Smart Solutions

Program Description

Core Components for Model Fidelity

Personal Visits: Trained home visitors (parent educators) use the PAT Foundational Curriculum to share information and model practices to emphasize parent-child interactions, development-centered parenting, goal setting, and family well-being.
Group Connections: Partner sites implementing PAT host events that families can attend to obtain social support and information. Group connections can be open to any family and used as a recruitment opportunity or serve as an opportunity for enrolled families to connect with each other. There is no set group size requirements or limits. Examples of possible group connections include family activities, parent cafes, ongoing groups, presentations, and community events.
Resource Network: PAT maintains relationships with institutions and organizations in the community connecting families to resources that help them reach their goals and address their needs.
Child Health Review: The parent educator conducts a complete child health review within 90 days of enrollment or birth and then annually includes an update of the child’s health status, safety, and vision and hearing reviews.
Developmental Screenings: An approved PAT screening tool is used to screen the areas of language, cognitive, social-emotional, and motor development. This screening is completed withing 90 days of enrollment or birth and then annually. Screenings can be completed by the parent educator or by an outside professional if consistent with PAT screening standards.
Optional Adult Screenings: Some partners implementing PAT may offer adult screenings for mental health, substance use, and intimate partner violence.

Languages Materials are Available in

English, Spanish, French, German, Mandarin

Delivery Mode

Personal Visits: A hybrid approach combining In-person, phone call and video communications.
Group Connections: Outside the home is preferrable but a hybrid approach when necessary is appropriate.
Resource Network: Shared during a personal visit or group connection.
Child Screening: Conducted during personal visit

Dosage

Personal Visits: 60-to-90-minute home visit held at least once a month (more frequent visits as needed). At least 24 visits per year for families with 2 or more family experiences and stressors, per the PAT Family Experiences and Stressor list.
Group Connections: Monthly or more frequently
Resource Network: As needed
Child Developmental Screening and Health Review: Begin within 90 days of enrollment

Recommended program duration is 2 years. According to PAT Implementation guidance, it is highly recommended that affiliates begin services as early as possible in the age range served, to build strong relationships with families and maximize impact. While it is optimal for PAT affiliates to be designed to offer more than two years of services, affiliates must be designed to provide at least two years of services to families whose children are prenatal to kindergarten age. This does not mean that every family must participate for at least two years, but that the affiliate offers the opportunity for families to participate for at least two years depending on the age of their children when they enroll. For example, if an affiliate serves families until their children are age 5 and enrolls a family whose youngest child is 4 years old, it is understood that this family will have the opportunity to participate for one year.

Program Implementation

Infrastructure for Implementation

Materials: Necessary materials for implementation include a computer, internet access, printer, materials for parent-child activities, materials for group connections, and screening instruments.

Space: When hosting in-person group connections, the site must provide adequate space for all participants.

Staffing Requirements

Parent educators are PAT-trained home visitors with at least a high school diploma/GED and 2 years’ experience working with young children and/or parents. Preferably, parent educators will hold a 4-year degree in a relevant field such as early childhood education, or a 2-year degree, or 60 college hours in early childhood or a related field.

Parent educators can serve in full-time or part-time roles, depending on the partnership’s needs. Their caseload is adjusted accordingly. Parents as Teachers recommends that parent educators complete up to 40 home visits per month. When conducting 2 visits per family each month, this equates to serving a caseload of about 18 families with time allotted for travel, coordinating resources, making up missed visits, and other factors. Some partnerships may find it necessary to serve a smaller caseload due to factors such as longer travel times (over 30 minutes round trip), complex family needs requiring a high level of support and resource coordination, and larger family sizes (3 or more children), all of which may require additional time and resources to serve these families with fidelity.

All parent educators require reflective supervision. One supervisor can oversee up to 6-12 PAT parent educators. Supervisors may serve a small caseload of families. Those serving families are required to maintain their model certification and meet the PAT Essential Requirements around reflective supervision and professional development. Supervisors who also serve as parent educators should seek out reflective supervision from someone in their organization or informally partner with another organization to receive the support provided through reflective supervision. Supervisors not serving families are advised to maintain their model certification so they can stay up to date with the PAT Foundational Curricula and provide support during times of staff leave or turnover.

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Prevent Child Abuse North Carolina | PCANC (preventchildabusenc.org) or National Family Support Network for more information, training and certification.

Training for Model Fidelity

Training is provided by PAT National certified trainers through a video platform. The Foundational and Model Implementation training runs over a two-week period with a mixture of live virtual sessions and independent modules. Registration for training is available for affiliate parent educators on the PAT Website.

An additional 20 hours of ongoing, annual professional development is required for all parent educators in order to maintain their PAT certification.

