Parent Support Programs and Outcomes for Children

Introduction

Programs to support parents in their task of raising children have been in place for more than a century, with a variety of goals for families and types of services. Today, tens of thousands of such programs exist, most of them small, grass-roots, community-based programs that serve only a small number of families at any one time. Parent support programs do not share a uniform intervention, but they have a common goal – to improve the lives of children – and a shared strategy – to affect children by creating changes in parents’ attitudes, knowledge and/or behaviour. While the majority of parent support programs serve all families in a community, in the last decade or so, parent support interventions have been increasingly implemented with families whose children may be especially vulnerable to poor developmental outcomes because of poverty or a variety of other family risk factors. Parent support programs for at-risk families have focused on helping families reduce and cope with the stresses that threaten children’s well-being.

Subject

There is strong consensus that parents matter in how their children develop and function. Data from twin studies, as well as from hundreds of correlational studies, have linked multiple dimensions of parenting behaviour to different indicators of child outcomes.^1,2  Additional research has demonstrated the relationship between parenting practices and family socio-economic status. This body of research on the pivotal role of parenting behaviour in children’s development has constituted the theoretical underpinning for parent support interventions. Parent support programs seek to influence children’s outcomes by motivating changes in parents through a variety of social and practical supports, including case management that links families with services, education on child development and parenting practices, and social support through relationships with service staff and with other parents. Some programs for low-income families are also concerned with improving the economic self-sufficiency of families and providing support for parents in obtaining additional education, finding jobs or delaying subsequent pregnancies.

Problems

There is abundant research linking parental behaviour to child health and development. Brooks-Gunn recently summarized the research as showing that language stimulation and learning materials in the home are the parenting practices most strongly linked to school readiness, vocabulary and early school achievement, while parent discipline strategies and nurturance are most strongly linked to social and emotional outcomes such as behaviour and impulse control and attention.³ That is, discipline practices that do not help children develop their own internalized behaviour standards can also adversely affect children’s social and emotional functioning – their abilities to develop sustained social relationships and to take account of the needs and feeling of others, to control and direct their own impulses, and to focus their attention to plan and complete tasks successfully. There is also evidence that parent support for and involvement in their children’s school is related to children’s educational attainment by promoting school achievement.^4,5

At the same time, there is disagreement in the field about the strength of the evidence on the effectiveness of parent support programs for child outcomes, primarily because of the scarcity of studies with strong internal validity, i.e. reduced bias of different kinds. The question remains: whether it is possible to change parent knowledge, attitudes and/or behaviour through parent programs and, if so, whether these changes in parents translate into improved outcomes for children. 

Research Context

The evidence on the effectiveness of parent support programs at producing better outcomes for children is relatively limited, primarily because of the quality rather than the quantity of evaluation studies. That is, only a few studies have employed strong designs, either experiments in which families are randomly assigned to receive parent support services or to receive no systematic services, or strong quasi-experimental designs with well-constructed comparison groups. Also, the evidence is strongest in the domain of children’s cognitive school readiness. This may be because there are many more standardized and normed measures available in the cognitive domain, or it may be related to the strong interest in children’s cognitive readiness for school and their subsequent academic achievement. Evidence of the effectiveness of parent support programs on children’s cognitive and social development is far from conclusive. The absence of compelling research evidence on program impacts on children has left the door open for differing interpretations of the evidence and differing conclusions about the effectiveness of family support programs.  

Key Research Questions

The causal pathway from parent support programs to child outcomes has a number of links, starting with strongly implemented programs and adequate levels of participation by parents in the program services. Beyond these necessary but insufficient steps, it is assumed that outcomes for children are mediated by changes that the programs create in parents. Therefore, the first question on program impacts is whether parent support programs have been effective at changing parents’ attitudes or behaviours. If these changes can be shown, the subsequent research question is whether these changes in parents lead to improved outcomes for children in the cognitive domain or in the child’s social and emotional development. A third research question, especially difficult to answer but of strong interest for practitioners, is what types of programs are most effective. That is, do the programs that are more effective have elements in common, such as types of services, types of staff, methods of service delivery, etc.? The most complex research question addresses what works for whom: Are there types of parent support that are more effective for different types of children and families?

