Early Pathways Program (EPP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Early Pathways Program (EPP) has been rated by the CEBC in the area of: Parent Training Programs that Address Behavior Problems in Children and Adolescents.

Target Population: Children 6 years of age and younger with significant behavior and/or emotional problems and their primary caretaker(s)

For children/adolescents ages: 0 – 6

For parents/caregivers of children ages: 0 – 6

Brief Description

EPP is a home-based, parent-child therapy program for children 6 years of age and younger with significant behavior and/or emotional problems. It was designed specifically for a diverse population of very young children who come from families living in poverty, most of whom meet criteria for a psychiatric diagnosis. EPP emphasizes psychoeducation, direct clinician modeling to parents and other primary caretakers of effective strategies to strengthen the child’s positive behaviors and reduce challenging ones, parent practice of new strategies with clinician feedback, and parent coaching. Treatment occurs weekly for an average of 8-12 weeks with booster sessions added as needed

Program Goals:

The goals of the Early Pathways Program (EPP) are:

  • Strengthen the parent-child relationship
  • Improve parent-child interactions during play
  • Reduce the child’s behavior problems
  • Increase the child’s positive behaviors
  • Improve the parent’s nurturing skills
  • Improve the parent’s appropriate limit-setting skills for the child’s challenging behaviors while discouraging the use of verbal and corporal punishment
  • Increase the parent’s knowledge of appropriate developmental expectations for their child and to apply them
  • Improve the parent’s thoughtfulness and calmness when managing their child’s behavior problems
  • Improve the parent’s confidence in managing new problems that emerge after EPP ends

Essential Components

The essential components of the Early Pathways Program (EPP) include:

  • Establishing rapport and trust between the clinician, parent (or primary caregiver), and child
  • Communicating clear rules for in-home, EPP sessions [e.g., parent and child present for all sessions; other immediate and extended family members and nonfamily members (mother’s partner) are encouraged to participate; cancellation and no-show policy]
  • Completing of required paperwork (e.g., informed consent, HIPPA, release of information)
  • Conducting a clinical interview, self-report instruments on child’s behavior and parenting practices, and direct observation of parent-child play interactions
  • Developing an initial treatment plan and goals with copy given to parent at the first session
  • Ensuring child safety by having clinicians observe the home and provide necessary safety supplies to fix problems such as a window lock for an open second floor window, outlet covers for uncovered electric outlets, cupboard locks for easy to open cupboards with potentially poisonous cleaning materials, safety gates for stair, etc.
  • Providing advocacy by having clinicians routinely ask parents about family and child needs and assist in meeting these needs (scheduling an appointment with a pediatrician, enrolling the child in a school or arranging an evaluation for special services – speech, special education) or make appropriate referrals to community agencies and providers (counseling for a parent who is depressed, contacting agencies that provide the family with basic needs – food, housing, electricity, heat)
  • Teaching Child-Led Play strategies to parents with toys available in the home or brought by the clinician which requires the parents to observe and positively comment on child’s play without directions or questions; encouraging parents to continue this activity daily in-between therapy sessions to strengthen the parent-child relationship]
  • Using a Cognitive Parenting Strategy, such as the familiar Stop and Go Traffic Light with a STAR acronym, when confronted with challenging behaviors, parents are taught to Stop (red light), Think (yellow light), Ask (yellow light), and Respond (green light) to encourage the parents to slow down their impulsive and often negative reactions and instead interact with their child in a calm, thoughtful manner; teaching brief anger and stress management strategies to parents is included
  • Instructing parents in normal early childhood developmental expectations and encouraging them to monitor their expectations for their children to ensure they are being reasonable
  • Strengthening positive child behaviors (e.g., compliance, picking up toys, going to bed, toileting, etc.) by teaching parents how recognize and consistently reinforce positive behaviors in their child using a variety of positive child-specific rewards including edibles and tangibles
  • Reducing problem child behaviors (e.g., serious tantrums, property destruction, self-injury, aggression, hyperactivity, noncompliance, etc.) by teaching parents effective, behavior-specific treatment strategies including redirection (for children under 2 years old), ignoring (extinction), natural consequences, and time-out
  • Addressing emotional problems (e.g., separation anxiety, nightmares, fears, trauma) by working with the child and parent to address the child’s emotional difficulties
  • Creating a more predictable home environment by assisting parents in establishing regular routines for their young child in terms of meal times, play time, bath and bed times and often creating a family-specific visual chart to help parents maintain a regular routine
  • Assessing the child’s progress during each session using a Treatment Report and sharing it with the parent at the end of the session and asking the parent about how the week went and any new concerns that arose with their child or new advocacy needs
  • Concluding the final session with a posttest that essentially repeats the intake evaluation, encouraging parents to contact the clinician if new issues/questions emerge, and providing booster sessions in the home when needed
  • Note: Normally, if progress in the young child’s behavior is not observed by the third treatment session, the clinician and parent have a frank discussion about the parent’s level of engagement and follow through with EPP. As families in poverty have many barriers that interfere with treatment adherence and ongoing family crises (child illness, intimate partner violence), it may not be reasonable for them to fully implement EPP. Clinicians and parents may agree to suspend treatment until the family is in a better position to become fully engaged and implement the program with their young child.

