Parenting Matters Supporting Parents of Children Ages 0-8 (2016) / Chapter Skim
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4 Universal/Preventive and Widely Used Interventions
4 Universal/Preventive and Widely Used Interventions
Pages 125-228
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From page 125... ...
Following this review, the chapter turns to a discussion of the use of information and communication technologies to support parenting. The chapter then examines the research evaluating the impact on parenting of income, nutrition, health care, and housing support programs and parental and family leave policies described in Chapter 3.
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programs (e.g., Head Start and Early Head Start)
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. Multiple randomized controlled studies have examined tools for enhancing anticipatory guidance, such as telephone advice lines, supplemental parent education via DVD, Websites, and waiting-room kiosks (Bergman et al., 2009; Christakis et al., 2006; Kempe et al., 1999; Paradis et al., 2011; Sanghavi, 2005)
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Healthy Steps for Young Children is a model of care and enhanced anticipatory guidance in which a pediatric health care provider and a child specialist with training in child development (e.g., nurse, social worker) partner to provide well-child care.
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Patient-Centered Medical Homes and Shared Decision Making The patient-centered medical home is a relatively new model of care in which primary care providers serve as the medical home for patients, offering team-based and coordinated care to increase the receipt of preventive services and reduce the need for specialty or emergency room care. Early findings from a review of randomized controlled trials and longitudinal studies suggest that interventions based on this model have a small positive impact on patient experiences with health care and a small to moderate effect on the delivery of primary care services (Jackson et al., 2013)
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. A randomized intervention in North Carolina enrolled adolescent mothers with their first child in the Adolescent Parenting Program, which offers case management and peer
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. After conception, universal parenting programs promote healthy pregnancy and delivery, often through education and counseling to increase parents' knowledge of child development and use of effective parenting practices.
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One large randomized controlled trial examined the impact of this model on key outcomes, including adequacy of prenatal care and rates of preterm birth. Analysis of data from individuals who enrolled and participated (N = 993)
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. Breastfeeding A systematic review of 10 randomized controlled studies of primary care-based educational interventions designed to improve breastfeeding practices among low-income women found that such interventions are effective in encouraging mothers to initiate breastfeeding as well as to continue breastfeeding 3 months postpartum.
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From page 134... ...
Most health care settings with interventions related to child obesity focus on children who are already overweight or obese rather than on primary prevention. One systematic review found that only 8 of 31 randomized controlled trials in primary care demonstrated significant benefits with respect to child weight (Seburg et al., 2015)
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From page 135... ...
. In a separate meta-analysis of c randomized controlled trials and controlled clinical trials of interventions aimed at preventing children's exposure to tobacco smoke delivered primarily in the context of health care (including such components as provision of educational materials, counseling, and telephone check-ins)
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Some public education initiatives use media to disseminate information relevant to promoting parenting knowledge, attitudes, and practices to a broad audience. An example is the universal component of the Triple P-Positive Parenting Program, referred to as Triple P level 1.
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Other media efforts focused on parenting are organization driven. ZERO TO THREE, for example, is a nonprofit organization founded by experts in child development, health, and mental health that disseminates evidence-based parenting information nationwide.
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And information and communication technologies make it possible to customize and tailor information to the needs of the parents based on their background and social circumstances. The use of information and communication technologies is discussed further later in this chapter.
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implemented a randomized controlled trial of an intervention combining the New York State parenting curriculum (which focused on reflection-based parenting skills with specific child care competencies) and exposure to BTIO, with the control group experiencing only the BTIO curriculum.
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The Supporting Healthy Marriage Program (Hsueh et al., 2012) was a randomized controlled trial involving 6,298 low-income married couples, expecting or with a child, at eight sites assigned randomly either to one of four couples-group programs plus a family support worker or to a no-treatment control condition.
