanguageandcommunicationdevelopment,emotionalengagement,andsocialinteraction.xxiiWhat


oughttobeanaturally-occurringperiodofbondingbetweenaparentandyoungchildcandevolveintostressfulandnegativeinteractionsorneglect.Connectionstoresponsiveandsupportivenetworks,services,andinstitutionscanincreaseknowledgeandunderstandingofchilddevelopmentandparentalbehaviorforparentsofinfants,whichislikelytoleadtoimprovedoutcomesinsocialdevelopmentandschoolreadiness.xxiiiHigh-qualityhomevisiting,parentingeducation,andfamilypreservationprogramsthatarecoordinatedwithearlylearningprogramsandotherformalandinformalsupportscanteachandsupportparentstomeettheirchildren’ssocial,emotional,andphysicalneeds.xxivSafeatHome.Childmaltreatmentisthemostpowerfulevidenceofanegativeornon-existentparent-childrelationship.Neglect(alsocalled“actsofomission”or“unresponsivecare”)ismoreprevalentthanabuse,accountingfor75percentofabuseandneglectcasessubstantiatedbychildprotectiveservices.xxvThemostfrequentcategoriesofneglect,asdefinedbyfederalchildwelfarepolicy,arephysicalneglect(notprovidingforbasicneedslikenutrition,hygiene,orappropriateclothing)andinadequatesupervision(leavingchildrenunsupervised,notprotectingthemforsafetyhazards,providinginadequatecaregivers,orengaginginharmfulbehaviors).xxviChildrenwholivewithparentalneglectorabuseandotheradversechildhoodexperiences(ACEs)whentheyareveryyoungcanexperiencedevelopmentaldelays,limitedvocabularydevelopment,andreducedself-regulationskills,schoolreadinessandacademicoutcomes.xxviiTheselifeexperiencesinchildhoodalsocancontributetochronicillnesseslaterinadulthood.xxviiiReadingwithChildren.Readingregularlywithparentsimprovesyoungchildren’slanguagedevelopment,earlyreadingachievementandschoolreadiness.Whenadultsreadtoyoungchildrenandengagetheminrichconversations,childrendeveloplargervocabularies,learntoreadmoreeasily,andgrowstrongeremotionally.Earlylanguageandliteracydevelopconcurrently,beginningatbirthwithongoingvisual,vocal,andverbalexchangesbetweenaveryyoungchildandhisorherprimarycaregivers.xxixWhetherparentsusebookstoengagewiththeirchildrendependsbothontheirknowledgeoftheimportanceofreadingandwhethertheyhavethenecessaryresources.Toxiclevelsoffamilystress,unstablehousingandhomelessness,andtheriskofviolenceinthehomecanreducepositiveparent-childinteractionsandnegativelyimpactparents’capacitytoreadregularlywiththeiryoungchildren.xxxV. Context Matters: Positive Parent-Child Interactions Thefollowingissuesareimportanttoconsiderwhenplanningpolicy,practiceandprogramstrategiestoaddressPositiveParent-ChildInteractions.FamilyPoverty.Livinginpovertycanaffectthechemicalmake-upofourbodiesinwaysthatundermineparents’abilitiestoprovidethesafe,strong,nurturingrelationshipsthatyoungchildrenneedforhealthylanguage,cognitive,andsocial-emotionaldevelopment.xxxiRepeatedstress—suchasnotknowingwherethenextmealiscomingfrom—resultsinmoreeasilytriggered,morefrequent,andlonger-lastingburstsofstresshormones,whichimpacthealth,learning,decision-makingabilities,andself-regulation.xxxiiSuccessfulparentinginterventionsaddressthesechronicstressors,inadditiontobuildingparents’skillsandprovidingthemwithinformationaboutchilddevelopment.


ParentalDepression.Prenatalandpost-partumdepressionareriskstohealthyparent-childinteractions.Maternaldepressioncanendangeryoungchildren’scognitive,social-emotional,andbehavioraldevelopment,aswellastheirlearningandphysicalandmentalhealthoverthelongterm.xxxiiiAlthoughmostresearchhasbeenonmaternaldepression,fathersalsoexperiencedepression.Estimatesofpaternaldepressioninthefirstseveralmonthsafterthebirthofachildrangefromfourto25percentofnewfathers.xxxivDepressionandstresspriortobirthcanreduceexpectantmothers’participationinprenatalcareandtransmithighlevelsofmaternalstresshormonestotheunbornchildthroughtheplacenta.Theseconditionscanalsoresultinmorebabiesbeingbornpretermand/oratlowbirthweight.Afterbirth,mothers’andfathers’stressanddepressioncanreduceparent-childinteractions,impactingchildren’ssocial-emotionalandlanguagedevelopment.Untreatedmaternaldepressioncanincreasetheriskofchildmaltreatmentaswellaschildren’sownriskofdepression,separationanxiety,anddifficultbehavior.xxxvBetween10and20percentofpre-andpost-partumwomenexperienceclinicallydiagnosabledepression.Amonglow-incomemothers,thisrisestoabout60percent.xxxviGrandparentsRaisingGrandchildren.In2015,nearlythreemillionU.S.childrenwerebeingraisedbytheirgrandparents,anincreaseofhalfamillionoverthepastdecade.xxxviiSevenpercentofNorthCarolinachildrenunderage18(170,000)livedinfamiliesheadedbygrandparents.Ofthese,nearlyoneintwochildrenarefiveyearsofageoryounger.xxxviiiComparisonofdatafrom2007to2015revealsasubstantialincreaseinthenumbersofchildrenlivingwithgrandparents,about35,000children.xxxixAfricanAmericansareoverrepresentedamongthesefamilies—fiveintenwereWhiteandfourintenwereBlack/AfricanAmerican.Sevenintenwereunder60yearsofage.Oneinfourlivedatorbelowthefederalpovertylevel.xlAmericanCommunitySurveydatafrom2008-2012revealsgrandparentsraisingtheirgrandchildrenmakeupaboutthreeandahalfpercentofthetotalNorthCarolinapopulation(about200,000people).Abouthalfofthesegrandparentsbearsoleresponsibilityfortheirgrandchildren,andmosthavebeencaringforthemforyears.xliGrandparentswhobecomeprimarycaregiversexperienceagreatdealofsatisfactionfromtakingonthisrole,butmanyalsoexperiencedepression,healthproblems,legalandfinancialproblems,roleconflictsintheirmarriagesandwork,aswellassocialisolationandstigma.xliiVI. Policy Options to Support Positive Parent-Child Interactions FederalFundingforPositiveParent-ChildInteractions.Maximizeenrollmentinfederalprogramsthatfocusonsupportingpositiveparent-childinteractions.Somefederally-fundedprogramsincludeactivitiesdesignedtosupportpositiveparent-childinteractionsandfamilyengagement,including:

