Step-by-Step Parenting Program®

About This Program

Target Population: Parents with learning differences whose children are at risk of being neglected due to parenting skill deficiencies including parents who learn best with a step-by-step approach, such parents with learning difficulties related to intellectual disabilities, learning disabilities, low literacy, and acquired brain injury. The program may be helpful to all parents, other caregivers, and babysitters who need to learn parenting and child-care skills.

For parents/caregivers of children ages: 0 – 3

Program Overview

The Step-by-Step Parenting Program® breaks down essential child-care skills for children from birth to about 3 years or age into small steps. A wide-range of parenting skills are covered related to child health, safety, and development, including: newborn care; feeding and nutrition; diapering; bathing; home and sleep safety; first aid; toilet training; parent-child interactions; and positive behavior support. The Step-by-Step Parenting Program® combines the Step-by-Step Parenting Program Manual, instructions, modelling, roleplaying, and performance feedback to help teach the parents the above skills. The 238-page Step-by-Step Child-Care Parenting Program Manual includes over 50 step-by-step child-care checklists developed with the input of pediatric health care professionals and consumers, and corresponding picture books for about half of these skills.

Program Goals

The goals of the Step-by-Step Parenting Program® for the target population are:

  • Increase parenting skills to reduce the risk of, or actual, child neglect
  • Increase knowledge of child health, child development, and child behavior problems
  • Instill the learned skills and continue to use them
  • Generalize learned parenting skills to all situations in which the skills are needed
  • Develop a natural support network for the family

Logic Model

View the Logic Model for Step-by-Step Parenting Program®.

Essential Components

The essential components of Step-by-Step Parenting Program® include:

  • Identification of barriers and supports to successful parenting such as parental life history, physical and mental health, and current abilities; social support; family characteristics such as size, accommodation, and income; and child health, development, and behavior
  • Use of Step-by-Step Checklists to identify specific parenting knowledge and skills strengths and needs
  • Use of the above assessment information to develop a comprehensive family support plan to address needs, working in collaboration with the parents, child protection, other agencies, and the family's informal support system, as needed
  • Direct behavioral parent training with the parents in the home to teach parenting skills
  • Parent education that involves step-by-step and behavioral teaching methods including task analysis, simple instructions, visual aids, prompting, modeling, roleplaying, programming for generalization and maintenance, positive reinforcement, and performance feedback
  • Initial focus on what the parent is doing right (i.e., positive reinforcement) and gradual introduction of constructive feedback based on steps missed or performed incorrectly on checklists
  • Work on only one or a few skills at a time so as not to overload parent
  • Objectively monitoring skill acquisition, maintenance, and generalization of parenting skills using Step-by-Step Checklists
  • Monitoring of the effects of parent education on child health, development, and behavior
  • Gradual fading out home visits and building natural support systems

Program Delivery

Parent/Caregiver Services

Step-by-Step Parenting Program® directly provides services to parents/caregivers and addresses the following:

  • Lack of parenting skills, neglectful care of children, parents may have learning differences, risk of child neglect, risk of children with developmental delays and behavior problems
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: The family is involved in identifying its support network, designing family support plan and setting goals. Other support systems that could be involved include natural supports (e.g., family, friends) and services as needed.

Recommended Intensity:

1 home visit per week for 1.5-2 hours; the number of visits may be extended to 2 visits per week, especially for newborns, or when there are many needs. Usually, the more visits per week, the faster goals are accomplished. Duration of visit depends on activities needing to be covered – e.g., how many skills need to be trained and/or monitored.

Recommended Duration:

About 2 years, though the length may be considerably less or somewhat more depending number of goals and rate of achievement of goals

Delivery Setting

This program is typically conducted in a(n):

  • Birth Family Home

Homework

Step-by-Step Parenting Program® includes a homework component:

Parents are expected to practice skills trained in between visits.