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In another randomized controlled trial involving parents of children entering kindergarten, positive effects were found on both mothers' and fathers' marital satisfaction and the children's adaptation (hyper ctivity and aggression) , according to their teachers a (Cowan et al., 2011)
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. The more than 250 home visiting programs implemented and studied at the state and local levels in the United States during the late 20th and early 21st centuries reflected those public health and education roots as well as an emphasis on prevention of child maltreatment (Boller et al., 2010; Paulsell et al., 2010)
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. Home Visiting Logic Model: Changing Parenting Knowledge, Attitudes, and Practices to Improve Child Outcomes As depicted by the prenatal and early childhood home visiting logic model in Figure 4-1, some of the problems home visiting is designed to address include poor birth outcomes (low birth weight)
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144 FIGURE 4-1 Illustrative prenatal and early childhood home visiting logic model. NOTE: HIV = home visiting; KAPs = knowledge, attitudes, and practices.
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. In addition, the legislation identified the specific outcome areas that had to be impacted by the selected programs and the performance measures on which the states would have to report each year, which included positive parenting practices and three child outcome a reas -- child health, child development and school readiness, and reductions in child maltreatment.4 A national evaluation is also under way to assess MIECHV implementation and impacts (Michalopoulos et al., 2013)
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to meet program objectives. NFP has strong evaluation results from randomized controlled trials con ducted in New York (Olds et al., 1997)
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Evaluations of Durham Connects have found favorable primary and second ary impacts on child health (e.g., reductions in child receipt of emergency care) , positive parenting practices, and use of community resources.
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As seen in Table 4-1, positive parenting practices were not measured in the evaluations of some programs; however, this does not necessarily mean that parenting was not part of the program logic model. For example, the program description for Child FIRST states that parenting enhancements are expected as a result of the program, but parenting practices were not measured in the study that provided evidence of the program's effectiveness based on impacts on child outcomes (Lowell et al., 2011)
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UNIVERSAL/PREVENTIVE AND WIDELY USED INTERVENTIONS 149 TABLE 4-1 Number of Favorable Impacts of Home Visiting for Primary Outcomes Compared with Total Number of Outcomes Reviewed for Models with Evidence of Effectiveness, by Outcome Domain Outcome Family Child Positive Economic Development Reductions Parenting Self- Child and School in Child Practices Sufficiency Health Readiness Maltreatment Child FIRST Not Not Not 5/16 1/3 measured measured measured Durham Not Not 6/9 Not Not Connects/Family measured measured measured measured Connects Early Head Start- 3/28 Not Not 2/36 Not Home Visiting measured measured measured Early Intervention 0/9 Not 8/18 Not Not Program for measured measured measured Adolescent Mothers Early Start (New 3/3 Not 2/4 2/6 1/2 Zealand) measured Family Check-Up 2/2 Not Not 3/14 Not for Children measured measured measured Family Spirit 0/5 Not Not 10/40 Not measured measured measured Health Access Not 2/3e 6/9 Not 1/1 Nurturing measured measured Development Services Healthy Not Not 1/3 Not Not Beginnings measured measured measured measured Healthy Families 2/50 Not 0/9 9/43 1/34 America measured Healthy Steps f 0/1 Not 2/2 0/2 Not measured measured Home Instruction 1/10 Not Not 3/20 Not for Parents measured measured measured of Preschool Youngsters Maternal Early 1/6 Not 0/3 Not Not Childhood measured measured measured Sustained HomeVisiting Program continued
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bThis report focuses on Healthy Steps as implemented in the 1996 evaluation. HHS has determined that home visiting is not the primary service delivery strategy and the model does not meet current requirements for MIECHV program implementation cOne of the 21 outcomes were unfavorable or ambiguous.
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Overall, while many individual evaluations of home visiting programs have shown impacts on parenting practices tied to positive developmental outcomes, the average impacts of home visiting on parenting practices are not large. Nor is there a strong pattern of effects on parenting practices across evaluation studies and home visiting models.
