Black or African American
21%
McCombs-Thornton, K., Wang, Y., & Sturmfels, N. (2023). Parents as Teachers Family Outcomes: New Insights from the Mother and Infant Home Visiting Program Evaluation (MIHOPE). Parents as Teachers National Center. https://parentsasteachers.org/wp-content/uploads/2024/10/PAT-Family-Out…
Model(s): Parents as Teachers (PAT)®
Child Development and School Readiness
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Brief Infant Toddler Social and Emotional Assessment (BITSEA), total problem score | 15 months old | Moderate | 0.13 | Not statistically significant, p>0.05 | 364 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received any early intervention services | 15 months old | Moderate | 0.18 | Not statistically significant, p>0.05 | 355 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Use of nonparental child care | 15 months old | Moderate | 0.27 | Statistically significant, p≤0.05 | 354 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Use of nonparental child care | 15 months old | Moderate | 0.04 | Not statistically significant, p>0.05 | 115 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, Subgroup: Hispanic |
Child Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Any Medicaid-paid nonbirth hospitalizations | 15 months old | Moderate | 0.07 | Not statistically significant, p>0.05 | 426 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| At risk of being overweight | 15 months old | Moderate | 0.12 | Not statistically significant, p>0.05 | 308 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Normal weight | 15 months old | Moderate | 0.09 | Not statistically significant, p>0.05 | 308 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Number of Medicaid-paid child emergency department visits | 15 months old | Moderate | 0.19 | Not statistically significant, p>0.05 | 380 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Number of Medicaid-paid immunizations | 15 months old | Moderate | 0.02 | Not statistically significant, p>0.05 | 380 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Number of Medicaid-paid well-child visits | 15 months old | Moderate | 0.05 | Not statistically significant, p>0.05 | 380 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Primary care provider for the child | 15 months old | Moderate | 0.08 | Not statistically significant, p>0.05 | 366 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Underweight | 15 months old | Moderate | 0.01 | Not statistically significant, p>0.05 | 308 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Number of Medicaid-paid child emergency department visits | 15 months old | Moderate | 0.18 | Not statistically significant, p>0.05 | 128 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, Subgroup: Hispanic |
Family Economic Self-Sufficiency
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Health insurance coverage for the child | 15 months old | Moderate | 0.24 | Not statistically significant, p>0.05 | 426 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received any disability insurance during the past month | 15 months old | Moderate | 0.25 | Not statistically significant, p>0.05 | 357 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received SNAP during the past month | 15 months old | Moderate | 0.22 | Not statistically significant, p>0.05 | 357 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received TANF during the past month | 15 months old | Moderate | 0.11 | Not statistically significant, p>0.05 | 357 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received WIC during the past month | 15 months old | Moderate | 0.09 | Not statistically significant, p>0.05 | 356 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| U.S. Household Food Security Survey Short Form, Household food insecurity | 15 months old | Moderate | 0.00 | Not statistically significant, p>0.05 | 354 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Received SNAP during the past month | 15 months old | Moderate | 0.27 | Not statistically significant, p>0.05 | 115 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, Subgroup: Hispanic |
Maternal Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Current smoker | 15 months old | Moderate | 0.07 | Not statistically significant, p>0.05 | 354 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| New pregnancy after study entry | 15 months old | Moderate | 0.03 | Not statistically significant, p>0.05 | 351 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Parenting Stress Index - Short Form (PSI-SF), parent-child dysfunctional interaction | 15 months old | Moderate | 0.08 | Not statistically significant, p>0.05 | 358 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Parenting Stress Index - Short Form (PSI-SF), parental distress | 15 months old | Moderate | 0.08 | Not statistically significant, p>0.05 | 359 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Received any behavioral health services | 15 months old | Moderate | 0.10 | Not statistically significant, p>0.05 | 354 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Substance use during the past three months | 15 months old | Moderate | 0.17 | Not statistically significant, p>0.05 | 353 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
Positive Parenting Practices
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME), home interior | 15 months old | Moderate | Not available | Not statistically significant, p>0.05 | 329 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME), parental support for learning and literacy | 15 months old | Moderate | Not available | Not statistically significant, p>0.05 | 326 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME), parental verbal skills | 15 months old | Moderate | Not available | Not statistically significant, p>0.05 | 334 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Infant-Toddler Home Observation for Measurement of the Environment (IT-HOME), parental warmth | 15 months old | Moderate | Not available | Not statistically significant, p>0.05 | 333 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Three-Bag Task composite score of parental supportiveness | 15 months old | Moderate | 0.12 | Not statistically significant, p>0.05 | 311 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Three-Bag Task composite score of parental supportiveness | 15 months old | Moderate | 0.03 | Not statistically significant, p>0.05 | 105 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, Subgroup: Hispanic |
