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Implementing Parents as Teachers (PAT)®

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

November 2013

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For PAT, we reviewed 15 studies, including seven randomized controlled trials (RCTs) or quasi-experimental designs and 8 standalone implementation studies. (Please see the study database for a list of the studies.)

Six of the studies we reviewed (two RCTs and four implementation studies) were based solely on an adaptation to PAT implemented in New Zealand. For this reason, these studies are discussed only in the section dedicated to Program Model Adaptations or Enhancements.

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Characteristics of Program Model Participants

Across four of the studies reviewed, the average age of the parents enrolled in PAT ranged from 17 to 26 years. In one study, children enrolled in PAT ranged in age from 6 months to 3 years and 10 months. Four studies only enrolled mothers (not fathers).

One study included a sample that was 100 percent African American and participants in another study were predominantly African American. Five other studies enrolled families with a range of racial and ethnic characteristics. Across these five studies, the percentage of program participants that were African American ranged from 18 to 57 percent; the percentage of program participants that were Hispanic ranged from 10 to 83 percent; the percentage of program participants that were white ranged from 20 to 70 percent; and the percentage of program participants that were another or multiple racial backgrounds ranged from 3 to 15 percent.

Seven studies discussed the socioeconomic characteristics of the program participants in their samples. Three studies described the participants as low income or working class; in another study, nearly 80 percent of participants reported incomes of less than $25,000. One study reported that 49 percent of the participants had a low socioeconomic status (SES) according to the Hollingshead SES scale. In four studies, 16 to 32 percent of program participants received Aid to Families with Dependent Children or Temporary Assistance to Needy Families; in one of these studies, 5 percent of participants were employed.

Five of the studies reviewed reported that program participation was voluntary. One study reported that a few of the families were ordered to participate by family court in order to prevent their children from being placed into foster care.

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Location and Setting

Across the eight studies that described the locations of PAT, programs were located in Missouri, New York, North Carolina, Ohio, a coastal Mid-Atlantic state, and along the East Coast, in the South, and in the West. There were also several California locations, including Los Angeles, San Diego, Santa Barbara, and San Bernardino counties, as well as the Salinas Valley. Across seven studies, programs were located in urban, suburban, and rural locations.

Four studies described the types of agencies that implemented PAT. The agencies included school districts, social and health service agencies, and county level offices.

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Staffing and Supervision

Four studies reported that PAT services were provided by paraprofessional parent educators and one study reported using professional staff. Five studies noted that the parent educators were certified or attended training provided by the national PAT office. In one of these studies parent educators were required to have a bachelor’s degree and in another, requirements included a bachelor’s degree plus three years experience working with parents and young children, and state certification or licensure in a related area. In another study, seven parent educators had bachelor’s degrees in a related area and one was still attending college.

One study reported how supervision was conducted across the four sites included in the study. In one site, parent educators received weekly supervision from the coordinator and team meetings were held twice monthly. Staff were encouraged to discuss mutual clients more frequently. In another site, project staff meetings increased from monthly to weekly during the demonstration and the project coordinator reviewed cases monthly. In the third site, weekly team meetings were held and included administrative issues and clinical case supervision by the program manager. In the fourth site, sessions for individual supervision occurred at least monthly.

Three studies reported on the number of families with which each parent educator worked. Across these studies, parent educators’ caseloads ranged from 30 to 50 families.

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Program Model Components

Across eight of the nine studies reviewed, the PAT programs provided home visiting as well as other services. Additional services included parent groups; screenings and assessments for conditions such as developmental delay or hearing impairment; access to a resource network; and access to books, videos and toys.

Two studies reported that the PAT programs used the Born to Learn curriculum. Four other studies mentioned that parent educators were trained in the standard PAT curriculum.

Two studies reported that at least some program materials were provided in Spanish.

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Program Model Adaptations or Enhancements

One study mentioned adaptations and enhancements made to the program. In this study, the PAT curriculum was supplemented with materials to make PAT more engaging for teenage parents and to strengthen the program’s prenatal component. In addition, a group of program participants received the standard PAT program as well as intensive case management in order to meet the dual needs to teen mothers. Case management provided support through early, responsive intervention that helped them deal with challenges such as finishing school, creating a positive living environment, and becoming good parents.

Six studies reported on a New Zealand adaptation to PAT, known as Parents as First Teachers (PAFT)*. Four of the studies focused on the pilot phase and two on post-pilot implementation. According to one study, PAFT preserved the core PAT components but modified the curriculum to integrate PAFT within New Zealand’s existing services, added a liaison position to facilitate cultural awareness of and communication with native communities, and according to another study, added a Māori component to the curriculum following the pilot to emphasize traditional Māori childbearing and childrearing beliefs and practices. One study of the pilot implementation reported that materials were available in English only, which presented a challenge; a later study reported that materials were available in Māori and six Pacifika languages.

One study reported mothers were 26 years old on average. Another indicated PAFT enrolled families from a range of native and non-native ethnic groups; three additional studies reported that 17 to 31 percent of participants were Māori. In two studies, most mothers lived with their partners (86 to 91 percent); in four studies, 6 to 28 percent of caregivers were single. In three studies, 27 to 35 percent of families had low incomes or earned less than the average income.

Across four studies, parent educators who delivered home visits had a degree or equivalent experience in early childhood education, childhood nursing, health, or social work. According to one study, parent educators received two weeks of pre-service training and one week annually of ongoing training. Two studies about the pilot phase reported that most parents (92 to 98 percent) received the minimum recommended number of home visits over the three-year period; in a post-pilot study, parents overall received fewer than the minimum recommended number of visits, on average. One study noted that nearly 75 percent of home visits lasted one hour and 25 percent were longer than an hour.

*As of 2016, implementation support is no longer available for PAFT (New Zealand).

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Dosage

Two studies described how long participating families remained in PAT. In one study, families who began home visits averaged about 18 months of participation. In the other study, 46 percent of families remained in the program zero to ten months, 39 percent remained in the program 10 to 20 months, and 14 percent of families remained in the program 20 to 30 months.

In two studies, the average number of home visits that families received ranged from 10 to 17. One of the studies also mentioned that families attended an average of two PAT group meetings.  

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Fidelity Measurement

One study included information about how fidelity to the PAT model was monitored. In this study, programs were monitored for (1) home visit attendance; (2) coverage of curriculum material; and (3) performance related to executing the program curriculum, establishing a rapport with clients, and similar activities.

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Costs

One study discussed a cost analysis performed between 1995 and 1997 that reported on the average cost of program services. The costs are expressed as the cost per unit of service:

  • Home visit without developmental screening: $92.64
  • Home visit with developmental screening: $101.68
  • Telephone home visit: $30.50
  • Drop in and play session (excluding preparation time): $104.10
  • Parent support group meeting (excluding preparation time): $35.78

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Lessons Learned

Three studies described lessons that were learned during implementation of the program. Across these three studies, the lessons included (1) mothers tended to value their parent educators and felt more connected to them than to the PAT program; (2) both beneficial activities, such as employment or attending school, as well as detrimental circumstances, such as instability in the families served, hindered parent engagement in PAT, although employment and school attendance was not related to dropping out; and (3) program participants that received the expected level of intensity tended to experience the greatest gains.

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