• ChildCareDevelopmentFund(CCDF)• EarlyHeadStartandHeadStart• FamilyServicesthroughtheChildren’sBureau• IDEAPartCandPartB• HomeVisiting• LibrariesandMuseums• QualityRatingandImprovementSystems(QRIS)• StateFundedPreschool


• StateChildCareLicensingRequirements• TitleIoftheElementaryandSecondaryEducationAct(ESEA).xliii

Activitiesincludedacrossthesefederally-fundedprogramsincludeflexibleprogramhourstoaccommodateparents’schedules,homevisitsandparent-teacherconferences,parenteducation,skillbuildingtraininginparent-childinteractions,andlinkagestoothercommunityservices.SeeAppendixAforachartoftheseprogramsandthespecificactivitiestheyinclude.xlivAccesstoMaternalMentalHealthScreeningandTreatment.WithNorthCarolinamembersofPostpartumSupportInternational,xlvidentifygapsinthedeliveryofpre-andpostpartummentalhealthscreeningandaccesstotreatment.Analysesshouldconsiderrace/ethnicityandgeographicdata.Policysolutionsmayincludechangesinprivateorpublichealthcaresystemsandreimbursementtoensurewidespreadaccesstoscreeningandtreatmentservices.Maternaldepressionimpactsparent-childinteractions,andscreeningisthefirststeptowardsreducingtheincidenceofdepression.Morethanhalfofthe14medicalpracticeswithintheCommunityCareofNorthCarolina(CCNC)networkroutinelyscreenformaternalpostpartumdepression.InJuly2016,NorthCarolina’sMedicaidprogrambegantoreimburseprovidersforuptofourpostpartummaternaldepressionriskscreens.xlviScreeningthatisnotfollowedbytimelytreatment,however,willnotimprovethecapacityofmotherswithyoungchildrentoparentinapositive,responsivemanner.Nationaldataanalysisrevealsthatmanyadultswhohavebeenscreenedformentalhealthchallengesstilldonotreceivetreatment.xlviiSeethePathwaysEarlyInterventionbrief.VII. Practice Options to Support Positive Parent-Child Interactions Streamliningtheapplicationprocessforfamilysupportsandbundlingservicestoreduceadditionalstressonfamilies.Servicesforadultswithdisabilitieshasproventhebenefitofa“nowrongdoor”policyforeligibilitydeterminationandajointapplicationacrossserviceprograms.xlviiiSimultaneousenrollmentacrossprogramslikeMedicaid,Children’sHealthInsurancePrograms(HealthChoice),SNAP(foodstamps),andothertypesofassistanceforfamiliesatriskcanreducefamilystressandincreasetheratesofenrollment.xlixGovernmentagenciescanreviewinternalandinteragencyrulesandapplicationprocedurestosimplifyandstreamlinetheapplicationprocess.DatarevealsthateligibleNorthCarolinafamiliesareunder-enrolledorunder-servedinformalsupportsknowntoimprovefamilywell-being.Participationintheseprogramsimprovesshort-andlong-termchildandfamilyhealth,educational,andeconomicoutcomesbyhelpingensurethatlow-incomefamilies’andchildren’sbasicneedsaremet.lTheNorthCarolinaWorkSupportStrategiesInitiativeaimstostreamlinepolicies,servicedelivery,andprogrameligibilitytocreatea“nowrongdoor”system.liAspartoftheinitiative,NorthCarolinacontinuestoexpandimplementationofitsNCFASTintegratedeligibilitysystematthestateandcountylevels.SeealsotheFormalandInformalFamilySupportsbrief.


ProgramsincludedinNCFASTare:

• FoodandNutritionServices,NorthCarolina’sSNAPprogram• Medicaid,andNCHealthChoice,NorthCarolina’sCHIPprogram• TANFandWorkFirst• SubsidizedChildCare/ChildCareFinancialAssistance• RefugeeAssistance

Includingpracticesshowntoimproveparent-childinteractionsinstate-andcommunity-fundedparentingsupportprogramsTherecentfederalCompendiumofParentingInterventionshasidentifiedagroupofresearch-informedpracticesthatwhenimplementedwithfidelitycansupportpositiveparent-childinteractions.Theyinclude:

• Focusingonparents’strengths,self-efficacy,andempowerment• Affirmingparents’culturaltraditions,beliefs,andpracticesrelatedtoraisingchildren• Sharinginformationwithparents,suchasinformationaboutchilddevelopmentandlearning• Teachingormodelingparentinganddisciplineskills,suchasstrategiesformanagingchallenging

behaviorsorsupportingachild’slearning• Modelinghealthyinteractionswithchildren,suchashowtofollowachild’sleadduringplayor

howtosetappropriatelimits• Changingparents’attitudesandbeliefs• Reducingparentalstressbyimprovingaccessthroughcasemanagementorservicereferrals• Improvingsocialsupport• Workingwithparentsonareasotherthanparenting

Programsthatintentionallyincludethesepracticesresultinimprovedparent-childinteractions,morepositiveparentinganddisciplinepractices,andreducedparentingstressandchildmaltreatment.Childrenexperienceincreasedsocial-emotionalcompetence,increasedcognitive,languageandliteracydevelopment,andincreasedattachmenttotheirparents.liiVIII. Evidence-Based Program Options to Support Positive Parent-Child

Interactionsliii TheCompendiumofParentingInterventionsdevelopedbythefederalAdministrationforChildrenandFamiliesfindsthatthereare“asignificant,butlimitednumberofparentinginterventions”withpublishedevidenceoftheireffectivenessinearlycareandeducationsettingsandevenfewerthatweredesignedforspecificethnicandculturalgroups.livTheCompendiumalsonotesthat:

• Agenciesthatratetheevidence-baseofprograms(suchastheCaliforniaClearinghouseofEvidence-BasedProgramsandthefederalHomeVisitingEvidenceofEffectivenessClearinghouse)oftenusedifferentterminologythatmaynotbecomparable.Afewexamplesinclude“adequateevidence,”“evidence-based,”and“programthatworks.”