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Parenting knowledge, attitudes, and practices were not assessed. Child development and school readiness Family Spirit, HFA, PAT, Child FIRST, and NFP showed the greatest number of favorable impacts on child development and school readiness in the HomVEE review, although there were many null effects for each of these programs.
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HV CoIIN aims to achieve improvement in outcomes in four areas targeted by home visiting programs: breastfeeding, maternal depression, family engagement, and child development. HV CoIIN uses the Institute for Healthcare Improvement's Breakthrough Series Collaborative Model (Institute for Healthcare Improvement, 2003)
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HV CoIIN is the first national initiative to apply continuous quality improvement (CQI) methods to evidence-based home visiting programs to improve critical outcomes for vulnerable families with young children ages 0-5.
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Designing interventions that generate large impacts on parent practices in promoting children's cognitive skills has proved difficult. Two large meta-analyses of randomized controlled trials have included evaluations of parent skills training in relation to children's cognitive outcomes.
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demonstrated effectiveness in randomized controlled trials with respect to parent engagement during the preschool years, at ages 3 and 4-5, respec tively. For Let's Play in Tandem, weekly home visits for 1 year were used to train parents in how to engage children in activities designed to promote vo cabulary, emergent literacy, and numeracy skills, as well as self-regulation.
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In one randomized controlled study, interactions between high-risk parents and their children over developmentally stimulating, age-appropriate learning material (e.g., a book or a toy) followed by review and discussion between parents and child development specialists, were found to improve children's cognitive and language skills at 21 months compared with a control group, and also reduced parental stress (Mendelsohn et al., 2005)
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From page 158... ...
, 2-hour weekly workshops with parents over a 15-week period were used to complement existing Head Start teacher-parent workshops for families of children in randomly selected intervention classrooms. The complementary workshops, led by a trained facilitator, focused on teaching parents how to engage with their children at home in activities focused on literacy (e.g., helping their children learn the letters in their names)
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In a randomized field experiment of the Parent and Children Together Program (Mayer et al., 2015) -- a 6-week intervention with English- and Spanish-speaking parents of children enrolled in Head Start programs -- three behavioral tools were employed (text reminders, goal setting, and social rewards)
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(A brief description of both programs and numbers of families served can be found in Chapter 3.) In addition to education services directed at children, Head Start and Early Head Start programs are required to provide parents with activities that may include (1)
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With respect to child outcomes, both cohorts showed statistically significant impacts on children's language and literacy development while they were in Head Start, although these effects dissipated when children reached elementary school. By the end of 3rd grade, the only favorable impact was on reading, and this was only for the 4-year-old cohort.
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There were no other impacts on child outcomes for the Early Head Start center-based group. In sites using the mixed approach (center-based and/or home visiting services)
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In some cases, these targets are complemented by attempts to improve alignment between home and classroom learning contexts. The Companion Curriculum, for example, uses Head Start teachers to encourage parents' participation in the classroom and provide workshops and activity spaces in the classroom that are focused on training parents to engage in parent-child learning activities.
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. In terms of parenting knowledge, attitudes, and practices, the New Chance Demonstration provided parenting education designed to promote positive parenting practices and better mother-child relationships and to reduce the stresses associated with parenthood.
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. Services were intended to extend from birth through kindergarten or 1st grade but, in contrast to Head Start and some Early Head Start programs, were not built on a high-quality classroom-based program for children.
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To date, implementation studies have shown promise for the program in addressing the quality gap of service delivery and parent engagement. A randomized controlled trial currently under way is compar ing children at age 3 who are cared for at home or in other settings with
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A brief summary of two ECE programs developed in the latter half of the 20th century, in which children assigned to comparison groups faced different and often worse conditions than they do today, is provided in Box 4-4. Parent Engagement in School Settings and School-Related Activities, Prekindergarten through Grade 3 Beyond stimulation of and support for learning activities in the home, parents engage in their children's early learning and education through an array of practices aimed collectively at promoting educational success and well-being.