Resources Needed to Run Program

The typical resources for implementing the program are:

One full-time parent educator is needed for every 10-15 families. Smartphones, tablets or laptops recommended to video record parenting skills performance and parent-child interactions for video feedback to parent and monitoring parent and child behaviors.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Home visitors should have at least a Bachelor's degree in psychology, applied behavior analysis, nursing, early childhood education, social work, or special education. Home visitors need to have a unique set of knowledge and skills. They need to know about child development, health and safety, while at the same time knowing how to teach adults with learning difficulties using behavioral and adult teaching strategies. Home visitors need to be able to develop rapport with parents with learning differences, observe parenting skills using the Step-by-Step checklists, and then provide parent training that matches the learning style of the parent. Teaching strategies usually include breaking down skills to small steps, and using simple instructions, visuals, modeling, roleplaying, practice and positive and corrective feedback.

Supervisors should have at least a Bachelor's degree (but preferably a Master's) in a relevant profession: psychology, early childhood education, nursing, social work, applied behavior analysis. Supervisors should have experience conducting the program themselves, as well as supervisory skills and experience in establishing and maintaining worker adherence to the intervention approach through ongoing training, monitoring and performance feedback. Program adherence monitoring checklists are provided in the Step-by-Step Parenting Program Manual.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

  • Feldman, M. (2022). Step-by-step parenting program manual: Basic child-care, health, safety, and parent-child interactions for parents and caregivers of children zero-three years of age (2nd ed.). Author.

To preserve program integrity, the manual only is provided to participants in the 3-day in-person or virtual Step-by-Step Parenting Program training.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

The 3-day training takes place onsite for one organization or at a central location for regional training for multiple agencies for approximately 25 participants at a time. Virtual training is an option. Completion certificates are provided for participants who complete the 3-day training. A trainer-the trainer training is one extra day. Follow-up consultations may be provided, upon request. A virtual 2- to 3-hour introduction to the Step-by-Step Parenting Program and parenting by persons with learning differences is available that could accommodate up to 100 participants.

Number of days/hours:

The primary Step-by-Step Parenting Program training takes 3 full days (e.g., 9-4 each day). The train-the-trainer training last one additional day (to receive this training, participants must first complete the 3-day training and practice implementing the Step-by-Step Parenting Program). The introductory session lasts 2-3 hours.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Step-by-Step Parenting Program®.

Formal Support for Implementation

There is formal support available for implementation of Step-by-Step Parenting Program® as listed below:

The program developer is available to provide assistance on implementation of the Step-by-Step Parenting Program, as well as follow-up case consultations. See the bottom of the entry for contact information.

Fidelity Measures

There are fidelity measures for Step-by-Step Parenting Program® as listed below:

A set of observational/self-monitoring Parent Educator Adherence Checklists and Scoring Forms are included in the Step-by-Step Parenting Program Manual that is provided to participants in the 3-day training.

Implementation Guides or Manuals

There are implementation guides or manuals for Step-by-Step Parenting Program® as listed below:

The current Step-by-Step Parenting Program Manual provides information on program implementation by service agencies and individual parent educators but focuses on how to implement the program with individual families. The manual is available to participants of the 3-day program training.

Research on How to Implement the Program

Research has been conducted on how to implement Step-by-Step Parenting Program® as listed below:

  • McDaniel, B., & Dillenburger, K. (2007). Can childhood neglect be assessed and prevented through childcare skills training? Child Abuse Review, 16, 120–129. https://doi.org/10.1002/car.950

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Safety and Child/Family Well-Being

Feldman, M. A., Case, L., & Sparks, B. (1992). Effectiveness of a child-care training program for parents at-risk for child neglect. Canadian Journal of Behavioural Science, 24(1), 14–28. https://doi.org/10.1037/h0078698

Type of Study: Randomized controlled trial
Number of Participants: 34

Population:

  • Age — Adults: 16–42 years; Children: 1–23 months
  • Race/Ethnicity — 31 Caucasian-Canadian, 1 Japanese-Canadian, 1 Afro-Canadian, and 1 Chinese-Canadian
  • Gender — Adults: 34 Female; Children: 21 Male and 13 Female
  • Status — Participants were mothers with intellectual disabilities.

