Parents as Teachers

About This Program

Target Population: Families with an expectant mother or parents of children up to kindergarten entry (usually 5 years)

For parents/caregivers of children ages: 0 – 5

Program Overview

Parents as Teachers is an early childhood parent education, family support and well-being, and school readiness home visiting model based on the premise that "all children will learn, grow, and develop to realize their full potential." Based on theories of human ecology, empowerment, self-efficacy, attribution, and developmental parenting, Parents as Teachers involves the training and certification of parent educators who work with families using a comprehensive curriculum. Parent educators work with parents to strengthen protective factors and ensure that young children are healthy, safe, and ready to learn. An agency may choose to use the Parents as Teachers model to focus services primarily on pregnant women and families with children from birth to age 3 or through kindergarten.

Program Goals

The four goals of Parents as Teachers are:

  • Increase parent knowledge of early childhood development and improve parenting practices
  • Provide early detection of developmental delays and health issues
  • Prevent child abuse and neglect
  • Increase children's school readiness and school success

Essential Components

The essential components of Parents as Teachers include:

  • Personal Visits: Home visitation is a key component of the Parents as Teachers model, with personal visits of approximately 60 minutes delivered at a minimum once a month, depending on family needs. Parent educators share research-based information and use evidence-based practices by partnering, facilitating, and reflecting with families. Parent educators use the Parent as Teachers curriculum in culturally sensitive ways to deliver services that emphasize parent-child interaction, development-centered parenting, goal setting and family well-being.
    • Parent-child interaction focuses on promoting positive parenting behaviors and child development through parent-child activities.
    • Development-centered parenting focuses on the link between child development and parenting on the key developmental topics (e.g., attachment, discipline, health, nutrition, safety, sleep, transitions/routines, healthy births).
    • Developing goals and a vision for the future is vital for family. Parent educators work collaboratively with families to identify, set, and achieve goals that lead to positive outcomes.
    • Family well-being includes a focus on family strengths, capabilities, skills, and the building of protective factors.
  • Screenings:
    • Annual child health, hearing, vision, and developmental screenings, beginning within 90 days of enrollment, are a component of the model. Child screenings:
      • Assess developmental progress regarding cognitive, language, social-emotional, and motor skills
      • Screen for delays or problems in vision/hearing/health
      • Provide information about child’s health and developmental progress through on-going tracking of developmental milestones
    • Many programs also carry out adult screenings to identify parental depression, substance abuse, and intimate partner violence.
  • Group Connections: Another component of the Parents as Teachers model is monthly or more frequent group connections, which parents can attend with their child to obtain information and social support and share experiences with their peers. Group connections formats include family activities, presentations, community events, parent cafes, and ongoing groups. There are no set recommendations of the group size.
  • Resource Network: Additionally, Parents as Teachers maintains ongoing relationships with institutions and community organizations that serve families. Parent educators help families identify needs, set goals, connect with appropriate resources, and overcome barriers to accessing services.

Program Delivery

Parent/Caregiver Services

Parents as Teachers directly provides services to parents/caregivers and addresses the following:

  • Pregnant or parent of a child prenatal through Kindergarten in possible high-risk environments:
    • Teen parents
    • Low income
    • Parental low educational attainment
    • History of drug abuse in the family
    • Chronic health conditions effecting the child or parents
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: This program involves the family or other support systems in the individual's treatment: Children in the family are included in the home visits that focus on parent-child interaction. Other family members in the home such as grandparents are also invited to take part in home visits. Parents are connected to other agencies in the community as the need arises.

Recommended Intensity:

At least 12 home visits annually to families with one or no high-needs characteristics. At least 24 home visits annually to families with two or more high-needs characteristics. In some cases, visit frequency may be gradually decreased as the family transitions out and into other services. Home visits last approximately 60 minutes. At least 12 group connections (or meetings) annually, Annual screening of children for developmental, health, hearing, and vision problems each year

Recommended Duration:

At least two years

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Child Care Center
  • Community Agency
  • Foster/Kinship Care
  • Outpatient Clinic
  • School

Homework

Parents as Teachers includes a homework component:

There are parent-child follow-up activities in the curriculum for the parent educators to choose from based on parenting behaviors or child development they want to encourage. Parent educators introduce a follow-up activity at the end of their visits, and encourage parents to engage in it before the next personal visit. Families are also encouraged to read together between visits.