• Someprogramsarefoundtobeeffectiveinachievingcertainoutcomesbutnotothers—evenwhentheoutcomesaresimilarorrelated.Forexample,ahomevisitingprogrammightproduceimprovementsinpositiveparent-childrelationships,interactions,positiveparentingpractices,


andattitudes,butnoimprovementsinpositivedisciplinepractices,parentalwell-being,knowledgeofchilddevelopment,parentingstress,orchildmaltreatment.

Theprogramslistedbelowhavebeenidentifiedbyoneormorecompendiaofevidence-basedprogramsorinterventions.Thespecificprogramsvarybytypesoffamiliesserved(universalvs.targeted)andtheagesofchildrenserved(birthtoearlyelementaryschool).lvDetailedinformationisprovidedinAppendixBforeachofthefollowingprograms.NameoftheProgram RatedBy1-2-3Magic CompendiumAdultsandChildrenTogetherRaisingSafeKids–ACT CompendiumChicagoParentProgram CompendiumChildFIRST HOMVEECircleofSecurity CompendiumEarlyHeadStartHomeVisiting HOMVEEEarlyStartNewZealand HOMVEEEffectiveBlackParentingProgram CompendiumFamilyCheckUpforChildren HOMVEEHealthAccessNurturingDevelopmentServices(HANDS) HOMVEEHealthyBeginnings HOMVEEHealthyFamiliesAmerica HOMVEEHomeInstructionforParentsofPreschoolYoungsters(HIPPY) HOMVEEIncredibleYearsAttentiveParentingProgram SAMHSANREPPInsideOutDad(Note:Thisisanexampleofaprogramcitedbyoneresourceasevidencebased,whileanotherresource(CaliforniaClearinghouse)indicatesthereisnotenoughevidencetorateit.

NationalFatherhoodInitiative

MaternalEarlyChildhoodSustainedHome-VisitingProgram(MECSH) HOMVEENurse-FamilyPartnership(NFP) HOMVEENurturingParentingPrograms SmartStart

ResourceGuideParentCorps CompendiumParentsasTeachers(PAT) HOMVEEPlayandLearnStrategies(PALS) HOMVEESafeCare(Augmented) HOMVEESystematicTrainingforEffectiveParenting(STEP) CompendiumTripleP HOMVEE


Appendix A. BUILD Initiative: Integrating Family Engagement to Support Positive Parent-Child Interactions ThenationalBUILDInitiativehascataloguedasetoffederally-fundedservices,supportsandprogramsthatincludegoalsandactivitiesdesignedtopromotepositiveparentingandsupportparent-childinteractions.

• ChartI,below,showstheseactivitiesacrossthevariousprograms,withthosethatdirectlyimpactparent-childinteractionsortheparent-childrelationshipnotedatthetopofthechartandhighlightedingrey.

• ChartIIprovidesadescriptionofeachprogramorsystemincludedinChartI,withthosethatdirectlyimpactparent-childinteractionsortheparent-childrelationshiphighlightedingrey.lvi

ThechartswerereplicatedfromanalysesbythenationalBUILDInitiative.lviiThedescriptionscitedirectlyfromthatreport.ChartI:ParentingSupportAcrossFederally-FundedProgramsorSystems

Strategy/Activity/Practice

CCDF (Early)HeadStart

FamilySupport

IDEAPartC

IDEAPartB

HomeVisiting

QRIS Libraries/Museums

PreK Licensing TitleIESEA

Activitiesfacilitateparent-childrelationship

x x x x x x

Curriculumfocusedonsupportingparent-childinteractions

x x x x

Parentaccesstoprogramatanytime x x x x x x x x x x

Homevisits x x x x Parent-teacherconferences x x x x x x

Familycommunicationinprimarylanguage x

Parent/Familyeducation x x x x x

Parent-childgroups x x x x x TransitionsPK-K x x x x x x Intergenerationalactivities x x x x x x x

Linkstocommunitysupports x x x x x


ChartII:ProgramDescriptionsProgramorSystem

Description/Philosophy:EngagingFamiliesandSupportingParent-ChildRelationship

ChildCareandDevelopmentFund

Increasestheavailability,affordabilityandqualityofchildcare.Consumereducationaroundchildcarechoicesisrequiredandthestateleadagencyisrequiredtocoordinatewithemploymentservicesandworkforcedevelopment.Therearenofederalrequirementsrelatedtofamilyengagementandparent-childinteraction.

EarlyHeadStartandHeadStart

ParentandfamilyengagementinHeadStart/EarlyHeadStart(HS/EHS)isaboutbuildingrelationshipswithfamiliesthatsupportfamilywell-being,strongrelationshipsbetweenparentsandtheirchildren,andongoinglearninganddevelopmentforbothparentsandchildren.Themodelembodiesafamilypartnershipstrength-basedapproach,collaborationwithparents,programmaticdecision-makingdrivenbyfamiliesandsupportforfamily-childinteractions.

FamilyServices(Children’sBureau)

AspartofChildren’sBureaufunding,familysupportservicesunderthePromotingSafeandStableFamiliesprogramincludecoordinatedprogramsofcommunity-basedfamilysupportservices,familypreservationservices,time-limitedfamilyreunificationservices,andadoptionpromotionandsupportservices.TheCommunity-BasedGrantsforthePreventionofChildAbuseandNeglectprogramincludescommunity-based,prevention-focusedprogramsandactivitiesdesignedtostrengthenandsupportfamiliestopreventchildabuseandneglect.