Location/Institution: Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate home-based parent training [now called Step-by-Step Parenting Program] consisting of instructions, picture books, modeling, feedback, and tangible reinforcement to teach crucial child-care skills (e.g., diapering, bathing, feeding, safety) to low IQ mothers considered at-risk for child neglect. Participants were randomly assigned to training or a control group, and also compared to a group of nonhandicapped mothers with similar-aged children. Measures utilized include observational checklists. Results indicate that after training, the mean percent correct score of the training group was similar to that of the nonhandicapped comparison mothers, with both significantly greater than the mean of the control group. The training group maintained improvements following training, and the control group, when subsequently trained, had a mean score of 92%. Finally, where it could be observed, the health of the children improved with the parents learning proper child-care (e.g., elimination of diaper rash, increased rate of weight gain, toilet training). Limitations include the small sample size, the length of follow-up, and that it may not be generalizable to other populations due to the ethnic composition of the group.

Length of controlled postintervention follow-up: Average=28 weeks.

Feldman, M. A., Sparks, B., & Case, L. (1993). Effectiveness of home-based early intervention on the language development of children of mothers with mental retardation. Research in Developmental Disabilities, 14(5), 387–408. https://doi.org/10.1016/0891-4222(93)90010-H

Type of Study: Randomized controlled trial
Number of Participants: 28

Population:

  • Age — Not specified
  • Race/Ethnicity — 96% Caucasian-Canadian and 4% Japanese-Canadian
  • Gender — 100% Female
  • Status — Participants were mothers with intellectual disabilities.

Location/Institution: Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effects of a home-based parent training program [now called Step-by-Step Parenting Program] for mothers with mental retardation on the language development of their children who were at risk for language delay. Participants were randomly assigned to either an interaction training or attention-control group. A comparison group of nonmentally retarded mothers was also examined. Measures utilized include the Wechsler Adult Intelligence Scales-Revised (WAIS-R), the Bayley Scales of Infant Development (BSID), and the Kent Adaptation of the BSID. Results indicate that after training, the interaction training group scores were no longer lower than those of the comparison group of mothers without mental retardation and were also significantly higher than the scores of the control group on all maternal positive interactions, child vocalizations, verbalizations, language, and social domains. Speech emerged significantly sooner in the interaction training group as compared to the control group. Limitations include the small sample size, variability in the length of follow-up, and high drop-out rate in follow-up.

Length of controlled postintervention follow-up: Varied - 13 to 82 weeks

Feldman, M. A., & Case, L. (1997). The effectiveness of audiovisual self-instructional materials in teaching child-care skills to parents with intellectual disabilities. Journal of Behavioral Education, 7(2), 235–257. https://doi.org/10.1023/A:1022897226255

Type of Study: Other quasi-experimental
Number of Participants: 13

Population:

  • Age — Adults: 20–40 years; Children: 2–40 months
  • Race/Ethnicity — Not specified
  • Gender — Adults: 11 Female and 2 Male; Children: Not specified
  • Status — Participants were parents with intellectual disabilities referred via court order or referral by child protection agencies, advocates, family members, family physicians, and public health nurses.

Location/Institution: Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of the Step-by-Step [now called Step-by-Step Parenting Program] self-instructional pictorial child-care manuals with and without accompanying audiotaped instruction for parents with intellectual disabilities. Participants were randomized to (a) audiotape + manual, (b) manual alone, or (c) a no training control group. Measures utilized include the Bayley Scales of Infant Development (BSID) and the Wide Range Achievement Test-Revised (WRAT-R). Results indicate that self-instructional materials were effective in teaching 22 of 26 skills to levels seen in parents without intellectual disabilities. Eighty-one percent of the skills were maintained over a follow-up period and self-learning effects were replicated when the parents received self-instructional materials for the original no-training control skill. Despite the low literacy skills of the parents, for most of them no advantage was found in adding the audiotape to the illustrations. Three parents only reached criterion after an audiotape was added to the manual alone skill. Consumer satisfaction ratings were uniformly high, and those parents who stated a preference preferred the pictorial manuals without, as opposed to with, the audiotape. Limitations include the small sample size and length of follow-up.

Length of controlled postintervention follow-up: 1, 3, and 6 months.

Feldman, M. A., Garrick, M., & Case, L. (1997). The effects of parent training on weight gain of nonorganic-failure-to-thrive children of parents with intellectual disabilities. Journal on Developmental Disabilities, 5, 47–61.