Languages

Parents as Teachers has materials available in languages other than English:

French, German, Mandarin, Spanish

For information on which materials are available in these languages, 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:

Staffing Requirements - PAT programs have two primary staff positions: (1) parent educators who provide home visiting services and (2) their supervisors. It also is recommended that the affiliate identify staff to serve as the data entry specialist and to provide administrative support to the parent educators and supervisors.

Staff Ratio Requirements - The PAT program requires that a supervisor be assigned not more than 12 parent educators to supervise, regardless of whether the parent educators are full-time or part-time employees. The PAT program also requires that full-time parent educators complete no more than 60 visits per month, with new parent educators (those working for PAT less than one year) conducting no more than 48 visits per month. Fifty visits per month is the optimal number to be completed by full-time parent educators in their second year or beyond, and 40 visits per month is the optimal number to be completed by full-time parent educators in their first year.

Average Cost per Family and Purchase of Program Model or Operating License - On its website (see link at bottom of page), the PAT National Center provides a Budget Toolkit for programs to estimate basic program implementation costs (including affiliate fees), from which a per-family cost can be estimated. Curriculum materials are included in the cost of training and renewal. Some affiliates offer incentives to help retain families. The costs for family incentives vary by affiliate.

Data Systems/Technology Requirements - The PAT National Center has developed and offers a data management system, Penelope, and offers free access to it for PAT affiliates. Affiliates are not required to use Penelope, but affiliates should use a data-tracking or management information system.

Education and Training

Prerequisite/Minimum Provider Qualifications

The PAT program requires that, at a minimum, parent educators have a high school diploma or general equivalency degree (GED) and at least two years’ previous supervised work experience with young children and/or parents. The PAT program prefers for parent educators to have at least a four-year degree in early childhood education or a related field, or at least a two-year degree, or 60 college hours in early childhood or a related field. It is recommended that parent educators have prior experience working with young children and/or parents.

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:
  • Donna Hunt O'Brien, Director, Training and Curriculum Development
    Parents as Teachers National Office
    www.parentsasteachers.org
    phone: (866) 728-4968 x276
Training is obtained:
  • Requirements for Program Certification: To become an approved PAT model affiliate, all applicants must (1) contact the PAT National Center or state PAT office to review expectations for fidelity and quality and to assess their fit with the PAT model; (2) submit an affiliate plan that covers program design and services, funding sources, service population, leadership, recruitment and retention, public awareness efforts, and evaluation; (3) receive approval of a final affiliate plan; (4) send parent educators to pre-service training; and (5) have parent educators undergo professional development to renew certification annually.
  • Pre-Service Staff Training: The PAT National Center requires all parent educators implementing the PAT model to attend and successfully complete a three-day foundational training and a two-day model implementation training. Affiliates that offer services to families with children age 3 years through kindergarten must attend a second foundational training. The PAT National Center also requires that supervisors complete the two-day model implementation training and recommends that they attend the foundational training. Additional training might be needed to administer assessments or outcomes measures required by a funder or sponsoring agency. In addition to the trainings, the PAT National Center offers professional development opportunities for professionals who work with special populations. The trainings are one- or two-day sessions taught by instructors experienced with working with the special populations.
  • In-Service Staff Training: To renew certification, the PAT National Center requires that parent educators complete a minimum of 20 hours of professional development during the first year, 15 hours the second year, and 10 hours per year thereafter.
  • Training Materials: Training materials, including the foundational training guides, PAT Toolkit Cards, and Model Implementation Guide, are available to parent educators and supervisors through the PAT National Center.
  • Qualified Trainers: All training sessions are taught by experienced, certified PAT national trainers with backgrounds in education, human development, or social services; most trainers have delivered PAT or are actively involved in doing so.
  • Technical Assistance: Technical assistance and implementation support are available to PAT affiliates through the National Center’s Affiliations and Program Support department, which includes PAT state offices and approved regional technical assistance specialists.
Number of days/hours:

At least 5 days of initial training and more for supervisors and those working with special populations (see above for more information)

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Parents as Teachers as listed below:

Prior to sending home visitors to attend a training, new organizations must complete an Affiliate Plan that details their implementation plan. Information on how to start and implement a program is available in the Quality Assurance Guidelines posted at www.parentsasteachers.org.

Formal Support for Implementation

There is formal support available for implementation of Parents as Teachers as listed below:

The PAT National Center provides ongoing technical assistance to any organization who is implementing the Parents as Teachers model and requests assistance. Each state is assigned a National Center technical assistance provider who provides statewide information as well as one-on-one work with the programs. Technical assistance is provided on a variety of topics with a focus on meeting the 17 Parents as Teachers essential requirements. These essential requirements focus on staffing and staff oversight, visit frequency, delivering home visits, using the require forms, screenings and participating in model fidelity reviews. The National Center also provides technical assistance to those programs using the Penelope database. .