IDEAPartC Statewidesystemsofcoordinated,comprehensive,multidisciplinary,interagencyprogramsandmakingearlyinterventionservicesavailabletochildrenwithdisabilities,agedbirththrough2,andtheirfamilies,arerequired.TheIDEArequiresthatearlyinterventionservicesbeprovidedinnaturalenvironments,whichincludethehomeoracommunitysettingwherethechildwouldbeparticipatingiftheydidnothaveadisability.Eachchildandfamilyhasanindividualizedfamilyserviceplan(IFSP)createdattheonsetofservices,whichguidesdelivery.

IDEAPartB,section619

Assistancetostatesinprovidingafree,appropriatepubliceducationintheleastrestrictiveenvironmentforchildrenwithdisabilitiesages3through5.Statesmayincludepreschool-agedchildrenwhoareexperiencingdevelopmentaldelays,asdefinedbythestateandasmeasuredbyappropriatediagnosticinstrumentsandprocedures,whoneedspecialeducationandrelatedservices.Tothemaximumextentappropriate,childrenwithdisabilitiesareeducatedwithchildrenwhodonothavedisabilities.EachchildhasanIndividualizedEducationPlan(IEP)informedbyexpertassessmentofthechildandacceptedbytheparent.

IntensiveHomeVisiting(MIECHVincluded)

Intensivehomevisitingprogramsusethehomevisitor-familyrelationshipasthetoolthroughwhichalltheworktakesplace;thecentralityoftheparent-childrelationshiptohomevisitingisakeyfeaturethatdefinesthedeliveryofeachhomevisitingmodel,regardlessofthemodelusedbytheprogram.Homevisitorsworkdirectlywithparents,throughintensive,oftenweekly,homevisits,tosupportthemintheirparentingrole,developtheirskillstointeractwiththeirchild,andsupporttheirchild’shealthydevelopment.

LibrariesandMuseums

Museumsandlibrariesbringauniquefocusonfamilyengagementandtheparent-childrelationshipwiththeirroleasconnectorsthatbridgethegenerationsandbringchildren,theirparents,andtheirfamiliestogetherinfunandnonthreateningsettingsthatbuildmutualknowledge,skills,andself-efficacy.


QualityRatingandImprovementSystem(QRIS)

AQRISisamethodtoassess,improveandcommunicatethelevelofqualityinearlycareandeducationsettings.AQRISincludesthefollowingcomponents:(1)qualitystandardsforprogramsandpractitioners,(2)supportsandaninfrastructuretomeetsuchstandards,(3)monitoringandaccountabilitysystemstoensurecompliancewithqualitystandards,(4)ongoingfinancialassistancethatislinkedtomeetingqualitystandards,and(5)engagementandoutreachstrategies.AsQRISinvolveslevelsofquality,thefamilyengagementandsupportfortheparent-childrelationshipvariesacrossthelevels,involvingmoreintensivestrategiesatthehighestlevels.

State-fundedPreschool

State-fundedpreschoolprogramshaveastheirprimarygoaltoenhancethelearninganddevelopmentofchildren,particularlythoseatgreatestrisk,andensureyounglearnersarereadyforschoolsuccess.Statesmakethedeterminationaroundfamilyengagementandparent-childrelationshipfocusandactivities.

StateLicensingRequirements

Federallawrequiresthatstateshavepoliciesinplacetoprotectthehealthandsafetyofchildreninchildcareinthreeareas:thepreventionandcontrolofinfectiousdiseases;buildingandphysicalpremisesafety;andhealthandsafetytrainingappropriatetotheprogramsetting.Thestandardssetbystatesforlicensingchildcarecentersandfamilychildcarehomesvarygreatlyinareasoftraining,groupsizeandratioandenvironmentandincludethemostbasicstandardsaroundengagingwithfamilies,suchasexchanginginformationatthebeginningandendoftheday.

TitleIofESEA Localschools,districtsandLEAsmayopttouseTitleIfundingtorunpreschoolprogramming.Thisprogrammingistypicallytargetedathighneed,eligiblechildren.ProgramsusingTitleIfundingarerequiredtoimplementparentalinvolvementactivities.


Appendix B. Evidence-Based Program Descriptions Narrativedescriptionsaregenerallyciteddirectlyfromthereferencedsource.1-2-3Magic1-2-3Magicaimstoeducatecaregiversaboutage-appropriateexpectationsandchildbehaviorproblems.Familiesservedareparentsandcaregiversofchildren18monthsto12yearsold.Theprimaryfocusisonimprovingparent-childrelationshipsanddecreasingchildren’sdisruptiveandoppositionalbehaviors,whileincreasingpositivebehaviors.Otherobjectivesaretoreducefamilystressandincreasemaritalsatisfaction.lviii

AdultsandChildrenTogetherRaisingSafeKids–ACTACTaimstohelpparentsandcaregiversprovidesafeenvironmentsinwhichtoraisechildrenwithoutviolence.ACT-RSKisdesignedtopreventandreducechildmaltreatment,increasepositive,nonviolentparentingskills,andreducechildren’saggression.ACT-RSKisacommunity-basedinterventionforgroupsofparentswithchildrenfrombirthtoeightyearsold.ACT-RSKhasbeenadaptedforandpilotedwithincarceratedfathers.Interventionobjectivesaretoeducateparentsandcaregiversaboutpositive,effectiveparenting,strengthenfamiliesandcreateasafeandhealthyenvironmentthatpreventschildmaltreatment.lixChicagoParentProgramChicagoParentProgramwasdevelopedwiththeparticipationandinputofapanelofsevenAfrican-AmericanandfiveLatinoparents.Theinterventionfocusesontheparent-childrelationshiptobuildpositiveparentingstrategiesthatpromotechildren’ssocio-emotionaldevelopmentwhilereducingbehaviorchallenges.Familiesservedincludeparentsandcaregiversofchildrentwotofiveyearsold.CPPwasoriginallydevelopedforAfrican-AmericanandLatinoparentswithlowincomesraisingyoungchildreninurbancommunities.Itisdesignedtoserveaculturallyandeconomicallydiverseaudience.Interventionobjectivesaretonurturechildsocialandemotionaldevelopment,reducechildbehaviorchallenges,andpromotepositiveparentingstrategieswhilereducingharshorinconsistentparentingbehaviors.lx