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Perry provided 1-2 years of part-day educational services plus weekly home visits by teachers to 58 low-income, low-IQ African American children ages 3 and 4 in Ypsilanti, Michigan, during the 1960s. Meetings with groups of parents were also organized (Weikart and Lambie, 1970)
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UNIVERSAL/PREVENTIVE AND WIDELY USED INTERVENTIONS 169 Growth promoting Community Teacher Affordances Parent Knowledge Knowledge & Attitudes & Attitudes Social Capital Family Child Attributions & Motivation Child Academic Achievement & Learning Child Learning Skills & Strategies Family Engagement in Education FIGURE 4-2 Hypothesized benefits of parents' engagement in children's early education for children's achievement and school success. SOURCE: Dearing et al.
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, practice recommendations for interventions targeting parent engagement in early childhood education tend to emphasize the value of cultivating positive parenting through connections between home and school. Also emphasized is the importance of ensuring that these partnerships can be "culturally sensitive (responsive to values, priorities, and interaction styles of families)
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used an approach similar to that of the Family Literacy Program for improving parent engagement in children's math learning. Specifically, Head Start teachers trained parents in the use of math learning activities and games designed to promote developmentally sequenced learning of number concepts, arithmetic operations, logical reasoning, geometric concepts, and patterns.
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New information and communication technologies provide numerous opportunities to deliver interventions with the potential to improve parenting. Digital delivery of parenting interventions has been explored as a way to overcome barriers to participation and to increase the reach, sustainability, and impact of interventions.
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In contrast to Internet access, African Americans and whites are equally likely to own a cell phone of some kind and also have similar rates of smartphone ownership (File and Ryan, 2014; Zickuhr and Smith, 2012)
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174 PARENTING MATTERS TABLE 4-2 Computer and Internet Use among U.S. Households, 2013 Percentage of Total Percentage of Households Households Households with an (in with a Internet Household Characteristic thousands)
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In addition, digital delivery of parenting interventions may reduce challenges associated with uneven implementation that often occur with face-to-face interventions, including those provided across multiple sites, where adherence to protocols may vary (Breitenstein et al., 2014, 2015)
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The body of research on the use of technology and media to improve parenting knowledge and skills and provide social support for parents is relatively small but growing. This research has included evaluations of parenting programs, several of which are discussed in Chapter 5, that have been adapted from a face-to-face to an online format (e.g., Triple P Online, the Incredible Years)
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Ninety Head Start families with high levels of child behavior issues joined the study, which was implemented as part of a randomized controlled trial. Participation rates were comparable to those in the group-based Incredible Years Program, and among a subset of participants (45 families)
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In a randomized controlled trial involving 371 mother-child dyads, mothers who received ellular phone-enhanced training from home visitors (i.e., tailored c cell phone text messages about skill usage delivered twice a day and weekly phone calls to discuss the text message content and other issues raised by mothers) used significantly more positive parenting skills relative to waitlist controls.
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to overreact and respond harshly during disciplinary interactions with their children and more likely to follow through with promised consequences. These parents also reported a reduction in their children's problem behaviors and greater gains in their own self-efficacy and intention to engage in positive parenting practices (Irvine et al., 2014)
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A review of 114 studies of patient education in primary care settings using primarily randomized controlled designs looks at parents' preference for delivery formats for information on such topics as positive parenting practices, children's behavioral self-management, and skills for improving the well-being of both children and families (Glascoe et al., 1998)
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The Earned Income Tax Credit and Child Tax Credit As discussed in Chapter 3, the Earned Income Tax Credit (EITC) , which offsets the amount owed in taxes for low-income working families, is one of the largest poverty alleviation programs for the nonelderly in the United States (Center on Budget and Policy Priorities, 2016)
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A growing literature, none of it relying on random assignment, has demonstrated associations between the generosity of EITC payments and maternal work, stress, and health-related outcomes and behaviors; parenting practices discussed in Chapter 2, such as receipt of prenatal care and breastfeeding; and child well-being. Consistent evidence suggests that tax credits improve employmentrelated outcomes for most recipients.
