A home-visiting model involving Parent Educators working with families to strengthen protective factors and ensure that young children are healthy, safe and ready to learn.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
Parents as Teachers (PAT) is an early childhood parent education, family support and wellbeing and school readiness home-visiting model. The program is based on the premise that all children will learn, grow, and develop to realise their full potential. PAT involves training and certification of Parent Educators who work with families using a comprehensive curriculum, to strengthen protective factors and ensure that young children are healthy, safe and ready to learn.
Aims
- Increase parent knowledge of early childhood development
- 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.
Impact
Evidence was mixed and inconclusive across the outcomes that were measured in the included studies.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Yes | Not found |
| System | Family preservation | Not found | Not found | Yes |
| System | Health service use | Yes | Yes | Not found |
| System | Out-of-home care | Yes | Yes | Not found |
| Child | Education | Yes | Yes | Not found |
| Child | Mental health/behaviour | Yes | Yes | Not found |
| Child | Wellbeing | Yes | Yes | Not found |
| Parent/caregiver | Parenting | Yes | Yes | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Reading the Menu page.
PAT has an evidence rating of Well-supported+.
This means that PAT has evidence from at least 2 randomised controlled trials (RCT) and/or quasi-experiments (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 6 research outputs from 5 primary studies. Another systematic review with meta-analysis, RCT and 3 QEs were identified but did not count towards the evidence due to concerns with study quality. PAT has not received a Very well-supported rating as a rigorous systematic review with meta-analysis has not been conducted.
| Study design | Number of research outputs included (Note: Can include research outputs from the same study) |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 4 |
| Quasi-experiment | 2 |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and the quality of evidence from the included studies.
The studies were conducted in the United States and Switzerland and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The studies were conducted in the United States and Switzerland.
Sample characteristics
- The studies’ sample sizes ranged from 244 (131 intervention, 113 control) to 7,386 (2,662 intervention, 4,724 control) families.
- Eligibility criteria varied across the studies; for example, families exhibiting psychosocial risk factors, socially high risk families, first time mothers, low-income families and families living in a PAT area.
Implementation
Delivery model, mode and setting
- PAT is delivered in-person, to families in their homes by Parent Educators.
Target cohort
- Families with an expectant mother or parents of children up to kindergarten entry.
Program delivery
- PAT has 2 primary staff positions: Parent Educators who provide home visiting services and their supervisors.
- PAT 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 conducting no more than 48 visits per month. 50 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.
- The first step for organisations interested in implementing the PAT home-visiting model is to review the essential requirements and to assess and review their community and organisational context, including but not limited to community needs, relationships, funding sources, staffing, and capacity. The next step is to contact the technical assistance provider who can help you complete your Affiliate Plan. Your Affiliate Plan will be reviewed and must be approved by the national Parents as Teachers office prior to registering staff for training.
- To help achieve fidelity to the PAT model, the PAT National Centre 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.
Manuals and guides
- 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 Centre.
- Technical assistance and implementation support are available to PAT affiliates through the National Centre’s Affiliations and Program Support department, which includes PAT state offices and approved regional technical assistance specialists.
Additional information
- The Parents as Teachers website has more information about the model.
Staffing
- PAT requires that, at a minimum, Parent Educators have a high school diploma or general equivalency degree (GED) and at least 2 years’ previous supervised work experience with young children and/or parents. PAT prefers for Parent Educators to have at least a 4-year degree in early childhood education or a related field, or at least a 2-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.
Training
- The PAT National Centre requires all Parent Educators implementing the PAT model to attend and successfully complete a 3-day foundational training and a 2-day model implementation training. Affiliates that offer services to families with children aged 3 through to kindergarten must attend a second foundational training.
- The PAT National Centre also requires that supervisors complete the 2-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.
- The PAT National Centre also offers professional development opportunities for professionals who work with special populations. The trainings are one- or 2-day sessions taught by instructors experienced with working with the special populations.
- To renew certification, the PAT National Centre 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.
To our knowledge, PAT is not available and has not been implemented in Australia.
Cost
The PAT National Centre 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.
References
Studies identified and included in the review
- Chaiyachati BH, Gaither JR, Hughes M, Foley-Schain K & Leventhal JM (2018). Preventing child maltreatment: Examination of an established statewide home-visiting program. Child Abuse & Neglect, 79:476-484.
- Drotar, D., Robinson, J., Jeavons, L., & Lester Kirchner, H. (2009). A randomized, controlled evaluation of early intervention: the Born to Learn curriculum. Child: care, health and development, 35(5), 643–649.
- Lahti M, Evans CBR, Goodman G, Schmidt MC & LeCroy CW (2019). Parents as Teachers (PAT) home-visiting intervention: A path to improved academic outcomes, school behavior, and parenting skills. Children and Youth Services Review, 99:451-460.
- Neuhauser, A., Ramseier, E., Schaub, S., Burkhardt, S., & Lanfranchi, A. (2018). Mediating role of maternal sensitivity: enhancing language development in at-risk families. Infant Mental Health Journal, 39(5), 522–536.
- Schaub S, Ramseier E, Neuhauser A, Burkhardt SC & Lanfranchi A (2019). Effects of home-based early intervention on child outcomes: A randomized controlled trial of Parents as Teachers in Switzerland. Early Childhood Research Quarterly, 48:173-185.
- Wagner M, Spiker D, Hernandez F, Song J & Gerlach-Downie S (2001). Experiences and outcomes for families and children - SRI Project P07283. Smith Richardson Foundation Inc, California US.
Studies identified but not counted towards the evidence rating due to study quality
- Drazen SM, Haust M (1993). Raising Reading Readiness in Low-Income Children by Parent Education. Draft. Cornell University, New York US.
- Pfannenstiel JC, & Seltzer DA (1989). New Parents as Teachers: Evaluation of an early parent education program. Early Childhood Quarterly, 4(1):1-18.
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21(2):171-202.
- Wagner MM & Clayton SL (1999). The Parents as Teachers program: Results from two demonstrations. Future of Children, 9(1):91-115.
- Wagner M, Spiker D & Linn MI (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.