Implementing Play and Learning Strategies (PALS)

Entries in this row combine information across all versions of PALS. Only PALS Infant meets HHS criteria for an evidence-based home visiting model. Some other versions of PALS have at least one manuscript about a high- or moderate-quality impact study, but no version of the model other than PALS Infant meets HHS criteria for an evidence-based home visiting model.

Last updated: October 2012

Implementation experiences

Summary of sources

Information in this section is based on studies included in the HomVEE review. For the Play and Learning Strategies (PALS) model, we reviewed three randomized controlled trial (RCT) 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.)

The three articles we reviewed examined the same sample of study participants. As a result of this overlap, we refer to these as one study throughout the remainder of this section.

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Characteristics of model participants

The PALS model was designed to serve low-income mothers of infants and toddlers. The model consists of two curricula: an infant and a toddler version.

PALS enrolled 133 mother-infant pairs in the infant curriculum. To determine if the effects of the program differed depending upon birth status, the study recruited mothers of both full-term and very low birth weight infants. These families were then later recruited to participate in the toddler curriculum.

Upon enrollment in PALS, the mothers were an average of 28 years old. Fifty-five percent of the infants were female and two-thirds were born at very low birth weight. The infant curriculum was completed during the child’s first year, and the toddler curriculum was initiated when the children turned 2 years old.

The mothers who participated in the program were racially and ethnically diverse. Thirty-seven percent of mothers were African American, 34 percent were white, 27 percent were Hispanic, and 2 percent were other groups.

Mothers had completed an average of 12.6 years of education and their socioeconomic status ranged from upper-lower-class to lower-middle-class. Sixty-two percent of the study participants were single mothers.

Participation in PALS was voluntary.

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Location and setting

The study was implemented in Houston and Galveston, Texas. The model was developed and implemented by faculty affiliated with the Children’s Learning Institute of the University of Texas Health Sciences Center and the University of Texas Medical Branch.

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Staffing and supervision

The PALS model was implemented by home visitors who were supervised by the study’s principal investigators. All of the home visitors had at least a bachelor’s degree and experience working with families.

The study reported that before beginning service delivery, the principal investigators reviewed the curriculum and the home visitors had the opportunity to role-play home visits.

Every month, the principal investigators held three-hour group meetings with the home visitors during which they reviewed and discussed video recordings of select visits. The principal investigators also accompanied the home visitors on visits and provided feedback. The study did not provide any information on the ratio of home visitors to supervisors.

The study did not provide any information on home visitors’ caseloads.

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Model services

The PALS infant curriculum provided a 10-week series of weekly home visits designed to develop the responsive parenting skills of mothers. The PALS toddler curriculum was implemented over 11 weeks. According to the study, each week the home visitor introduced a new responsive parenting behavior and showed a video in which the behavior was demonstrated. The home visitor then video recorded the mother engaging in the behavior with her child. The mother and home visitor reviewed the video together and the home visitor encouraged the mother to critique her interaction. The home visitor commented on the infant’s reaction to the mother’s use of the new behavior to help the mother see the benefits of the approach and to encourage her efforts. At the next visit, the mother described her experiences using the behavior taught the previous week.

The PALS infant and toddler curricula targeted four areas of responsive parenting: (1) contingent responsiveness, (2) joint attention and engagement, (3) emotional support, and (4) interactive communication.

Families were video recorded engaging with their children multiple times throughout the intervention in order to assess change in mother and infant behavior. Research staff also assessed children’s language development using standardized measures, including the Peabody Picture Vocabulary Test and the Preschool Language Scale-3rd Edition.

Twice over the course of each program, the mothers had to teach an alternative caregiver (a supportive friend or family member) the responsive parenting behaviors they were learning. The mothers were then administered a knowledge and engagement scale checklist, which assessed how well they were able to teach the responsive parenting behaviors to their alternative caregivers.

Materials were available in Spanish and English.

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Model adaptations or enhancements

The study did not provide any information on model adaptations or enhancements.

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Dosage

The PALS infant curriculum was designed as a 10-week program and the toddler curriculum was designed as an 11-week program. In practice, the infant curriculum took participants 14.5 weeks to complete because of the challenge of scheduling visits with the alternative caregivers. Nine percent of the study participants did not complete all 10 visits. Ninety percent of participants completed all 11 visits of the PALS toddler curriculum.

PALS home visits were designed to last 90 minutes. The study did not provide information on how long the visits actually lasted.

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Lessons learned

The study did not include any lessons learned about implementing PALS.

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