Reductions In Child Maltreatment
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Any Medicaid-paid health care encounter for injury or ingestion | 15 months old | Moderate | 0.42 | Statistically significant, p<0.01 | 380 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Any substantiated maltreatment report | 15 months old | Moderate | 0.10 | Not statistically significant, p>0.05 | 440 families | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Loss of custody | 15 months old | Moderate | 0.02 | Not statistically significant, p>0.05 | 407 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Any Medicaid-paid health care encounter for injury or ingestion | 15 months old | Moderate | 0.37 | Not statistically significant, p>0.05 | 128 children | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, Subgroup: Hispanic |
Reductions in Juvenile Delinquency, Family Violence, and Crime
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Statistical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Received any domestic violence services | 15 months old | Moderate | 0.06 | Not statistically significant, p>0.05 | 354 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Revised Conflict Tactics Scale (CTS2), maternal experience with physical or sexual violence | 15 months old | Moderate | 0.41 | Not statistically significant, p>0.05 | 356 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample | |
| Revised Conflict Tactics Scale (CTS2), maternal perpetration of physical violence | 15 months old | Moderate | 0.17 | Not statistically significant, p>0.05 | 356 mothers | PAT vs. matched comparison group (MIHOPE), 2012–2015, United States, full sample |
This study included participants from the following locations:
- California
- Georgia
- Illinois
- Iowa
- Kansas
- Michigan
- Nevada
- New Jersey
- Pennsylvania
- South Carolina
- Washington
- Wisconsin
Study Participants
- Participants were eligible for the Mother and Infant Home Visiting Program Evaluation (MIHOPE) evaluation if they were age 15 years or older at enrollment, were pregnant or had a young child, and spoke English or Spanish proficiently.
- The intervention group included 218 participants who received PAT home visits for at least three months. The comparison group included 225 matched participants.
- Forty-four percent of the mothers were pregnant at the time of enrollment. At study entry, children were two months old on average.
- Outcomes were measured when children were approximately 15 months old.
Setting
Researchers recruited families from 21 local PAT programs in 12 U.S. states. The programs mainly operated in metropolitan areas.
Intervention condition
Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.
Comparison Conditions
Women assigned to the comparison group were not eligible to receive PAT services. They received information about other services in their local community.
Subgroups examined
- Race/ethnicity (African American/Black, Hispanic/Latina, White, or Multiracial/Another race)
- Pregnancy status at study entry (pregnant or not)
- First-time mother (first birth or not)
- Maternal education (less than high school, or high school or more)
- Experience of intimate partner violence (experienced intimate partner violence in the year prior to the study or not)
- Maternal emotional functioning (low, moderate, or high based on composite measure of depression, relationship anxiety, and relationship avoidance at study entry)
- Maternal psychological resources (at or below the median score, or above the median score based on a composite measure of mothers’ mental health including depressive symptoms and anxiety, mastery, and verbal abstract reasoning at study entry)
- Other adults in the home (biological father or other adult relative lives in the home, or not at study entry)
- Demographic risk (low, moderate, or high risk based on composite measure at study entry of mother receiving public assistance or Medicaid, mother being 20 years old or younger, child’s biological father not living in the home, and mother not being enrolled in school if younger than 19 years old or not having received a high school degree if at least 19 years old)
Funding Sources
This research was supported by the Parents As Teachers National Center. The MIHOPE data collection was supported by the Administration for Children and Families, funded by the U.S. Department of Health and Human Services under a competitive award, Contract No. HHS-HHSP23320095644WC.
Study design characteristics contributing to rating
| Design | Random assignment compromised? | Attrition | Baseline equivalence | Confounding factors? | Valid, reliable measures? |
|---|---|---|---|---|---|
| Non-experimental comparison group design | Not applicable | Not applicable |
Established on race/ethnicity, socioeconomic status, and baseline measures of the outcome(s) |
No |
Yes |
Notes from the review of this manuscript
Twenty-five findings across outcome domains rated low or indeterminate because the study did not provide enough information to establish that the outcome measure was reliable or because the reported reliability did not meet HomVEE standards. Four findings—Duration of breastfeeding, Health insurance coverage for the mother, Received any transportation services, and Mother received any services from a domestic violence shelter—rated low because the intervention and comparison groups were not equivalent at baseline or because the study did not collect a required baseline measure. One finding—Mother received education or training—rated low because the study used an unacceptable approach to imputing missing data. HomVEE obtained additional information needed to review the manuscript through correspondence with the authors.
The Mother and Infant Home Visiting Program Evaluation (MIHOPE) was a national evaluation of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. MIHOPE included four evidence-based home visiting models. This review focuses on Parents as Teachers (PAT) and the findings in McCombs-Thornton et al. (2023), which were secondary analyses of the MIHOPE data. HomVEE has reviewed additional analyses from the MIHOPE evaluation under Knox & Michalopoulos (2023) and Michalopoulos et al. (2019).