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. As for child outcomes, studies have found that EITC expansions in the early 1990s contributed to improved academic achievement in the form of higher test scores (especially in math)
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This lack of accountability and transparency means that little is known about TANF's effectiveness. It has been found in analyses of studies that included randomized controlled trials that TANF has saved money for both individuals and government (Muennig et al.,
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It has been found that state approaches to providing such service vary. Random assignment studies have found some positive effects from employment- and treatment-focused strategies.
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, the Supplemental Nutrition Assistance Program (SNAP) , and the National School Breakfast and National School Lunch Programs.
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WIC participation during pregnancy is consistently associated with longer gestations and higher birth weights, with effects tending to be greatest among children born to disadvantaged mothers. Other outcomes include improved child nutrition (e.g., increased vitamin and mineral intake, reduced consumption of fat and added sugars)
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. SNAP and National School Breakfast and National School Lunch Programs SNAP is the largest nutrition assistance program in the United States, reaching an average of 22.5 million households each month in 2015 (U.S.
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. The National School Breakfast and National School Lunch Programs provide nutritionally balanced, low-cost or free breakfasts and lunches to millions of children in public and nonprofit private schools and residential child care institutions each day (U.S.
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. Evidence indicates that health insurance has improved access to care for children, and utilization of primary and preventive care appears to increase after CHIP enrollment (American Academy of Pediatrics, 2014; McMorrow et al., 2014)
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. Balancing housing-related expenses with expenses for other necessities, such as nutritious foods and quality child care, can be especially difficult for low-income families.
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Evidence from systematic reviews and randomized controlled research suggests that housing improvements, especially those aimed at increasing household warmth, may positively impact physical and mental health and respiratory outcomes, as well as absences from school for children and from work for adults (Gibson et al., 2011; Howden-Chapman et al., 2007; Thomson et al., 2013)
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All children are expected to receive a substantial amount of routine preventive care, including immunizations, most of which require multiple doses at multiple visits; developmental surveillance, which detects delays in speech and language development, gross and fine motor skills, and behavioral, social, and emotional growth; screening for early or hidden illness; anticipatory guidance; and dental care. At present, the American Academy of Pediatrics and Bright Futures jointly recommend a minimum of seven visits in a child's first year and seven more in the following 3 years, followed by annual visits through age 21 (American Academy of Pediatrics, 2008)
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From page 194... ...
Moreover, the absence of a federal-level paid parental leave policy in the United States leaves many workers in a situation of combining a number of employee-provided benefits that may include sick leave, holiday and vacation leave, disability insurance, and paid or unpaid family leave in order to take time away from work to care for a newborn. Employers -- Family Medical Leave The patchwork of formal and informal support provided by employers to parents includes sick days; flexible paid time off that combines vacation, sick time, and family leave; telecommuting; and programs that allow employees to donate or share unused paid leave.
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Under the Family and Medical Leave Act of 1993 (FMLA) , employees may be eligible for up to 12 weeks a year of unpaid leave with job protection for the following circumstances: serious health condition; birth of a child or to care for the employee's newly born, adopted, or foster child; or to care for an immediate family member (spouse, child, or parent)
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1810) would guarantee up to 12 weeks of paid family leave, which parents could use to provide care for serious health conditions faced by themselves or family members or to meet care needs associated with the birth or adoption of a child.
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. Mothers who took paid leave through California's Paid Family Leave Program were found to breastfeed twice as long as those who did not take leave based on a cross-sectional survey and interviews (Appelbaum and Milkman, 2011)
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Preventive care is crucial to child health and development. For instance, immunizations protect recipients and the public against serious and potentially debilitating diseases.
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In addition, the variability in the body of literature available for various approaches (e.g., some having been tested in one or two randomized controlled trials, and others having been tested in multiple evaluations that utilized different designs) makes it challenging to draw conclusions about the relative effectiveness of the various approaches.