Fidelity Measures

There are fidelity measures for Parents as Teachers as listed below:

To help achieve fidelity to the PAT model, the PAT National Center requires that affiliates provide annual data on their fidelity to the program model through an Affiliate Performance Report. In addition, affiliates are expected to participate in the affiliate quality endorsement and improvement process in their fourth year of implementation and every fifth year thereafter.

Implementation Guides or Manuals

There are implementation guides or manuals for Parents as Teachers as listed below:

The Parents as Teachers Quality Standards are comprised of 17 essential requirements and 100 additional standards for high quality implementation. Parents as Teachers also provides the Quality Assurance (QA) Guidelines to assist organizations in understanding the expectations for model implementation. The QA Guidelines incorporate information that supports the implementation the Parents as Teachers quality standards. Finally, staff members attending Model Implementation training are also provided with the Model Implementation Guide which provides additional resources for model implementation. The Data in Motion manual helps affiliates to understand how, when and why to collect data and encourages them to use data to improve their programs and services.

Research on How to Implement the Program

Research has not been conducted on how to implement Parents as Teachers.

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 Outcomes: Safety and Child/Family Well-Being

Pfannenstiel, J. C., & Seltzer, D. A. (1989). New Parents as Teachers: Evaluation of an early parent education program. Early Childhood Quarterly, 4(1), 1-18. doi:10.1016/S0885-2006(89)90025-2

Type of Study: Pretest-posttest with comparison group
Number of Participants: 144

Population:

  • Age — 3 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were families volunteering for the New Parents as Teachers (NPAT) program and a comparison group drawn from the surrounding community.

Location/Institution: Missouri

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study compared scores on measures of cognitive and social ability for children whose parents had participated in the New Parents as Teachers (NPAT) [now called Parents as Teachers] demonstration program with a comparison group from the same community. Measures utilized include the Kaufman Assessment Battery for Children (KABC), the Preschool Language Scale (PLS), and the Battelle Developmental Inventory (BDI). Results indicated children in the NPAT group scored higher on all measures of development, except for the sequential processing scale of the KABC. Parents in the NPAT group also scored as more knowledgeable, except on measures of knowledge of intellectual development and hearing/motor development. Limitations included nonrandomization of intervention group, self-selection by NPAT parents and significantly older and more educated mothers on average in the NPAT group, and lack of follow-up.

Length of postintervention follow-up: None.

Pfannenstiel, J. C., Seitz, V., & Zigler, E. (2002). Promoting school readiness: The role of the Parents as Teachers program. NHSA Dialog, 6(1), 71-86.

Type of Study: Pretest-posttest with comparison group
Number of Participants: 2,375 children

Population:

  • Age — Entering Kindergarten (approximately 4-6 years)
  • Race/Ethnicity — 83% Nonminority
  • Gender — Not specified
  • Status — Participants were families with children entering public school.

Location/Institution: Missouri

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized the Parents as Teachers (PAT) program to assess children’s school readiness. Measures utilized include the School Entry Profile and the Parent/Guardian Survey. Families who had received the PAT program were compared on these measures to a group who had not. Results showed that parents in the PAT program reported reading to their children more often and were more likely to enroll them in a preschool program. Statistical analysis also indicated direct effects of the program on school readiness, suggesting that parenting practices had changed. Finally, impoverished children whose families received PAT and who attended preschool had readiness scores equivalent to those of children from nonimpoverished homes. Limitations include lack of randomization of participants.

Length of postintervention follow-up: 2-3 years.

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.

Type of Study: Randomized controlled trial
Number of Participants: 665

Population:

  • Age — Children: 0-3 years; Adult: Mean=24.1-24.3 years
  • Race/Ethnicity — Children: Not specified; Adult: 29.4 % White, 58.2% African American, and 12.4% Hispanic/Asian/Other
  • Gender — Children: Not specified, Adult: 100% Female
  • Status — Participants were families in Parents as Teachers (PAT).