ChildFirstChildFirstworkstodecreasetheincidenceofemotionalandbehavioraldisturbance,developmentalandlearningproblems,andabuseandneglectamonghigh-riskyoungchildrenandfamilies.ChildFirstservespregnantwomenandfamilieswithchildrenbirththroughagefive.Amentalhealth/developmentalclinicianandcarecoordinatorworkasateamtoprovideservicesthatincludeacomprehensiveassessmentofchildandfamilyneeds,observationandconsultationinearlycareandeducationsettings,afamilyandchildplanofcare,aparent-childmentalhealthintervention,andcarecoordination.Theprogramtypicallylastssixto12months,dependingonafamily’sneeds.Duringthefirstmonth,theclinicianandcarecoordinatorconductjointhomevisitstwiceperweek,andthereaftervisitsoccureitherseparatelyorjointlyandatleastweekly.lxiCircleofSecurity(COS)CircleofSecurityisagroup-basedinterventiondesignedtocreateasecureattachmentbetweenchildrenandtheircaregivers,orhelpthemshifttoone.Researchhasshownthatchildrenwithsecureattachmentstocaregivershavestrongeremotional,social,andcognitiveresourcesthantheirnon-securepeers.lxii


CircleofSecurityParenting(COS-P)is“morescalable”and“lessintense”thanCOS.CircleofSecurityHomeVisit(COS-HV)isamodificationofCOStohomevisitingprograms.Familiesservedare“high-risk”parentsorcaregiversofchildrenages0to5.Interventionobjectivesaretopromoteorshifttosecureparent-childattachmentforbetterchildoutcomes,helpparentsrecognizechildcuesthatsignalexplorationandseekingofhavenofsafety,andhelpparentslearnappropriateresponsesandsensitivitytochild’sattachmentneeds.lxiiiEarlyHeadStartHomeVisitingEarlyHeadStarttargetslow-incomepregnantwomenandfamilieswithchildrenfrombirththroughage3,mostofwhomareatorbelowthefederalpovertylevelorwhoareeligibleforPartCservicesundertheIndividualswithDisabilitiesEducationActintheirstate.Theprogramprovidesearly,continuous,intensive,andcomprehensivechilddevelopmentandfamilysupportservices.EHSprogramsincludehome-orcenter-basedservices,acombinationofhome-andcenter-basedprograms,andservicesprovidedinfamilychildcarehomes.Wefocushereonthehome-basedserviceoption.EHShome-basedservicesincludeweekly90-minutehomevisitsandtwogroupsocializationactivitiespermonthforparentsandtheirchildren.Homevisitorsarerequiredtohaveknowledgeandexperienceinchilddevelopmentandearlychildhoodeducation;principlesofchildhealth,safety,andnutrition;adultlearningprinciples;andfamilydynamics.Aninfantmentalhealthhome-basedservicesadaptationofEHShome-basedservicesaimstohelpparentsbuildstrongerrelationshipswiththeirinfantsandtoddlers,fosterhealthyfamilyfunctioning,andsupporttheemotionalhealthofbothparentandchild.Threestudiesfoundpositiveparentingasaprimaryoutcome;23didnot.Fivestudiesfoundpositiveparentingasasecondaryoutcome;30didnot.lxivEarlyStart(NewZealand)EarlyStartisahomevisitingprogramthatshowsresultsforpositiveparenting.EarlyStartisavoluntaryhomevisitingprogramdesignedtoimprovechildhealth,reducechildabuse,improveparentingskills,supportparentalphysicalandmentalhealth,encouragefamilyeconomicwell-being,andencouragestable,positivepartnerrelationships.EarlyStartwasdesignedtobeamainstreamprogram,targetingat-riskfamilieswithnewbornsandchildrenuptoage5.However,thedeveloperstookstepstoensurethatthemodelwouldalsobeculturallyresponsivetotheMāori,anindigenouspopulationofNewZealand.Homevisitorsdeliverservicesatvaryinglevelsofintensity,dependingonthefamily’sneeds.Familieswiththehighestneedsreceiveuptothreehoursofhomevisitsandindirectcontactperweek(level1),familieswithmoderateneedsreceiveuptothreehoursofhomevisitingeverytwoweeks(level2),andfamilieswithlowerneedsreceiveuptoonehourofhomevisitingmonthly(level3).Thefourthandfinallevelofservicesincludesuptoonehourofcontacteverythreemonths.Homevisitorsinconsultationwiththeirsupervisorsdeterminewhenafamilyisreadytoprogresstothenextlevel.Threestudiesfoundpositiveparentingresultsasaprimaryoutcome.lxvEffectiveBlackParentingProgramThisprogramisacognitive-behavioralparentingskillstraininginterventionadaptedfromtheConfidentParentingProgram.ThefocusoftheinterventionistoaddressissuesspecifictoAfrican-Americanparents,relatedtoparentingskills.EBPPemphasizeshelpingparentschangethe“harshdisciplinarypractices”that“originatedhistoricallyassurvivaladjustmentstoslavery,”andhelpingconveypositivemessagestotheirchildrenabouttheirculturalheritage.EBPPwasoriginallydevelopedforparentsofAfrican-Americanchildrenagestwoto12.Mostofitsevaluationstudieshavebeenconductedwithfamiliesinthiscommunity.However,since1988,EBPPhasbeenusedwithteenageAfrican-Americanparentsandtheirbabies,andwithAfrican-Americanparentsofadolescents.Interventionobjectivesaretohelpparentsenhancethequalityoftheirrelationshipswiththeirchildren,useparentingstrategies