Recent Research Results

A comprehensive meta-analysis of the effects of parent support programs summarizes child outcome data for parents and children from evaluations of more than 200 programs.⁶ The average effects on parents varied by the outcome domain. The strongest effects were on parenting behaviour and parenting attitudes/knowledge, where the average effect size was .24 (a quarter of a standard deviation on the scale on which the outcome is measured). Program effects on family functioning and parent mental health were smaller, with average effect sizes below .20. The effect sizes were strongly influenced by a handful of programs with very large effects. Across the program evaluations, the effect sizes for the majority of programs clustered around 0-.15 of a standard deviation (s.d.). The larger average effect was produced by between 20 and 25% of the programs that had effect sizes larger than .5 (which is considered to represent a moderate-to-large effect). The parent support programs had effects for children as well. The programs looked at a wide variety of outcomes in both the cognitive and social-emotional domains. In the domain of social and emotional development, the average effect was .22; for cognitive development, it was .29. The average effect was largest for preschool children’s programs (average = .39 s.d.). The majority of parent support programs had very small effect sizes for child outcomes, clustered around 0-.15 of a standard deviation. 

The fact that a small percentage of parent support programs had significant effects while most did not begs the question of whether these effective programs had elements in common. The meta-analysis suggests that programs with stronger effects on children’s social and emotional development share three characteristics: (a) the program targets children with a specific need that has been identified by the parents, such as a behavioural or conduct disorder or developmental delay (also corroborated by Brooks-Gunn^a; (b) the program uses professional rather than paraprofessional staff; or (c) the program provides opportunities for parents to meet together and provide peer support as part of the service delivery approach. In general, case management, i.e. helping parents identify and access needed services, was not an effective strategy.  One possible reason for this absence of effects is that the relevant services may not be available, for example, mental-health services or better housing.  

This meta-analysis also showed that programs that combine parent support services and early childhood education also have larger-than-average effects on both parents and children. This finding from the meta-analysis has been corroborated by the evidence that many of the early childhood education interventions that have been shown to have long-term effects provide early childhood education and family support services.^7,8,9

The enhanced effects of parent support programs that combine work with parents and direct educational services for children raise the question of which component is responsible for the child effects – the parent support or the early childhood education. Analyses of findings from an earlier intensive child development program for low birth weight children and their parents (the Infant Health and Development Program) suggest that the cognitive effects for the children were mediated through the effects on parents, and the effects on parents accounted for between 20 and 50% of the child effects.¹⁰ A recent analysis of the Chicago Child Parent Centers, an early education program with a parent support component, examined the factors responsible for the program’s significant long-term effects on increasing rates of school completion and decreasing rates of juvenile arrest.¹¹ The authors conducted analyses to test alternative hypotheses about the pathways from the short-term significant effects on children’s educational achievement at the end of preschool to these long-term effects, including (a) that the cognitive and language stimulation children experienced in the centres led to a sustained cognitive advantage that produced the long-term effects on the students’ behaviour; or (b) that the enhanced parenting practices, attitudes, expectations and involvement in children’s education that occurred early in the program led to sustained changes in the home environments that made them more supportive of school achievement and behavioural norms, which in turn produced the long-term effects on the students’ behaviour. Structural equation modelling showed that both the cognitive advantage gained by the children and the family support experiences were linked to long-term program effects on children. Family factors (involvement in schools and reduced abuse and neglect) were shown to be significant mediators of the effect of the preschool program on high school completion, while only parent involvement in schools was a mediator of juvenile arrest rates. Also, while both the cognitive advantage and family support explained impacts on early child outcomes, such as school achievement, family support explained more of the effects on juvenile delinquency and about equally explained the effects on school completion.