Child/Adolescent Services

Early Pathways Program (EPP) directly provides services to children/adolescents and addresses the following:

  • Serious tantrums, property destruction, aggression, self-injury, hyperactivity, noncompliance and other behavior problems; separation anxiety, fears and nightmares, other emotional difficulties

Parent/Caregiver Services

Early Pathways Program (EPP) directly provides services to parents/caregivers and addresses the following:

  • Parent or caregiver of a young child (6 years and under) with serious behavior problems; parents with significant problems/symptoms of their own are referred to other community resources, agencies and providers
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: All individuals living in the home (older siblings, extended family members, parent partners) are encouraged to participate in EPP so that the child is receiving consistent feedback from everyone to strengthen their positive behaviors and reduce their problem ones. At times, a special family meeting may be called to encourage everyone to “get on the same page” for the child’s benefit.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care

Homework

Early Pathways Program (EPP) includes a homework component:

Parents are provided a Behavior Plan at the conclusion of each session describing what they are to do for the week before the next session. A place on the Behavior Plan is included for the parent to check whether or not they followed the plan. These plans are reviewed at the beginning of each home session

Languages

Early Pathways Program (EPP) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Clinicians must be trained in EPP and have safety training for going into homes in unsafe neighborhoods.
  • An area of the home needs to be identified that will provide as few distractions as possible (no TV, cell phones, etc.).
  • Clinicians bring appropriate toys, safety devices, rewards (stickers), program materials (home routine chart).
  • Clinicians carry a guide that has available community services and providers for the child, parent, and family.
  • Clinicians need reliable transportation.
  • Clinicians have a file for each child including all of the required paperwork.

Minimum Provider Qualifications

Clinicians normally have a minimum of a Bachelor’s degree in the human services field or extensive experience as a home visitor. Supervisors normally have a Master’s degree in psychology, social work or counseling, are licensed in the state, and have three years of experience implementing EPP.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

In addition to the 20-hour on-line professional training program and manual, onsite training is provided for graduate student interns each year. Overviews of EPP are presented at state, regional, and national conventions.

Number of days/hours:

The online professional training is 20 hours long. The student interns spend 600 hours at the clinic and normally require a full 15-week semester to become competent in delivering EPP.

Implementation Information

Since Early Pathways Program (EPP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Early Pathways Program (EPP).

Formal Support for Implementation

There is no formal support available for implementation of Early Pathways Program (EPP).

Fidelity Measures

There are fidelity measures for Early Pathways Program (EPP) as listed below:

There is a fidelity measure where basic treatment concepts and strategies are broken down in measureable units and supervisors directly observe providers with parents to determine if they are implementing the program as intended.

Implementation Guides or Manuals

There are implementation guides or manuals for Early Pathways Program (EPP) as listed below:

A training manual is available at https://www.eventbrite.com/e/early-pathways-on-line-training-course-registration-17747683800

Research on How to Implement the Program

Research has been conducted on how to implement Early Pathways Program (EPP) as listed below:

Mattek, R. J., Jorgenson, E. T., & Fox, R. A. (2010). Home-based therapy for young children in low-Income families: A student training program. The Family Journal: Counseling and Therapy for Couples and Families, 18, 189-194.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Fox, R. A., & Holtz, C. A. (2009). Treatment outcomes for toddlers with behavior problems from families in poverty. Child and Adolescent Mental Health, 14, 183-189. doi:10.1111/j.1475-3588.2009.00527.x

Type of Study: One group pretest-posttest study
Number of Participants: 102

Population:

  • Age — Children: 1-5 years, Parents: Not specified
  • Race/Ethnicity — Children: 43% African American, 21% Latino, 21% Caucasian,15% mixed ethnicity or other; Parents: Not specified
  • Gender — Children: 59 Boys and 43 Girls, Parents: Not specified
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems and their parents.