andskillsshowntobehelpfulinraisingprosocial,competent,andhealthychildren,conveypositivemessagesaboutculturalheritage,andhelpparentsguidechildren’sdevelopmentawayfromdelinquency,droppingoutofschool,andsubstanceabuse.Thisprogramalsohaspositiveoutcomesspecifictoparent-childinteractions.lxviFamilyCheckUpforChildrenThisisahomevisitingprogramthatshowsresultsforpositiveparenting.Itisapreventativeprogramforhighriskfamilies,tohelpparentsaddresstypicalchallengesthatarisewithyoungchildrenbeforethesechallengesbecomemoreseriousorproblematic.Themodelincludesthreehomevisitswithatrainedparentconsultantwhohasanadvanceddegreeinpsychologyorarelatedfield.Afterthethreehomevisits,theparentconsultantmakesrecommendationsforafamily-basedinterventiontailoredtotheneedsofthefamily,suchasparentmanagementtraining,preschoolconsultation,orcommunityreferrals.Itisratedasevidence-basedbyHomeVisitingEvidenceforEffectiveness(HOMVEE).Twostudiesfoundpositiveparentingresultsasaprimaryoutcome.lxviiIncredibleYearsAttentiveParentingProgramisasetofthreeinterlocking,comprehensive,anddevelopmentally-basedtrainingprogramsforchildrenandtheirparentsandteachers.Theseprogramsareguidedbydevelopmentaltheorythatlooksattheroleofmultipleinteractingriskandprotectivefactorsinthedevelopmentofconductproblems.Thethreeprogramsaredesignedtoworkjointlytopromoteemotionalandsocialcompetenceandtoprevent,reduce,andtreatbehavioralandemotionalproblemsinyoungchildren.lxviiiTheIncredibleYearsParentProgramservesparentsofinfantsandtoddlers,preschoolersandschool-agedchildrentoage12years.Theprogramsfocusonstrengtheningparent-childinteractionsandrelationships,reducingharshdiscipline,andfosteringparents'abilitiestopromotechildren'ssocial,emotional,andlanguagedevelopment.Intheprogramsforparentsofpreschoolersandschool-agechildren,participantsalsolearnhowtopromoteschoolreadinessskillsandareencouragedtopartnerwithteacherstobecomeinvolvedintheirchildren'sschoolexperiences,promotingacademicachievement,socialskills,andemotionalself-regulation,andreducingconductproblems.Eachprogramincludesprotocolsforuseasapreventionprogramorasatreatmentprogramforchildrenwithconductproblemsandattention-deficit/hyperactivitydisorder.lxixHealthAccessNurturingDevelopmentServices(HANDS)HANDSisahomevisitingprogramisavoluntaryhomevisitingprogramdesignedtopreventchildmaltreatment,improvefamilyfunctioning,facilitatepositivepregnancyandchildhealthoutcomes,andmaximizechildgrowthanddevelopment.Theprogramtargetsfirst-timepregnantmothersorparentswithchildrenuptothreemonthsoldwhohavemultiplechallenges,suchassingleparenthood,lowincome,substanceabuseproblems,orbeingvictimsofabuseordomesticviolence.Atrainedparaprofessionalorprofessionalhomevisitor,suchasasocialworker,conductsprenatalandpostnatalhomevisitswithparents;providesparentinginformation,problemsolvingtechniques,andparentingskilldevelopment;andaddressesbasicneeds.Thelevelofservicesofferedtofamiliesvariesandisbasedontheneedsofthefamilyandthepaceatwhichtheyprogressthroughtheprogram.Positiveparentingwasnotmeasuredasanoutcome.lxxHealthyBeginningsHealthyBeginningsisahomevisitingprogramstartedasademonstrationprojectinSydney,Australia,implementedfrom2007to2010.HealthyBeginningstargetedfirst-timemothersofinfantsfromsociallyandeconomicallydisadvantagedareas.Themodelaimedtopreventchildhoodobesitybyimprovingchildren’sandfamilies’eatingpatterns,reducingsedentaryactivitiessuchastelevisionviewing,andincreasingphysicalactivity.InHealthyBeginnings,nursehomevisitorsaddressedthefollowingtopics


duringeachvisit:infantnutritionandphysicalactivity,familynutritionandphysicalactivity,andfamilysocialsupport.Thehomevisitorsofferedreferralsifthefamilyhadquestionsorconcernsunrelatedtothediscussiontopics.Telephonesupportwasavailablebetweenvisits.Familiesreceivedeighthomevisitsfromtheprenatalperiodthroughage24months.Eachvisitrangedinlengthfrom45to90minutes.Tenstudiesshowedresultsofpositiveparentingasasecondaryindicator.lxxiHealthyFamiliesAmerica(HFA)HFAisahomevisitingprogramthatshowsresultsforpositiveparenting.HealthyFamiliesAmerica(HFA)goalsincludereducingchildmaltreatment,improvingparent-childinteractionsandchildren'ssocial-emotionalwell-being,andpromotingchildren’sschoolreadiness.LocalHFAsitesselectthetargetpopulationtheyplantoserveandofferhour-longhomevisitsatleastweeklyuntilchildrenare6monthsold,withthepossibilityforlessfrequentvisitsthereafter.Visitsbeginprenatallyorwithinthefirstthreemonthsafterachild’sbirthandcontinueuntilchildrenarebetween3and5yearsold.Inaddition,manyHFAsitesofferparentsupportgroupsandfatherinvolvementprograms.Sitescanalsodevelopactivitiestomeettheneedsoftheirspecificcommunitiesandtargetpopulations.lxxiiThreestudiesfoundpositiveparentingpracticesasaprimaryoutcome;33foundnoeffectonthisindicator.Fivestudiesfoundpositiveparentingasasecondaryoutcome;35foundnoeffectasasecondaryoutcome.lxxiiiHomeInstructionforParentsofPreschoolYoungsters(HIPPY)Hippyisahomevisitingprogramthatshowsresultsforpositiveparenting.Theprogramaimstopromotepreschoolers’schoolreadinessandsupportparentsastheirchildren’sfirstteachersbyprovidinginstructioninthehome.Theprogrammodelisdesignedforparentswholackconfidenceintheirabilitiestopreparetheirchildrenforschool,includingparentswithpastnegativeschoolexperiencesorlimitedfinancialresources.HIPPYoffersweekly,hour-longhomevisitsfor30weeksperyear,andtwo-hourgroupmeetingsatleastsixtimesperyear.HIPPYsitesareencouragedtoofferthethree-yearprogrammodelserving3-to5-yearolds,butcanofferatwo-yearprogrammodel.ThehomevisitingparaprofessionalsaretypicallydrawnfromthesamepopulationthatisservedbyaHIPPYsite,andeachsiteisstaffedbyaprofessionalprogramcoordinatorwhooverseesimplementationandsupervisesthehomevisitors.Onestudyfoundpositiveparentingpracticesasaprimaryoutcome;ninefoundnoeffectonthisindicator.Onestudyfoundpositiveparentingasasecondaryoutcome.lxxivInsideOutDadThisinterventionwasdevelopedbyNationalFatherhoodInitiative(NFI)tohelpincarceratedfathersimprovetheirparentingskillsanddevelopstrongerrelationshipswiththeirchildrenwhileinprisonandafterrelease.Theobjectivesoftheprogramareto(1)increasefathers'self-efficacy,(2)increasefathers'awareness,knowledge,andattitudesaboutbeinginvolved,responsible,andcommittedfathers,and(3)increasecontactbetweenfathersandtheirchildren.Theprogramconsistsoftwelvetwo-hourcoresessionsdeliveredweeklytogroupsofupto12fathers.Threeoptionalsessionsfocusonreentryissuessuchasreconnectingwithfamily,fathers'rightsandresponsibilities,childsupportandvisitswithchildren.Afourthoptionalsessionaddressestheroleofspiritualityinfatherhood.Sessionsareledbyoneortwofacilitators(tworecommendedforgroupsofeightormore).Facilitatorscanbecorrectionalfacilitystafforvolunteersfromthecommunity.Nospecificqualificationsarerequiredoffacilitators;trainingontheprogramthroughNFIisrecommendedbutnotrequired.lxxv