Location/Institution: Large urban programs serving a large proportion of low-income families

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study investigated the effectiveness of the Parents as Teachers (PAT) program with low-income families. Families were recruited through community services and agreed to be randomly assigned to receive the PAT program or to a comparison group. Measures utilized include the Knowledge of Infant Development Inventory, the Parenting Sense of Competence Scale, the Child Maltreatment Precursor Scale, the Home Observation and Measurement of Environment (HOME) Inventory, the Developmental Profile II, and the Adaptive Social Behavior Inventory. Results indicate lower scores on parent knowledge, attitude toward parenting, and parenting behaviors were noted for lower-income families. Few measures were affected by participation in the PAT program. These included higher self-reported happiness when caring for the child, greater acceptance of child behavior (2nd year) among moderate-income parents, and a greater tendency to read aloud or tell stories to the child among low-income parents. There was also a moderate effect on prosocial behavior among low-income children. Limitations include a high drop-out rate for the sample, inability to fully examine site differences due to the small sample sizes at the outcome assessment points, and lack of follow-up

Length of postintervention follow-up: None.

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

Type of Study: Pretest-posttest with comparison group
Number of Participants: 5,721 kindergarten children

Population:

  • Age — Assessed in third grade (approximately 7-9 years)
  • Race/Ethnicity — 15% Minority
  • Gender — Not specified
  • Status — Participants were public school students.

Location/Institution: Missouri

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study used path analysis to test how the Parents as Teachers (PAT) program affects children's school readiness and subsequent third-grade achievement. The subjects were kindergarten children chosen to be representative of all children beginning public school in the state of Missouri in the fall of 1998-2000 and subsequently re-located in the state's third-grade test database four to five years later (82% of the original Kindergarten sample). Students whose families had undergone PAT were compared to those who had not. Measures utilized include the Student Observation Record, the Parent/Guardian Survey, and the Missouri Assessment Program (MAP) Communication Arts Assessment. Results indicate that parents in PAT read to their children more often and were more likely to enroll them in preschool, which are predictors of school readiness. Statistical analysis also showed direct effects of PAT participation on school readiness, through better parenting practices. Length of PAT participation also predicted third grade achievement. Children of low-income families who received PAT and also attended a preschool program showed achievement levels approaching those of nonimpoverished families who did not attend preschool. Limitations include lack of randomization of participants and reliance on self-reported measures.

Length of postintervention follow-up: 4-5 years.

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. doi:10.1016/j.chiabu.2018.02.019

Type of Study: Pretest-posttest design with matched comparison groups
Number of Participants: 7,386

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were socially high-risk families involved with child welfare services.

Location/Institution: Connecticut

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The objective of this study was to assess the impact of voluntary participation in Parents as Teachers (PAT) for socially high-risk families on child maltreatment as identified by Child Protective Services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008, and December 31, 2011, who participated in Connecticut’s home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. Measures utilized include three CPS-related outcomes were ascertained: 1) investigated reports of maltreatment, 2) substantiated reports of maltreatment, and 3) out-of-home placements. Results indicate in the unmatched sample, families who participated in home-visiting had significantly higher median risk scores. After matching families on measured confounders, the percentages of families with CPS investigations were similar between the two groups. However, there was a 22% decreased likelihood of CPS substantiations (hazard ratio [HR] 0.78, 95% confidence interval) for families receiving home visiting. First substantiations also occurred later in the child’s life among home-visited families. There was a trend toward decreased out-of-home placement. Limitations include nonrandomization of participants, reliance on self-reported measures, use of administrative data for research purposes which has limitations, and lack of follow-up.

Length of postintervention follow-up: None.

Additional References

Avellar, S., Paulsell, D., Sama-Miller, E., & Del Grosso, P. (2014). Home visiting evidence of effectiveness review: Executive summary. Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Washington, DC. Retrieved from this link.

Burwick, A., Zaveri, H., Shang, L., Boller, K., Daro, D., & Strong, D. (January, 2014). Costs of early childhood home visiting: An analysis of programs implemented in the supporting evidence-based home visiting to prevent child maltreatment initiative: Final report. Mathmatica Research. Retrieved from this link.

Institute of Medicine and National Research Council. (2014). New directions in child abuse and neglect research. Washington, DC: The National Academies Press.

Contact Information

Allison Kemner, MPH
Title: Vice President, Research and Quality
Agency/Affiliation: Parents as Teachers
Website: www.parentsasteachers.org
Email:
Phone: (314) 432-4330 x1241
Fax: (313) 432-8963

Date Research Evidence Last Reviewed by CEBC: July 2018

Date Program Content Last Reviewed by Program Staff: February 2018

Date Program Originally Loaded onto CEBC: May 2008