Conclusions

Debate continues about the effectiveness of parent support interventions on outcomes for children. Program evaluations have shown the difficulty of producing sustained and comprehensive changes in parents. The subsequent link between changes in parents and positive consequences for their children’s development has been even harder to prove. The field has been plagued by research that has low internal validity, i.e. is susceptible to bias of different kinds. The evidence is strongest on the role of parent support services in supporting children’s cognitive development, especially for preschool children. The data are particularly strong for programs that combine a parent support intervention with direct educational services for children, and there is some evidence that both components contribute to improved outcomes for children. There is less evidence in the areas of social and emotional development; however, recent longitudinal analyses from a program with both early childhood and parent support services have provided new evidence linking parent support and long-term social outcomes.^12,13 

Implications

The vast majority of parent support programs are designed and implemented without attention to research or evaluation. This means that we continue to provide parent support interventions without increasing our understanding of whether and how our work with parents can lead to effects for children. This is particularly true for the domain of children’s social and emotional functioning, both because of inadequate measures and because of the current policy focus on cognitive outcomes for children that link to specific academic achievements, such as learning to read. The critical role of parenting in the lives of children provides a strong incentive to policy-makers and researchers to design programs that take advantage of these intimate and powerful familiar processes. Until we more clearly understand whether and how our interventions with parents affect children, the policy relevance of these programs will remain in question.

References

1. Brooks-Gunn J, Markman LB. The contribution of parenting to ethnic and racial gaps in school readiness. The Future of Children 2005;15(1):139-168. 
2. Collins WA, Maccoby EE, Steinberg L, Hetherington EM, Bornstein MH. Contemporary research on parenting: The case for nature and nurture. American Psychologist 2000;55(2):218-232.
3. Kreider H. A conversation with Jeanne Brooks-Gunn. The Evaluation Exchange Winter 2004/2005;10(4):12-13.
4. Barnett WS, Young JW, Schweinhart LJ. How preschool education influences long-term cognitive development and school success: A causal model. In: Barnett WS, Boocock SS, eds. Early care and education for children in poverty: Promises, programs, and long-term results. Albany, NY: State University of New York Press; 1998:167-184.
5. Reynolds AJ, Mavrogenes NA, Bezruczko N, Hagemann M. Cognitive and family-support mediators of preschool effectiveness: A confirmatory analysis. Child Development 1996;67(3):1119-1140.
6. Layzer JI, Goodson BD, Bernstein L, Price C. National evaluation of family support programs. Volume A: The meta-analysis. Final report. Cambridge, Mass: Abt Associates Inc.; 2001.
7. Yoshikawa H. Long-term effects of early childhood programs on social outcomes and delinquency. The Future of Children 1995;5(3):51-75. 
8. Zigler E, Taussig C, Black K. Early childhood intervention: A promising preventative for juvenile delinquency. American Psychologist 1992;47(8):997-1006.
9. Seitz V. Intervention programs for impoverished children: A comparison of educational and family support models. In: Vasta R, ed. Annals of child development: A research annual, vol. 7. Philadelphia, Pa: Jessica Kingsley Publishers; 1990:73-103.
10. Brooks-Gunn JC, McCarton CM, Casey PH, McCormick MC, Bauer CR, Bernbaum JC, Tyson J, Swanson M, Bennett FC, Scott DT, Tonascia J, Meinert CL. Early intervention in low-birth-weight premature infants: Results through age 5 years from the Infant Health and Development Program. JAMA -Journal of the American Medical Association 1994;262(16):1257-1262.
11. Reynolds AJ, Ou SR, Topitzes JW. Paths of effects of early childhood intervention on educational attainment and delinquency: A confirmatory analysis of the Chicago Child-Parent Centers. Child Development 2004;75(5):1299-1328.
12. Campbell FA, Pungello EP, Miller-Johnson S, Burchinal M, Ramey CT. The Development of Cognitive and Academic Abilities: Growth Curves from an Early Childhood Educational Experiment. Developmental Psychology 2001;37:231-242.
13. Campbell FA, Ramey CT, Pungello EP, Sparling J, Miller-Johnson S. Early Childhood Education: Young Adult Outcomes from the Abecedarian Project. Applied Developmental Science 2002;6:42-57.

Note:

^a It is important to note that the meta-analysis of evaluations of parent support programs, like other meta-analyses, showed that the size of the impacts of any of the parent support programs is strongly related to the type of evaluation design. The largest average effects were reported in pre-post studies; the next largest in quasi-experimental studies; and the smallest effects were reported for randomized studies.