MaternalEarlyChildhoodSustainedHome-VisitingProgram(MECSH)isaHOMVEE-ratedevidence-basedprogramthatshowsresultsforpositiveparenting.BasedinAustralia,theprogramisdesignedtoenhancematernalandchildoutcomesbyprovidingantepartumservicesinadditiontothetraditional


postpartumcarewomenreceivethroughAustralia’suniversalsystemformaternal,child,andfamilyhealthservices.MECSHtargetsdisadvantagedpregnantwomenatriskforadversematernaland/orchildhealthanddevelopmentoutcomes.Registerednursesconductaminimumof2560-to90-minutehomevisits,frompregnancyanduntilthechild’ssecondbirthday.Duringthevisits,nursesfocusonparenteducation,maternalhealthandwell-being,familyrelationships,goalsetting,andotherissuessuchashousingandfinances.Alsoavailableareparentinggroups,activitiestolinkfamiliestothecommunity,andreferralstootherspecializedcare(suchasdieticiansanddrugandalcoholcounselors).Onestudyfoundpositiveparentingresults;fivedidnot.lxxviNurse-FamilyPartnership(NFP)isaHOMVEE-ratedevidence-basedprogramthatshowsresultsforpositiveparenting.Theprogramisdesignedforfirst-time,low-incomemothersandtheirchildren.Itincludesone-on-onehomevisitsbyatrainedpublichealth-registerednurse.Thevisitsbeginearlyinthewoman’spregnancy(withprogramenrollmentnolaterthanthe28thweekofgestation)andconcludewhenthechildturnstwoyearsold.NFPisdesignedtoimprove(1)prenatalhealthandoutcomes,(2)childhealthanddevelopment,and(3)families’economicself-sufficiencyand/ormaternallifecoursedevelopment.ThereisalsoanalternateimplementationofNFP,whichhasparaprofessionals,ratherthannurses,conductthehomevisits.Theparaprofessionalsreceivethesamelengthoftrainingasthenursesandcarriedthesamecaseloads,buthadahighersupervisor-to-homevisitorratio.Fivestudiesfoundpositiveparentingpracticesasaprimaryresult;18foundnoeffect.Onestudyfoundpositiveparentingasasecondaryoutcome.lxxviiNurturingParentingPrograms(NPP)NPPiscitedasanevidence-basedprogrambytheSmartStartResourceGuideofEvidence-BasedProgramsandPractices.Theprogramsarefamily-basedandtargetallfamiliesatriskforabuseandneglectwithchildrenbirthto18yearsofage.Servicescanbeofferedinagroupsetting,inahome-visitingsetting,orasacombinationofbothgroupmeetingsandhomevisitation.GoalsoftheNurturingParentingProgramsareto:

• Preventrecidivismofabuseandneglectinfamiliesreceivingsocialservices• Stoptheintergenerationalcycleofchildabusebyteachingpositiveparentingbehaviors• Lowertherateofmultipleteenagepregnancies

Componentsoftheprograminclude:

• Developingempathyandfacilitatingparent-childbondingandattachment• Teachingparentsappropriateexpectationsofchildren’sgrowth,particularlywaystopromote

children’sfeelingsofself-worth,trust,andsecurity• Employingdisciplinethatpromotesthedignityofchildrenandadults• Empoweringadultsandchildrentonurturethemselves,others,andtheirenvironments• Helpingallfamilymembersdevelopameaningfullevelofself-awarenessandacceptance

Theprogramshavebeenadaptedforspecialpopulations,includingHmongfamilies,militaryfamilies,Hispanicfamilies,African-Americanfamilies,teenparents,fosterandadoptivefamilies,familiesinalcoholtreatmentandrecovery,parentswithspeciallearningneeds,andfamilieswithchildrenwithhealthchallenges.lxxviiiParentCorpsParentCorpsisapopulation-levelapproachtoreducetheimpactofpovertyonearlychildhoodhealthanddevelopment,byengagingandsupportingbothparentsandteachersofyoungchildren.Itisbroadly


