Implementing Parents as Teachers (PAT)® Meets HHS Criteria

Last updated: October 2019

Implementation experiences

Summary of sources

Information in this section is based on studies included in the HomVEE review. For Parents as Teachers, we reviewed 15 studies, including 7 randomized controlled trials (RCTs) or quasi-experimental designs and 8 standalone implementation studies. (Please see Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness studies.)

Six of the studies we reviewed (two RCTs and four implementation studies) were based solely on an adaptation to Parents as Teachers implemented in New Zealand. For this reason, these studies are discussed only in the section dedicated to Model Adaptations or Enhancements.

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Characteristics of model participants

The average age of the parents enrolled in Parents as Teachers ranged from 17 to 26 years (four studies). Children ranged in age from 6 months to 3 years and 10 months (one study). Four studies only enrolled mothers (not fathers).

The percentage of program participants that were African American ranged from 18 to 100 percent (six studies); 10 to 83 percent of participants identified as Hispanic (five studies); 20 to 70 percent identified as White (five studies); and 3 to 15 percent identified as another or multiple races (five studies).*

Participants were low-income or working class (three studies). Forty-nine percent of the participants had a low socioeconomic status (SES) according to the Hollingshead SES scale (one study). Sixteen to 32 percent of program participants received Aid to Families with Dependent Children or Temporary Assistance to Needy Families (four studies); and five percent of participants were employed (one study).

*The count of studies for each racial and ethnic category comprises studies that included sample members from the racial or ethnic category. If the study did not include sample members from a particular category, the study is not included in the count.

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Location and setting

Programs were located in Missouri, New York, North Carolina, Ohio, a coastal Mid-Atlantic state, and along the East Coast, in the South, and in the West. There were also several California locations, including Los Angeles, San Diego, Santa Barbara, and San Bernardino counties, as well as the Salinas Valley. Programs were located in urban, suburban, and rural locations.

Implementing agencies included school districts, social and health service agencies, and county level offices.

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Staffing and supervision

Parents as Teachers home visits and other services were provided by paraprofessional parent educators (four studies), and professional staff (one study). Parent educators were certified or attended training provided by the Parents as Teachers National Office (five studies). In one of these studies, parent educators were required to have a bachelor’s degree and in another, requirements included a bachelor’s degree plus three years of experience working with parents and young children, and state certification or licensure in a related area. In another study, seven parent educators had bachelor’s degrees in a related area and one was still attending college.

One study reported how supervision was conducted across the four sites included in the study. In one site, parent educators received weekly supervision from the coordinator and team meetings were held twice monthly. Staff were encouraged to discuss mutual clients more frequently. In another site, project staff meetings increased from monthly to weekly during the demonstration and the project coordinator reviewed cases monthly. In the third site, weekly team meetings were held and included administrative issues and clinical case supervision by the program manager. In the fourth site, individual supervision occurred at least monthly.

Parent educators’ caseloads ranged from 30 to 50 families (three studies).

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Model services

Parents as Teachers programs provided home visiting as well as other services (eight studies). Additional services included parent groups; screenings and assessments for conditions such as developmental delay or hearing impairment; access to a resource network; and access to books, videos and toys.

Parents as Teachers programs used the Parents as Teachers curriculum (six studies).

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Model adaptations or enhancements

In one study, the Parents as Teachers curriculum was supplemented with materials to make Parents as Teachers more engaging for teenage parents and to strengthen the model’s prenatal component. In addition, a group of program participants received the standard Parents as Teachers model as well as intensive case management in order to provide additional support for the teen mothers. The case management support helped them deal with challenges such as finishing school, creating a positive living environment, and becoming good parents.

Six studies reported on a New Zealand adaptation to Parents as Teachers, known as Parents as First Teachers (PAFT)*. Four of the studies focused on the pilot phase and two on post-pilot implementation. According to one study, PAFT preserved the core Parents as Teachers components but modified the curriculum to integrate PAFT within New Zealand’s existing services, added a liaison position to facilitate cultural awareness of and communication with native communities, and according to another study, added a Māori component to the curriculum following the pilot to emphasize traditional Māori childbearing and childrearing beliefs and practices. One study of the pilot implementation reported that materials were available in English only, which presented a challenge; a later study reported that materials were available in Māori and six Pacifika languages.

Mothers were 26 years old on average (one study). Another indicated PAFT enrolled families from a range of native and non-native ethnic groups; three additional studies reported that 17 to 31 percent of participants were Māori. Most mothers lived with their partners (86 to 91 percent) (two studies); 6 to 28 percent of caregivers were single (four studies). Twenty-seven to 35 percent of families had low incomes or earned less than the average income (three studies).

Parent educators who delivered home visits had a degree or equivalent experience in early childhood education, childhood nursing, health, or social work (four studies). According to one study, parent educators received two weeks of pre-service training and one week annually of ongoing training. Two studies about the pilot phase reported that most parents (92 to 98 percent) received the minimum recommended number of home visits over the three-year period; in a post-pilot study, parents overall received fewer than the minimum recommended number of visits, on average. Nearly 75 percent of home visits lasted one hour and 25 percent were longer than an hour (one study).

*As of 2016, implementation support is no longer available for PAFT (New Zealand).

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Dosage

Families who began home visits averaged about 18 months of participation (one study). Forty-six percent of families remained in the program 0 to 10 months, 39 percent remained in the program 10 to 20 months, and 14 percent of families remained in the program 20 to 30 months (one study).</p>

The average number of home visits that families received ranged from 10 to 17 (two studies). Families attended an average of two Parents as Teachers group meetings (one study).

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Lessons learned

Three studies described lessons that were learned during implementation of the model. Across these three studies, the lessons included (1) mothers tended to value their parent educators and felt more connected to them than to the Parents as Teachers program; (2) both beneficial activities, such as employment or attending school, as well as detrimental circumstances, such as instability in the families served, hindered parent engagement in Parents as Teachers, although employment and school attendance was not related to dropping out; and (3) program participants that received the expected level of intensity tended to experience the greatest gains.
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