Location/Institution: Large, urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the present study was to examine the effectiveness of the Parenting Young Children Program (PYC) [now called the Early Pathways Program (EPP)] for very young children with behavior problems, most of whom also had significant developmental delays and were living in poverty.. Measures utilized include the Eyberg Child Behavior Inventory, the Parent Behavior Checklist (PBC), the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Parent-Child Relationship Scale, and the Family Satisfaction Survey. Results indicate significant improvements were found for the children’s behavior problems and their compliance to parent requests. Limitations lack of a control group, high attrition rate, and lack of follow-up.

Length of postintervention follow-up: None.

Holtz, C. A., Carrasco, J. M., Mattek, R. J., & Fox, R. A. (2009). Behavior problems in toddlers with and without developmental delays: Comparison of treatment outcomes. Child & Family Behavior Therapy, 31, 292-311. doi:10.1080/07317100903311018

Type of Study: Pretest-posttest with a control group
Number of Participants: 54

Population:

  • Age — Children: Mean=2.45-2.88 years, Parents: Not specified
  • Race/Ethnicity — Children: 24 African American, 11 Latino, 11 Caucasian, 7 Mixed, and 1 Other; Parents: Not specified
  • Gender — Children: 27 Male and 27 Female, Parents: Not specified
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems and their parents.

Location/Institution: Urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study is to examine the effectiveness the Parenting Young Children Program (PYC) program [now called the Early Pathways Program (EPP)] for toddlers with behavior problems and developmental delays. Children were assigned to either a group with developmental delays or a group without developmental delays. Measures utilized include the Early Intervention Developmental Profile (EIDP), the Eyberg Child Behavior Inventory (ECBI), the Parent Behavior Checklist (PBC), Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Parent-Child Relationship Scale and the Family Satisfaction Survey. Results indicate that children with and without developmental delays experienced similar reductions in challenging behavior, enrichment in the parent-child relationship, and improvements in parenting behavior and skills. Parent-child interactions improved over time as children in the program demonstrated increased positive affect and responded more to their parents. Parents became more sensitive to their child’s cues and set appropriate limits on their challenging behaviors, resulting in decreased use of verbal and corporal punishment and an improvement in their ability to establish appropriate expectations. Limitations include lack of control group, high attrition rate, small sample size, and lack of follow-up.

Length of postintervention follow-up: None.

Carassco, J. M., & Fox, R. A. (2012). Varying treatment intensity in a home-based parent and child therapy program for families living in poverty: A randomized clinic trial. Journal of Community Psychology, 40, 621-630. doi:10.1002/jcop.21492

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — Children: Mean=2.49-2.72 years, Parents: Mean =28.5-31.9 years
  • Race/Ethnicity — Children: 36 African American, 10 Latino, 6 Caucasian, and 8 Mixed; Parents: Not specified
  • Gender — Children: 42 Male and 18 Female, Parents: Not specified
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems and their parents.

Location/Institution: Large, urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study addressed the question of whether increasing the intensity of the Parenting Young Children Program (PYC) program [now called the Early Pathways Program (EPP)] would improve results for young children with significant behavior problems from families living in poverty. Children were randomly assigned to either a standard condition or an intensity condition that provided 50% more treatment over a standard 8-week treatment period. Measures utilized include the Eyberg Child Behavior Inventory, the Parent Behavior Checklist (PBC), the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Parent-Child Relationship Scale and the Family Satisfaction Survey. Results indicate, based on multiple parent-report, direct observation, and clinician-report measures of the children and their caregivers, both groups improved on all measures from pretest to posttest and from pretest to follow-up. No differences in outcomes were found between the standard and intensity groups at posttest or follow-up. Limitations include reliance on self-reported measures, small sample size, and length of follow-up.

Length of postintervention follow-up: 4-6 weeks.