Cost and Purveyor Information

Contact Information

https://parentsasteachers.org/

314-432-4330

customerservice@parentsasteachers.org

Patti Learman: NC State Leader, ncpat@ncpat.org

Allison Kemner: Senior VP & Chief Research Officer, Allison.kemner@parentsasteachers.org

Cost Estimates

Cost estimates vary depending on factors such as affiliate status, existing use of the curriculum, and infrastructure needs. Contact the NC PAT State Leader (Patti Learman, ncpat@ncpat.org) for detailed pricing information specific to your needs and an Affiliate Inquiry Packet which includes an overview of the affiliate process as well as a budgeting tool kit.

NCPC Reporting & Evaluation

Purpose Service Code (PSC)

5509 - Parents as Teachers

Program Identifier (PID)

Parents as Teachers

Minimal Outputs for NCPC Reporting

FY 24-25

Number of parents/guardians participating in home visits †
Number of parents/guardians participating in group connections
Number of group connections held

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.

Minimal Outcomes for NCPC Reporting

FY 24-25:

Increase in positive parenting practices

Minimal Measures for NCPC Reporting

FY 24-25

Please select one of the following:

Keys to Interactive Parenting Scale (KIPS)
Parenting Interaction with Children: Checklist of Observations Linked to Outcomes (PICCOLO)
Parents’ Assessment of Protective Factors (PAPF)
Protective Factors Survey

NCPC Evidence Categorization

Evidence Based- 4 recent publications. 2 randomized control trials, 1 pretest-posttest with a nonequivalent control group, and 1 longitudinal study with propensity matched comparison groups.

Research

Research Summary

Four of the most recent publications on Parents as Teachers include a pretest-posttest study with a nonequivalent control group,¹ a randomized control trial set in Sweden,² a longitudinal study of former participants’ outcomes in grade school,³ and another randomized control trial in Switzerland.⁴ Participants included socially high-risk families who participated in a Parents as Teachers home visiting program for first-time mothers, families involved with the existing community-service infrastructure (e.g., pediatricians, midwives, counseling centers/offices) who were identified as having psychosocial risk factors, and families whose scores on a screening form based on the Heidelberg Stress Scale (HBS) indicated need. Results indicated families receiving home visits were 22% less likely to have substantiated reports of child maltreatment, and first substantiation occurred later in the child’s life as compared to families not participating in PAT. Participating families also demonstrated a trend toward fewer out-of-home placements. Children in the treatment group scored significantly higher in expressive language skills and significantly fewer problem behaviors. They also met a significantly larger proportion of developmental milestones than their peers in the control group. Their mothers scored higher on sensitivity at 12 months.

Additional publications included in the 2018 evidence review include 2 experimental studies that randomly assigned participants to groups,⁵, ⁶ 1 experimental study,⁷ 1 quasi-experimental study with a matched comparison group,⁸ 1 quasi-experimental study with structural equation modeling,⁹ 1 nonexperimental study with comparison groups,¹⁰ and 1 nonexperimental study.¹¹ Visit the Impact and Insights - Parents as Teachers webpage to view additional publications.

