Step-by-Step Parenting Program©

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. Step-by-Step Parenting Program© has been rated by the CEBC in the areas of: Prevention of Child Abuse and Neglect (Secondary) Programs and Working with Parents with Cognitive Disabilities: Programs.

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

Brief Description

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 Child-Care Manual, modelling, roleplaying, and performance feedback to help teach the parents the above skills. The 230-page Step-by-Step Child-Care Manual includes over 60 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© are to:

  • Objectively identify impediments and supports to successful parenting, and specific parenting skill deficits, so as to design a comprehensive family intervention.
  • Help the family organize supports and services to meet the family’s needs and keep the child safe.
  • Increase parenting skills to reduce the risk of, or actual, child neglect through in-home step-by-step parent training.
  • Improve child health, development, and behaviour problems related to parenting skill deficits.
  • Have the parents maintain learned skills over time.
  • Have the parents generalize learned skills to all situations in which they are needed.
  • Reduce need for out-of-home care placements and permanent removal of the child.
  • Help parents to decrease reliance on paid supports.
  • Help parents to develop a natural support network for the family.

Essential Components

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

  • Identification of impediments 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 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, 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

Parent/Caregiver Services

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

  • Lack of parenting skills, parents with learning differences, risk of child neglect, risk of child developmental delay 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.

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.

Languages

Step-by-Step Parenting Program© does not have materials available in a language other than English.

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.

Minimum Provider Qualifications

Home visitors should have a Bachelor’s degree in psychology, applied behavior analysis, nursing, early childhood, 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 learning 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.

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:

Onsite or at a location for a regional training. An introductory training could have up to 100 participants. Additional training should be agency specific for a smaller number (up to 20).

Number of days/hours:

Introductory training is 1 day. Additional training could be up to 3 days more depending on what the agency wants covered (e.g., more training on assessment methods, families with school-age children, case consultations).

Implementation Information

Since Step-by-Step Parenting Program© 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 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:

Maurice Feldman is available to provide assistance on implementation of the Step-by-Step program.

Fidelity Measures

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

An observational/self-monitoring parent education effectiveness checklist is included in the Step-by-Step Child-care Manual. An electronic version of the manual is available from Maurice Feldman at no charge.

Implementation Guides or Manuals

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

The current Step-by-Step Child-care Manual provides information on program implementation by service agencies, but focuses on how to implement the program with individual families. The manual is available from Maurice Feldman (mfeldman@brocku.ca) at cost.

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. doi:10.1002/car.950

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

Show relevant research...

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, 14-28.

Type of Study: Randomized controlled trial
Number of Participants: Adults: 16 to 42 years, Children: 1 to 23 months

Population:

  • Age — Adults: 16 to 42 years, Children: 1 to 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 comparison groups, outcomes, measures, notable limitations)
This study evaluated home-based parent training 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. The low IQ mothers were randomly assigned to training or a control group, and also compared to a group of nonhandicapped mothers with similar-aged children. Observational checklists were used to obtain data. 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 small sample size, length of follow-up, and may not be generalizable to other populations due to ethnic composition of group.

Length of postintervention follow-up: On 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.

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 comparison groups, outcomes, measures, notable limitations)
This study evaluated the effects of a home-based parent training program for mothers with mental retardation on the language development of their children who were at risk for language delay. The mothers with low intelligence quotient (IQ) were matched on child entry age and each member of the pair was 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 Adaption 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 small sample size, variability in the length of follow-up, and high drop-out rate in follow-up.

Length of 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.

Type of Study: Within-subject multiple baseline design
Number of Participants: Adults: 13, Children: Not specified

Population:

  • Age — Adults: 20 to 40 years, Children: 2 to 40 months
  • Race/Ethnicity — Not specified
  • Gender — Adults: 11 Females and 2 Males
  • 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 comparison groups, outcomes, measures, notable limitations)
This study evaluated the efficacy of the Step-by-Step Parenting self-instructional pictorial child-care manuals with and without accompanying audiotaped instruction for parents with intellectual disabilities. Parents 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 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 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 small sample size and length of follow-up.

Length of 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: Multiple baseline design
Number of Participants: 2

Population:

  • Age — Adults: 23.5 to 31 years, Children: 7 to 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 comparison groups, outcomes, measures, notable limitations)
This article evaluated the effects of parent training in conjunction with ongoing medical involvement on the weight gain of two children with Non-organic Failure to Thrive (NOFT). The primary measure was 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 small sample size, small number of data points, and that data on the statistical significance of the results was not presented.

Length of postintervention follow-up: 28 to 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.

Type of Study: Multiple baseline design
Number of Participants: 10

Population:

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

Location/Institution: Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the efficacy of self-instructional audiovisual child-care manuals. Measure utilized the Wide Range Achievement Test-Revised (WRAT-R). Results indicated 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 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.

Type of Study: Multiple baseline design
Number of Participants: Adults: 10, Children: 10

Population:

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

Location/Institution: Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of self-learning pictorial-parenting manuals in teaching basic child-care skills (e.g., diapering, treating diaper rash, bathing, safety) to parents with intellectual disabilities who are monitored by child protection agencies. Measure utilized the Wechsler Adult Intelligence Scales Revised (WAIS-R) and the Bayley Scales of Infant Development. Results indicated 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 postintervention follow-up: On average 47.4 weeks.

McDaniel, B., & Dillenburger, K. (2007). Can childhood neglect be assessed and prevented through childcare skills training? Child Abuse Review, 16, 120–129.

Type of Study: Pretest-posttest
Number of Participants: 6

Population:

  • Age — 16 to 25 years, Children- 1 to 6 months
  • Race/Ethnicity — Not specified
  • Gender — 100% Female, Children- 3 Male and 3 Female
  • Status — Participants were parents with intellectual disabilities.

Location/Institution: United Kingdom

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Step-by-Step Parenting Skills Program to carry out a task analysis of basic childcare skills (feeding and bathing); to conduct thorough behavioral assessments of young, vulnerable, single parents; to use modeling, feedback and reinforcement procedures to increase basic childcare skills; and to assess the effect of childcare skill training on the child’s welfare. Measure utilized the Step-by-Step Manual. Results confirm that parenting skills training can be used to assess and improve basic childcare skills. Limitations include the small sample size and that data on the statistical significance of the results was not presented.

Length of postintervention follow-up: 1 to 2 weeks.

References

Feldman, M.A. (2004). The Family Game: Enhancing parent-child cooperation and rapport to parents with learning problems. 2nd Edition. St. Catharines, ON: Author. Available via email from Maurice Feldman, email: mfeldman@brocku.ca

Feldman, M. A., & Aunos, M. (2010). Comprehensive competence-based parenting capacity assessment for parents with learning difficulties. Kingston, NY: NADD Press. Available at www.thenadd.org.

Feldman, M. A., & Case, L. (1993). Step-by-step child-care: A pictorial manual for parents, child-care workers, and babysitters. Toronto: Authors. Available via email from Maurice Feldman, email: mfeldman@brocku.ca

Contact Information

Name: Maurice Feldman, PhD, C.Psych., BCBA-D
Website: www.brocku.ca/social-sciences/departments-and-centres/centre-for-applied-disability/faculty/maurice-feldman
Email:
Phone: (905) 688-5550 x4894
Fax: (905) 378-5719

Date Research Evidence Last Reviewed by CEBC: July 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: March 2014