Parents as Teachers (PAT)
Category
Family Support
Child's Age
Prenatal, 0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years
Participant
Children, Parents/Guardian
Languages
English, Spanish, French, German, Mandarin, Other
Brief Description
Parents as Teachers (PAT) is a home-visiting program that provides families with personal visits, child screenings, group connections, and access to a resource network to support parents as they help their child learn, grow, and develop to their fullest potential. PAT seeks to increase parent knowledge of child development, improve parenting practices, provide early detection of developmental delays and health issues, prevent child abuse and neglect, promote school readiness, improve parent, child and family health and well-being, improve family economic well-being, and strengthen community capacity and connectedness.
Expected Impact
Based on the evidence reviewed, PAT is associated with the outcomes listed below. Additional publications and information can be found on Research and Results - Parents as Teachers and in Parents as Teachers Model Goals.
- Decreased likelihood of substantiated reports of child maltreatment
- Fewer out-of-home placements
- Improvements in the child’s talking, listening, and understanding
- Increase in the percentage of parents reading to their child every day
- Improvements in the areas of parenting efficacy and hopefulness, social support, and family health and safety
- Decreased likelihood of a Medicaid-paid health care encounter for injury or ingestion
- Increase in parent reports of receiving training or education
- Increase in the rate of employment for parents
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 are 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 120 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: 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, Other*
*Contact purveyor about additional available languages.
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.
The recommended program duration is 2 years. 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.
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.
Each PAT affiliate must have one or more clearly designated supervisor(s). A combination of education, work experience, interpersonal skills, and communication skills is critical for the supervisor. It is best practice for the supervisor to have a bachelor’s degree or beyond, and at least five years of experience working with families and young children. In addition, the supervisor needs to be committed to reflective supervision; data-informed practice; and continuous quality improvement. For more information, please contact the purveyor.
NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Positive Childhood Alliance North Carolina (PCANC) or National Family Support Network (NFSN) 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 to maintain their PAT certification.
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.
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- At least 4 recent publications, including a randomized control trial and quasi-experimental studies utilizing control/comparison groups.
Research Summary
Four of the most recent publications on Parents as Teachers (PAT) include a pretest-posttest study with a nonequivalent control group,1 a randomized control trial in Arizona,2 a quasi-experimental study using Mother and Infant Home Visiting Program Evaluation (MIHOPE) data,3 and a quasi-experimental, difference-in-difference study comparing data from PAT’s Penelope data system with the Current Population Survey Annual Social and Economic Supplement (CPS-ASEC).4 These studies sampled several groups, including socially high-risk families, first-time mothers, and parents of children ages 0-4 years old. The following measures were used: investigated reports of maltreatment, substantiated reports of maltreatment, out-of-home placements, the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), a question about the caregiver’s frequency of reading to their child over a seven-day period, the Healthy Families Parenting Inventory (HFPI), the Hearth Hope Index, the Home Safety Scale from the IT-HOME, questions about the caregiver and child’s health insurance status, resource utilization (total number of resources utilized), demographics (current education, job training, and employment status, among other factors), maternal physical health, maternal substance use and mental/emotional health, maternal experience with violence and the justice system, family relationships and parenting, and child characteristics. Results of these studies indicated that participation in PAT is associated with a decreased likelihood of substantiated reports of child maltreatment; a trend toward fewer out-of-home placements; improvements in the child’s talking, listening, and understanding; an increase in the percentage of parents reading to their child every day; improvements in the areas of parenting efficacy and hopefulness, social support, and family health and safety; decreased likelihood of a Medicaid-paid health care encounter for injury or ingestion; increase in parent reports of receiving training or education; increase in rate of employment for parents.
Additional publications and information can be found on Research and Results - Parents as Teachers, and in Parents as Teachers Model Goals.