Fox, R. A., Mattek, R., & Gresl, B. (2013). Evaluation of a university-community partnership to provide home-based, mental health services for children from families living in poverty. Community Mental Health Journal. 49, 599-610. doi:10.1007/s10597-012-9545-7

Type of Study: One group pretest-posttest
Number of Participants: 237

Population:

  • Age — Children: Mean=2.81-2.94 years, Parent: Mean=28.5-31.5 years
  • Race/Ethnicity — Children: 145 African American, 45 Latino, 20 Caucasian, and 27 Mixed Ethnicity, Parent: Not specified
  • Gender — Children:168 Male and 69 Female, Parent: Not specified
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems and their parents.

Location/Institution: Large, urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this pilot project was to implement the Parenting Young Children Program (PYC) [now called the Early Pathways Program (EPP)] in the homes of an at-risk population of children with significant emotional and behavior problems that were further complicated by developmental delays. Measures utilized include the Early Childhood Behavior Screen (ECBS), Eyberg Child Behavior Inventory, the Parent Behavior Checklist (PBC), the Diagnostic and Statistical Manual of Mental Disorders, and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL). Results indicate that following treatment, children’s prosocial behaviors increased and their challenging behaviors decreased. Additionally, parental expectations and nurturing increased and parent use of verbal and corporal punishment decreased. Limitations include follow-up on only a small sample of initial population, lack of control group, selection bias, and high attrition rate.

Length of postintervention follow-up: 4-6 weeks (99 participants) and 1 year (25 participants).

Gresl, B. L., Fox, R. A. & Fleischmann, A. (2014). Home-based parent-child therapy in low-income African American, Caucasian, and Latino Families: A comparative examination of treatment outcomes. Child & Family Behavior Therapy, 36(1), 33-50. doi:10.1080/07317107.2014.878193

Type of Study: One group pretest-posttest
Number of Participants: 183 (66 at follow-up – information listed below)

Population:

  • Age — Children: Mean=2.81-2.90 years, Parents: Not specified
  • Race/Ethnicity — Children: 22 African American, 22 Caucasian, and 22 Latino or Hispanic; Parents: Not specified
  • Gender — Children: 50 Male and 16 Female, Parents: Not specified
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems and their parents.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effects of the Parenting Young Children Program (PYC) [now called the Early Pathways Program (EPP)] for behavior problems in young children in low-income African American, Caucasian, and Latino families. Measures utilized include demographic information, the Early Childhood Behavior Screen (ECBS), the Parent Behavior Checklist (PBC), and the Family Satisfaction Survey. Results indicated caregivers across the three ethnic groups reported a decreased frequency of their child’s challenging behaviors, increased positive interactions with their child during play, improved parental expectations, higher levels of nurturing, and less reliance on the use of verbal and corporal punishment. Limitations include lack of control group, generalizability due to ethnicity of population, and length of follow-up.

Length of postintervention follow-up: 4-6 weeks.

Fung, M., P., Fox, R. A., & Harris, S. E. (2014). Treatment outcomes for at-risk young children with behavior problems: Toward a new definition of success. Journal of Social Service Research, 40, 623-641. doi:10.1080/01488376.2014.915283

Type of Study: One group pretest-posttest
Number of Participants: 447

Population:

  • Age — Children: Mean=3.16 years, Parents: Mean=29.7 years
  • Race/Ethnicity — Children: 52.8% African American, 19.9% Latino, 11% Caucasian, and 16.4% Multiracial; Parents: Not specified
  • Gender — Children: 67.1% Boys and 32.9% Girls, Parents: 89% Female
  • Status — Participants were children with developmental disabilities with externalizing behavioral problems.

Location/Institution: Mental health clinic in a large, urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effects of the Early Pathways (EP) [now called the Early Pathways Program (EPP)] on at-risk children under the age of five who were referred for severe behavior and emotional problems, such as aggression, oppositional behavior, and separation anxiety. Measures utilized include demographic information, the Early Childhood Behavior Screen (ECBS), the Parent Behavior Checklist (PBC), Parent-Child Play Assessment (PCPA), Family Satisfaction Survey, and the Parent-Child Relationship Scale (PCRS). Results showed that children demonstrated a significant decrease in the frequency and severity of challenging behaviors (e.g., hitting, kicking) as well as a significant increase in prosocial behaviors (e.g., sharing, listening). In addition, caregivers exhibited significant increases in the use of appropriate discipline strategies and nurturing activities with their children. Limitations include lack of control group, high attrition rate, low reliability of the PCPA, and length of follow-up.