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From page 200... ...
Some evidence sug gests that enhanced anticipatory guidance, such as that provided in Healthy Steps, is associated with improved parental knowledge of child development and improved parenting practices with respect to vaccination, as well as discipline, safety practices, and reading. • Preconception and prenatal care optimize maternal health and well-being prior to and during pregnancy.
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From page 201... ...
• In the area of two-generation ECE interventions, national longitu dinal data on the impact of Head Start provide little evidence that the program's parent components have a positive impact on the use of evidence-based parenting practices. Data on child outcomes are mixed, depending on the time of measurement and whether the data are reported by parents or teachers.
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From page 202... ...
Income, Nutrition Assistance, Health Care, and Housing Programs • A number of federal income, nutrition assistance, health care, and housing programs support families by providing financial assis tance and reducing other stressors that can interfere with parent ing, as well as by supporting parents in meeting the nutritional, safety, and health care needs of their children. • In the area of income support, nonrandomized studies show that the generosity of EITC payments is associated with increases in maternal work, improvements in maternal health-related outcomes and behaviors (including food security and receipt of prenatal and postnatal care)
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From page 203... ...
• Housing assistance programs help millions of parents find affordable and safe housing for themselves and their young children, resulting in improved food security and reduced poverty and homelessness. Parental and Family Leave Policies • Parental leave is associated with positive maternal and child health outcomes.
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. Notice of Proposed Rule Making on Head Start Program Performance Standards.
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. Effect of a paraprofessional home visiting intervention on American Indian teen mothers' and infants' behavioral risks: A randomized controlled trial.
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. Helping Head Start parents promote their children's kindergarten adjustment: The research-based devel opmentally informed parent program.
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From page 207... ...
. The effects of the healthy steps for young children program: Results from observations of parenting and child development.
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. A randomized controlled trial of an individualized motivational inter vention on smoking cessation for parents of sick children: A pilot study.
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. A parent coach model for well child care among low-income children: A randomized controlled trial.
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. Randomized controlled trial of universal postnatal nurse home visiting: Impact on emergency care.
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Child Development, 67(5)
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. The impact of the National School Lunch Program on child health: A nonparametric bounds analysis.
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. The labor supply effects of child care costs and wages in the presence of subsidies and the Earned Income Tax Credit.
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From page 214... ...
. Systematic review and meta-analysis of randomized controlled trials evaluating primary care-based interventions to promote breastfeeding in low-income women.
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From page 215... ...
. Getting ready: Results of a randomized trial of a relationship focused intervention on the parent-infant relationship in rural Early Head Start.
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. The effectiveness of Early Head Start for 3-year-old children and their parents: Lessons for policy and programs.
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From page 217... ...
. Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials.
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Barriers and engagement in education by ethnic minority parents of children attending Head Start. Cultural Diversity and Ethnic Minority Psychology, 16(1)
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. Effects of nurse home-visiting on maternal life course and child development: Age 6 follow-up results of a randomized trial.
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From page 220... ...
. Innovative delivery of newborn anticipatory guidance: A randomized, controlled trial incorporating media based learning into primary care.
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. Third Grade Follow-up to the Head Start Impact Study: Final Report.
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. A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct prob lems.
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From page 223... ...
. Promoting early intervention referral through a randomized controlled home-visiting program.
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From page 224... ...
. Fostering parental support for children's mathematical development: An intervention with Head Start families.
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From page 225... ...
. Building Their Futures: How Early Head Start Programs Are Enhancing the Lives of Infants and Toddlers in Low Income Families.
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. Making a Difference in the Lives of Infants and Toddlers and Their Families the Impacts of Early Head Start.
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. A randomized controlled trial of breastfeeding support and education for adolescent mothers.
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From page 228... ...
. Shared decision making in pediatrics: A systematic review and meta-analysis.
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