- ^ 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 LeCroy & Milligan Associates, Inc. (2024). This randomized control trial evaluated the effectiveness of Parents as Teachers (PAT) on child and caregiver outcomes measured at 6- and 12-months post-enrollment. The authors sampled Arizona-based families with a child ages birth to 4 years. Participants were randomly assigned to the PAT intervention group (n = 509) or a control group (n = 258) then completed assessments at baseline and at 6- and 12-month follow-ups. The authors noted a 69% retention rate from baseline to 6-month follow-up (n = 295 intervention; n = 166 control) and a 66% retention rate from 6-month to 12-month follow-ups (n = 274 intervention; n = 161 control). The intervention group received standard PAT services provided by trained and certified PAT Parent Educators. Most participants (83% of the intervention group) received at least 6 PAT home visits. On average, intervention participants completed 13.29 home visits at the 6-month follow-up and an average of 25.48 home visits by the 12-month follow-up. Measures included the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II), a question about the caregiver’s frequency of reading to their child over a seven-day period, the Healthy Families Parenting Inventory (HFPI), the Hearth Hope Index, the Home Safety Scale from the IT-HOME, questions about the caregiver and child’s health insurance status, resource utilization (total number of resources utilized), and demographics (current education, job training, and employment status, among other factors). Results found no significant differences between the intervention and control group. Most caregivers were female (97.6%) and their children were an average age of 19.9 months. Half of children were male (51.2%). Participants primarily identified as White, Hispanic (42.2%) or White, non-Hispanic (23.1%). A fifth of participants were beneficiaries of SNAP (20.0%). At the 6-month follow-up, participants in the intervention group demonstrated greater improvements on scales assessing child development (Vineland II), parenting practices and family functioning (HFPI and Hearth Hope Index), and family health and safety (Home Safety Scale and HFPI Family Risk Score) when compared to the control group. More specifically, they scored significantly higher on the Vineland II Listening and Understanding (p = 0.00) and Talking (p = 0.04) subscales. The intervention group was significantly more likely to read to their child every day (p = 0.04). They also scored significantly higher (more favorably) on the HFPI Parenting Efficacy subscale (p = 0.01), the Hearth Hope Index (p = 0.05), Home Safety Scale (p = 0.00), and HFPI Family Risk Score (p = 0.02). At the 12-month follow-up, the intervention group continued to demonstrate more favorable outcomes on the HFPI Parenting Efficacy subscale (p = 0.04) and Home Safety Scale (p = 0.05). Overall, these results indicate that participation in PAT was associated with improvements in the child’s talking, listening, and understanding; an increase in the percentage of parents reading to their child every day; improvements in the areas of parenting efficacy and hopefulness, social support, and family health and safety. The impacts of PAT were most significant at the 6-month mark. The primary study limitation was the challenges of conducting a study during the COVID-19 pandemic (as the study launched in April 2019).
- ^ See McCombs-Thornton et al. (2023). This quasi-experimental study utilized data from Mother and Infant Home Visiting Program Evaluation (MIHOPE). As part of MIHOPE, families were randomly assigned to participate in one of four home visiting models, including Parents as Teachers (PAT; n = 218), or a control group (n = 225). This study focused on families who participated in PAT and completed at least 3 months of home visits and used propensity score matching to construct a comparison group. Measures utilized in this study included self-reports of demographics, family economic self-sufficiency, maternal physical health, maternal substance use and mental/emotional health, maternal experience with violence and the justice system, family relationships and parenting, and child characteristics (see pages 6-7 of the report for more details). The authors found no significant differences between the PAT and control group. Participants primarily identified as Hispanic/Latina (36.6%), White (36.8%), or African American/Black (20.6%). Most participants had less than a high school degree or equivalent (42.4%) followed by some college or higher (24.6%). About half of participating mothers were employed for more than 12 months in the prior three years (48.4%) and most were married to their child’s biological father (34.8%). Nearly half of participants were pregnant at baseline (44.0%) and a third reported symptoms of depression or anxiety (32.1%). Most participants had health insurance/coverage (89.2%). On average, children were 2 months old at baseline and about a quarter of the children were born prematurely, under 5.5 pounds at birth, or spent time in a neonatal intensive care unit (26.3%). The authors found statistically significant differences in family outcomes for child development, child health, family economic self-sufficiency, and parenting at the 15-month follow-up, favoring the PAT participants. Mothers who participated in PAT showed significantly greater awareness of health and safety hazards at the 15-month follow-up than mothers in the control group (p < 0.05). They were also significantly less likely to have had a Medicaid-paid health care encounter for injury or ingestion (p < 0.01) or have any child maltreatment report (p < 0.001). Mothers in the PAT group were significantly more likely to report that they were receiving training or education (p < 0.05) and using nonparental child care at least once a week (p < 0.05). The PAT group reported greater parental sensitivity (p < 0.05) and used less control in their discipline strategies than the control group (p < 0.05). The authors found the greatest number of positive impacts for Black or African American families in PAT, followed by Hispanic/Latina families. PAT was also most impactful for participants with more psychological resources (above the median score for symptoms of depression and anxiety, mastery, and verbal abstract reasoning) and for those with less than a high school education. Additionally, the authors compared outcomes for families who received at least 3 months of home visiting in any model that used the PAT Foundational Criteria (n = 371) and a matched comparison group (n = 355), as the PAT curricula can be used with any home visiting model. They also limited this sample to those who were in a PAT program using the PAT Foundational Curricula (n = 201) and a matched comparison group (n = 205). The authors found that children receiving home visits using the PAT Foundational Curricula were significantly less distressed when directed by their parents to clean-up than children in the control groups (p < 0.05). This was true for both families in a PAT program using the PAT Foundational Curricula and those in another home visiting program using the curricula. Families in a PAT program using the PAT Foundational Curricula were significantly less likely than the control group to have a child maltreatment report (p < 0.01). Families receiving PAT visits with the PAT Foundational Curricula had a significantly greater awareness of health and safety hazards (p < 0.05) than the comparison group. Receiving home visits using the PAT Foundational Curricula, regardless of the program used for home visits, was associated with an increased likelihood of using nonparental child care at the 15-month follow-up (p < 0.05). Limitations to the study include the small sample sizes that resulted from stratifying the full MIHOPE sample to specific criteria. The MIHOPE data also did not assess the number of visits families completed during the first three months so it is unclear exactly what dosage participants received and how different dosages could have impacted their outcomes.