Length of postintervention follow-up: 4-6 weeks.

Fung, M. P., & Fox, R. A. (2014). The culturally-adapted early pathways program for young Latino children in poverty: A randomized controlled trial. Journal of Latina/o Psychology, 2, 131-145. doi:10.1037/lat0000019

Type of Study: Randomized controlled trial
Number of Participants: 137

Population:

  • Age — Children: Mean=3.89 years, Parents: Mean=28.87 years
  • Race/Ethnicity — Children: 48.5% Mexican, 27.2% Puerto Rican, 14.7% other (Dominican, Central American, Spanish), 9.6% mixed ethnicities (Mexican/Puerto Rican, Mexican Dominican); Parents: Not specified
  • Gender — Children: 73% Boys and 27% Girls, Parents: 94.9% Female
  • Status — Participants were Latino children referred for severe behavior and emotional problems and their parents.

Location/Institution: Large urban community in the upper Midwest

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the efficacy of a culturally adapted version of the Early Pathways (EP) program [now called the Early Pathways Program (EPP)] for children severe behavior and emotional problems, such as aggression, oppositional behavior, self-injury and property destruction. Children and their parents were randomly assigned to either immediate or delayed treatment groups. Measures utilized include the Short Acculturation Scale for Hispanics (SASH), the Early Childhood Behavior Screen (ECBS), the Parent Behavior Checklist (PBC), Diagnostic and Statistical Manual of Mental Disorders (DSM), Parent-Child Relationship Scale (PCRS), Family Satisfaction Survey (FSS), and the Parent-Child Play Assessment (PCPA). The immediate treatment group completed an intake, treatment, posttest, and four-six week follow-up sessions. The delayed treatment group completed an intake, waited four to six weeks, and repeated the pretest measures during a second intake before following the same treatment and assessment protocol as the immediate treatment group. Results indicate significant improvement on all measures along with and a high level of caregiver satisfaction with the intervention. Moreover, after the delayed group completed treatment, participants from both the immediate and delayed groups exhibited similar positive outcomes with successful maintenance of gains. Limitations include high attrition rate, all participants in wait-list group did not always complete treatment, reliance on self-reported measures, and length of follow-up.

Length of postintervention follow-up: 4 to 6 weeks.

Harris, S. E., Fox, R. A., & Love, J. R. (2015). Early Pathways therapy for young children in poverty: A randomized controlled trial. Counseling Outcome Research and Evaluation, 6, 3-17. doi:10.1177/2150137815573628

Type of Study: Randomized controlled trial
Number of Participants: 199

Population:

  • Age — Children: 1-5 years, Parents: Mean=28.16 years
  • Race/Ethnicity — Children: 41.2% Latino and 38.7% African American, Parents: Not specified
  • Gender — Children: 70.4% Male, Parents: Not specified
  • Status — Participants were children with disruptive behaviors and their parents.

Location/Institution: large, urban Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the effectiveness of the Early Pathways Program (EPP) in decreasing challenging behaviors in children. Children and their parents were randomly assigned to one of two EPP groups: an immediate treatment (IT) or wait-list control (WL) group. Measures utilized include the Early Childhood Behavior Screen (ECBS), the Parent Behavior Checklist (PBC), and the Family Satisfaction Survey. Participants allocated to the WL group were required to wait at least 4 to 6 weeks for treatment services after their initial intake. Results indicated that parents in the IT group reported significant improvements in their child’s disruptive and prosocial behaviors. In addition, they reported increased nurturing and decreased use of corporal and verbal punishment by themselves compared to the WL families. Limitations include reliance on self-reported measures, generalizability due to gender, and length of follow-up.

Length of postintervention follow-up: 3 months.

References

Fox., R. A., & Gresl, B. L. (2014). Early Pathways manual. Available at https://www.eventbrite.com/e/early-pathways-on-line-training-course-registration-17747683800

Fox., R. A., & Gresl, B. L. (2014). Early Pathways online training. Available at http://www.marquette.edu/education/early-pathways

Contact Information

Name: Robert A. Fox, PhD
Agency/Affiliation: Marquette University, College of Education
Website: www.marquette.edu/education/early-pathways/#
Email:
Phone: (414) 288-1469

Date Research Evidence Last Reviewed by CEBC: February 2016

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: May 2016