availableandeffectiveforlow-income,minoritychildrenlivinginlargeurbancenters.ParentCorpsbuildsonthestrengthsofculturally-diversefamiliesandaimstoaddressthechallengesofraisingandeducatingchildreninthiscontext.Theprogramservesparentsandteachersofchildrenthreetosixyearsold.Itisdesignedtobeauniversalinterventionforallchildrenandtorecognizethediversity,suchasimmigrationstatusandculturalidentity,foundinurbanareas.Interventionobjectivesaretoengageandsupportcommunitiesofparentsandearlychildhoodteachers,promotehigh-qualityhomeandclassroomexperiencesforyoungchildren,andstrengthenchildren’slearning,behavior,andhealth.lxxixParentsasTeachers(PAT)isaHOMVEE-ratedevidence-basedprogramthatshowsresultsforpositiveparenting.Thegoaloftheprogramistoprovideparentswithchilddevelopmentknowledgeandparentingsupport,provideearlydetectionofdevelopmentaldelaysandhealthissues,preventchildabuseandneglect,andincreasechildren’sschoolreadiness.ThePATmodelincludesone-on-onehomevisits,monthlygroupmeetings,developmentalscreenings,andlinkagesandconnectionsforfamiliestoneededresources.Parenteducatorsconductthehomevisitsusingstructuredvisitplansandguidedplanningtools.Localsitesofferatleast12hour-longhomevisitsannually,withmoreofferedtohigher-needfamilies.PATservesfamiliesforatleasttwoyearsbetweenpregnancyandkindergarten.PATaffiliateprogramsselectthetargetpopulationtheyplantoserveandtheprogramduration.Onestudyfoundpositiveparentingasaprimaryresult;43foundnoresult.Forty-twostudiesfoundnoresultasasecondaryoutcome.lxxxPlayandLearnStrategies(PALS)PALSisaHOMVEE-ratedevidence-basedprogramthatshowsresultsforpositiveparenting.Theprogramisdesignedtostrengthenparent-childbondingandstimulatechildren’searlylanguage,cognitive,andsocialdevelopment.Therearetwoversionsoftheprogram:PALSIInfantcurriculumforfamilieswithchildrenfivemonthstooneyear,whichconsistsof10weeklysessions;andPALSIIToddlercurriculumforchildren18monthstothreeyears,whichconsistsof12weeklysessions.Bothversionsareofferedthrough90-minutehomevisitsconductedbyaparenteducator.Parenteducatorsarerequiredtoreceivetrainingandcertificationfromtheprogramdeveloper,theChildren’sLearningInstituteattheUniversityofTexasHealthScienceCenter.TheChildren’sLearningInstituterecommendsthatPALSbeimplementedbyagencieswithsustainedfundingmechanismsandorganizationalstructuresthatcansupportprogramcontinuity,suchasHeadStart,EarlyHeadStart,andnot-for-profitearlychildhoodagencies.Elevenstudiesfoundpositiveresultsforparentingasaprimaryindictor.lxxxiSafeCare(Augmented)SafeCareAugmentedisaHOMVEE-ratedevidence-basedprogram.SafeCareaimstopreventandaddressfactorsassociatedwithchildabuseandneglectamongtheclientsserved.Eligibleclientsincludefamilieswithahistoryofchildmaltreatmentorfamiliesatriskforchildmaltreatment.SafeCarewasdevelopedtoofferamorestreamlinedandeasy-to-disseminateprogrambasedonkeycomponentsofitsprecursor,Project12-Ways.SafeCaretypicallyprovides18to22weeksoftrainingtoparentswithchildrenfrombirthtoagefive.Trainedhomevisitorsconduct60-to90-minuteweeklyorbi-weeklyhomevisitsfocusingonthreemodules:parent-child/parent-infantinteractions,infantandchildhealth,andhomesafety.AllSafeCaremodulesincludebaselineassessmentsandobservationsofparentalknowledgeandskills,parenttraining,andfollow-upassessmentstomonitorchange.Eachmoduletypicallyinvolvesoneassessmentsessionandfivetrainingsessions.Duringtheparenttrainings,SafeCarehomevisitorsexplaintherationaleforaparticularconcept,modeltheconcept,havetheparentpracticethesteps,andthenprovidefeedback.SafeCarehomevisitorsarenotrequiredtomeetspecificeducationrequirements.Positiveparentingwasnotmeasuredasaprimaryorsecondaryoutcome.lxxxii


SystematicTrainingforEffectiveParenting(STEP)STEPprovidesskillstrainingforparentstogivethemthetoolstheyneedtodealwithfrequentlyencounteredparentingchallenges.EarlychildhoodSTEPadaptstheSTEPprinciplesandtechniquesforusewithparentsofyoungchildren,focusingonchildbehavior,self-esteem,communication,cooperation,discipline,andsocialandemotionaldevelopment.Familiesservedareparentsofchildrenbirthtoagesix.Interventionobjectivesaretoimproveparents’understandingofnaturalandlogicalconsequences,reduceparentalstressandparents’potentialtobephysicallyabusive,improveunderstandingofchildbehaviorandmisbehaviorandgeneralfamilyfunctioning,improvecommunicationbetweenparentsandchildren,andimproveparentalconfidence.lxxxiiiTripleP(PositiveParentingProgram)TriplePisahomevisitingprogramforparentingandfamilysupportdesignedtopreventandtreatbehavioralandemotionalproblemsinchildrenfrombirththroughtheirteenageyears.Specializedinterventionstargetcertainsubgroups,includingchildrenwithadisabilityandindigenousfamilies.Tomeettheneedsofdifferentfamiliesandimplementingagencies,theTriplePsystemusesfivelevelsofincreasingintensity,arangeofdeliverymethods(suchasone-on-oneconsultationsinthehomeorgroupseminars),andstafffrommultipledisciplines(includingparaprofessionals,counselors,andnurses).Theintensityandlengthofservicesalsovariesacrosslevels.Forexample,PrimaryCareTripleP(Level3)includesapproximatelyfourindividualconsultationsof15to30minutesoveronetotwomonths,andEnhancedTripleP(Level5)includesapproximatelyeightindividualizedsessions,eachlasting60to90minutes.TheHomVEEreviewisbasedonTriplePinterventionswherehomevisitingwastheprimaryservicedeliverymechanismwithprenatalparentsorfamilieswithchildrenbirthtoage(TripleP–HomeVisiting).”Positiveparentingwasnotstudiedasaprimaryorsecondaryoutcomemeasure.lxxxiv

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