- ^ See Wang & Sturmfels (2023). This quasi-experimental evaluation utilized a difference-in-difference study design to compare employment, education, and income of caregivers who participated in Parents as Teachers (PAT) and a control group. Data was pulled from the PAT Penelope data system and the Current Population Survey Annual Social and Economic Supplement (CPS-ASEC) to form the PAT (n = 17,158) and control groups (n = 70,196). Both PAT and CPS-ASEC data include baseline and follow-up measures at the 1-year follow-up mark for participants’ education, employment, and income. PAT participants included in the study sample were primarily female caregivers (PAT = 85.3%), had an average age of 29 years, and most participants (59%) had a high school diploma, GED, or lower educational attainment. The CPS-ASEC group, on the other hand, had a more even ratio of male and female caregivers (female = 49.8%), were 31 years old on average, and had completed at least some college or technical training (61.2%). Participants were primarily White (PAT = 68%, CPS-ASEC = 78.9%) followed by Black or African American (PAT = 20.6%, CPS-ASEC = 11.4%). A third (33.4%) of PAT participants identified as Hispanic or Latino compared with only 15.7% of the CPS-ASEC group. Just over half of participants were not married (PAT = 51.7%, CPS-ASEC = 58.8%). Half of PAT participants were employed (50.1%) compared with 71.8% of the CPS-ASEC group. The median family income for participants in the PAT group was $10,652compared to $76,328 for CPS-ASEC participants. Most PAT participants lived below the federal poverty line (74.4%) compared to the CPS-ASEC group (10.7%). When assessing whether outcomes changed from baseline to the 1-year follow-up, the authors found significant improvements for PAT participants in employment and education. PAT participants who reported being unemployed at baseline were 16% more likely to be employed after 1 year than the CPS-ASEC group (p < 0.05). PAT participants not enrolled in high school at baseline were 69% more likely to enroll in high school at the 1-year follow-up than the CPS-ASEC group (p < 0.05). They were also 12% more likely to enroll in college, although this was not statistically significant (p < 0.1). These findings were moderated by racial and ethnic subgroups. Study limitations include the lack of reporting any statistical differences between the PAT and CPS-ASEC groups’ demographic characteristics. The authors did not find evidence of increased family income for PAT participants and suggest that this may be due to education (students may work less while pursuing their education), the short timeframe of 1 year, and the fact that the family income measure only included cash sources.
Researched Population
- Families identified as socially high-risk
- Low income families
- Caregivers who primarily identified as White, Black or African American, or Hispanic/Latino
- First-time mothers
- Parents of children ages 0-4 years
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
National Home Visiting Resource Center- rated Evidence-Based
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
LeCroy & Milligan Associates, Inc. (2024). Parents as Teachers Randomized Control Trial in Arizona: 6- and 12-Month Outcomes Report. https://www.lecroymilligan.com/_files/ugd/4d0a9d_3729c8f41ef34a2d9dfeb80b81c3073b.pdf
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-Outcomes-MIHOPE.pdf
Wang, Y., & Sturmfels, N. (2023). Exploring Employment and Education Outcomes for Caregivers Participating in Parents as Teachers: Home Visiting Outcomes Analysis Results. https://parentsasteachers.org/wp-content/uploads/2023/05/Employment-and-Education-Outcomes-Analyses_02282387.pdf
Date Evidence Last Reviewed by NCPC: May 2025
Date Content Last Reviewed by Model Purveyor: April 2025
Local Partnerships Currently Implementing
Local Partnerships in purple have adopted Parents as Teachers (PAT). Local Partnership contact information can be found here.