Type of Study: Other quasi-experimental
Number of Participants: 2

Population:

  • Age — Adults: 23.5–31 years, Children: 7–11.5 months
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were parents with intellectual disabilities with children who have been diagnosed with failure to thrive.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effects of parent training [now called Step-by-Step Parenting Program] in conjunction with ongoing medical involvement on the weight gain of two children with non-organic failure to thrive (NOFT). Participants received medical involvement from a team of medical professionals before being assigned parent training. After being assigned to parent training, they received both treatments in conjunction to evaluate the effects on weight gain. Measures utilized include the Bayley Scales of Infant Development (BSID). Results indicate that parent training, combined with ongoing medical advice and supervision, increased the children's weights to the point where they were no longer considered failure to thrive. Limitations include the small sample size, the small number of data points, and that data on the statistical significance of the results was not presented.

Length of controlled postintervention follow-up: 28–58 months.

Feldman, M. A., & Case, L. (1999). Teaching child-care and safety skills to parents with intellectual disabilities through self-learning. Journal of Intellectual and Developmental Disability, 24(1), 27–44. https://doi.org/10.1080/13668259900033861

Type of Study: Other quasi-experimental
Number of Participants: 10

Population:

  • Age — 26–34 years
  • Race/Ethnicity — Not specified
  • Gender — 90% Female
  • Status — Participants were parents with intellectual disabilities.

Location/Institution: Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of self-instructional audiovisual child-care manuals of a parent training program [now called Step-by-Step Parenting Program]. Participants received treatment in a time-series staggered design. Some participants received the parent training program first, while others did not receive the training until the first wave of participants revealed training effects. Measures utilized include the Wide Range Achievement Test-Revised (WRAT-R). Results indicate that self-instruction was effective with 9 out of 10 parents with 11 out of 12 skills. Additionally, consumer satisfaction was uniformly high. Limitations include the small sample size and that data on the statistical significance of the results was not presented.

Length of controlled postintervention follow-up: 1, 3, and 6 months.

Feldman, M. A., Ducharme, J. M., & Case, L. (1999). Using self-instructional pictorial manuals to teach child-care skills to mothers with intellectual disabilities. Behavior Modification, 23(3), 480–497. https://doi.org/10.1177/0145445599233007

Type of Study: Other quasi-experimental
Number of Participants: 10 parent/child dyads

Population:

  • Age — Adults: 19–39 years; Children: 3–22.5 months
  • Race/Ethnicity — Not specified
  • Gender — Adults: 10 Female; Children: 6 Male and 4 Female
  • Status — Participants were parents with intellectual disabilities.

Location/Institution: Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of self-learning pictorial-parenting manuals of a parent training program [now called Step-by-Step Parenting Program] in teaching basic child-care skills (e.g., diapering, treating diaper rash, bathing, safety) to parents with intellectual disabilities who were being monitored by child protection agencies. Participants received the parent training program in a multiple-probe-design after their home observation baseline. Measures utilized include the Wechsler Adult Intelligence Scales Revised (WAIS-R) and the Bayley Scales of Infant Development. Results indicate that the manuals alone increased child-care skills (to levels seen in parents without disabilities) in mothers in the study, and in 12 of 13 child-care skills. The remaining skill was acquired with the full training package. Limitations include the small sample size.

Length of controlled postintervention follow-up: Approximately 47.4 weeks.

Additional References

Feldman, M. A. (1998). Preventing child neglect: Child-care training for parents with intellectual disabilities. Infants & Young Children, 11(2), 1–11. Abstract available at this link.

Feldman, M. A. (2004). Self-directed learning of child-care skills by parents with intellectual disabilities. Infants & Young Children, 17(1), 17–31. Available at this link.

Feldman, M. A., & Aunos, M. (2010). Comprehensive competence-based parenting capacity assessment for parents with learning difficulties. NADD Press. Available from M. Feldman mfeldman@brocku.ca

Contact Information

Maurice Feldman, PhD, C.Psych., BCBA-D
Agency/Affiliation: Brock University
Website: brocku.ca/social-sciences/applied-disability-studies/step-by-step-parenting-program
Email:
Phone: (905) 650-2502

Date Research Evidence Last Reviewed by CEBC: October 2023

Date Program Content Last Reviewed by Program Staff: March 2020

Date Program Originally Loaded onto CEBC: March 2014