^ See Chaiyachati et al. (2018). This study utilized propensity score matching to compare socially high-risk families who participated in a Parents as Teachers home visiting program for first-time mothers and a comparison group of families who were eligible but did not participate. Participant demographics were not specified. Research measures included the following CPS-related outcomes: investigated reports of maltreatment, substantiated reports of maltreatment, and out-of-home placements. Families receiving home visits were 22% less likely to have substantiated reports of child maltreatment, and first substantiation occurred later in the child’s life as compared to families not participating in PAT. Participating families also demonstrated a trend toward fewer out-of-home placements.
^ See Schaub et al. (2019). This randomized control trial conducted in Sweden sampled families involved with the existing community-service infrastructure (e.g., pediatricians, midwives, counseling centers/offices) by identifying families with psychosocial risk factors and referring them to the study. Participants were randomly assigned to a treatment or control group. Data was collected at baseline/three months after birth, at 12 months, at 24 months, and at 36 months. Research measures included guided interviews, observations, parent questionnaires, Bayley Scales of Infant and Toddler Development (Bayley-III), Language Assessment- Brief (SBE-2-KT and SBE-3-KT), Snijders-Oomen Non-verbal Intelligence Test (SON-R 2½ -7), and Child Behavior Check List (CBCL 1½-5). Results indicated that children in the treatment group scored significantly higher in expressive language skills and significantly fewer problem behaviors. They also met a significantly larger proportion of developmental milestones than their peers in the control group.
^ See Lahti et al. (2019). This longitudinal study sampled former PAT participants who were in grade school at the time of the study compared to their peers in propensity score matched groups. Populations sampled in the research included children from preschool to 12th grade who identified as low-income, ESL/ELL, and primarily Hispanic. Measures included the Arizona Measurement of Educational Readiness to Inform Teaching (AzMERIT), Reading Analysis and Prescription System (RAPS 360), Arizona English Language Learner Assessment (AZELLA), school attendance/suspension records, Keys to Interactive Parenting Scales (KIPS), and Protective Factors Survey (PFS). Results indicated that former PAT participants scored higher than their peers on both the AzMERIT subtests for English Language Arts/reading achievement and math achievement. Additionally, their reading achievement scores on the RAPS 360 and English language learner achievement scores on the AZELLA were higher than their peers who had not been involved in PAT in early childhood. Former PAT participants had lower rates of absenteeism and lower numbers of suspension days than their peers. Parents who participated in PAT showed improvements over time in their KIPS and PFS scores, especially in relation to subscales for family functioning, social support, and concrete support.
^ See Neuhauser et al. (2018). This randomized control trial used data from a long-term intervention study known as ZEPPELIN to examine how PAT effects language development. Families were recruited to the study based on their scores on a screening form based on the Heidelberg Stress Scale (HBS). Participating families were randomly assigned to a treatment or control group. Research measures included the HBS, the CARE-Index, and Bayley Scales of Infant and Toddler Development (Bayley-III). Results indicated that children receiving PAT visits scored significantly higher on expressive language at 36 months and their mothers scored higher on sensitivity at 12 months.
^ See Wagner, Spiker, & Linn (2002). A summary of this source can be found in the previous Smart Start evidence review.
^ See Drotar et al. (2008). A summary of this source can be found in the previous Smart Start evidence review.
^ See Wagner & Clayton (1999). A summary of this source can be found in the previous Smart Start evidence review.
^ See Arnold (2012). A summary of this source can be found in the previous Smart Start evidence review.
^ See Zigler, Pfannenstiel, & Seitz (2008). A summary of this source can be found in the previous Smart Start evidence review.
^ See Owen & Mulvihill (1994). A summary of this source can be found in the previous Smart Start evidence review.
^ See Wakabayashi & Scharphorn (2015). A summary of this source can be found in the previous Smart Start evidence review.

Researched Population

Families experiencing identified stressors
Families referred by community resources (pediatricians, social workers, etc.)
Children from preschool to 12th grade (in a longitudinal study) who had participated in PAT in early childhood (prenatal to early kindergarten)
Families who identified as low-income, ESL/ELL, and/or Hispanic

Clearinghouse and Compendium References

California Evidence-Based Clearinghouse for Child Welfare- rated 3 Promising Research Evidence

Title IV-E Prevention Services Clearinghouse- rated Well-Supported

Home Visiting Evidence of Effectiveness- Meets criteria for the general population but not tribal populations

Bright Start TN

National Home Visiting Resource Center- rated Evidence-Based

Citations

Arnold, J.M. (2012). The Parents as Teachers program in Missouri and the resulting difference in academic effects for fifth-and sixth-grade students. Dissertation Thesis; Liberty University.

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

Drotar, D., Robinson, J., Jeavons, L., and Kirchner, H.L. (2008). A randomized, controlled evaluation of early intervention: the Born to Learn curriculum. Child: care, health and development, 35, 5, 643–649.

Lahti, M., Evans, C. B. R., Goodman, G., Schmidt, Cranwell Schmidt, M., LeCroy, C. W. (2019). Parents as Teachers (PAT) home-visiting intervention: A path to improved academic outcomes, school behavior, and parenting skills. Children and Youth Services Review, 99, 451-460. https://doi.org/10.1016/j.childyouth.2019.01.022

Neuhauser, A., Ramseier, E., Schaub, S., Burkhardt, S. C. A., & Lanfranchi, A. (2018). Mediating role of maternal sensitivity: Enhancing language development in at-risk families. Infant Mental Health Journal, 39(5), 522-536. http://dx.doi.org/10.1002/imhj.21738

Owen, M.T. and Mulvihill, B.A. (1994). Benefits of a Parent Education and Support Program in the First Three Years. Family Relations, 43(2), 206-212.

Schaub, S., Ramseier, E., Neuhauser, A., Burkhardt, S. C., & 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

Wagner, M. M. & Clayton, S. L. (1999). The Parents as Teachers program: Results from two demonstrations. The Future of Children, 9(1), 91-115.

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.

Wakabayashi, T., and Scharphorn, L. (2015). Results of the Innovative Approaches to Literacy Project. Evaluation conducted by The Center for Early Education Evaluation HighScope Educational Research Foundation.

Zigler, E., Pfannenstiel, J. C., & Seitz, V. (2008). The Parents as Teachers program and school success: A replication and extension. Journal of Primary Prevention, 29, 103-120.