Manuscript Detail
Screening decision | Screening conclusion |
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Passes screens | Eligible for review |
Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
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High | Randomized controlled trial | Low | Established on race and socioeconomic status | None | None |
Study participants | Mother-infant pairs were recruited from hospitals serving families from lower-income backgrounds and assigned to one of two intervention groups: PALS I or a Developmental Assessment of Skills (DAS) comparison group. Initially 264 mother-infant pairs were randomly assigned, 131 to the treatment group and 133 to the comparison group. After attrition, 241 mother-infant pairs (121 PALS I and 120 DAS) remained in the study. Approximately one-third of each group was African American, Hispanic, or Caucasian. Most were poor and unmarried. Mothers were all 18 years old or older at intake, and averaged 27.8 years old in the treatment group and 27.0 years old in the comparison group. On average, mothers had 12.6 years of education in both groups. Participants were followed over the course of 10 visits.Guttentag et al. (2006) and Smith et al. (2006) used the same sample as this study and described an analytic sample of this size and composition. Although the two studies do not include outcomes that are eligible for the HomVEE review, their information about the analytical sample size and composition provide an additional source of information for evaluating the Landry et al. (2006) study. |
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Setting | The study was conducted in the Houston-Galveston (Texas) area. |
Intervention services | PALS I consists of a series of 10 home visits, each lasting 1.5 hours and occurring approximately weekly. The home visits are guided by a curriculum that included (1) asking mothers to review their experiences across the past week related to their efforts to try targeted behaviors, (2) describing the current visit’s targeted behavior, (3) watching and discussing with mothers the educational videotape of mothers from similar backgrounds, (4) videotaping mothers interacting with their infants in situations that the mothers selected with coaching, (5) supporting mothers to critique their behaviors and the infants’ responses during the videotaped practice, and (6) planning with mothers how to integrate responsive behaviors into their everyday activities with laminated cards. The facilitator coached the mothers to use the targeted behaviors, including commenting on the infants’ responses when the behaviors were used. Sessions were available in both English and Spanish. |
Comparison conditions | Comparison group members received the same number of home visits from facilitators, which included discussions about new infant skills during the previous week and infant development and assessment. Facilitators provided mothers with answers to and handouts about their questions on infant skill development. |
Staff characteristics and training | Facilitators, who had bachelor’s or master’s degrees, were trained to use the curriculum in a flexible manner to meet the learning needs of individual families. Training included review of videotaped facilitated sessions and coaching by a supervisor. |
Funding sources | Department of Health and Human Services, National Institutes of Health, Grant HD36099. |
Author affiliation | Susan Landry, a study author, is a developer of this model. |
Findings details
Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
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High | Negative Affect (With Examiner) | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = -0.07 | Coefficient = 0.28 | Not Reported | Study reported = 0.70 | Statistically significant, p < 0.01 | footnote142The <em>p</em>-values are study reported. |
High | Social Skills: Cooperation | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 5.56 | Coefficient = 5.16 | Not Reported | Study reported = 0.39 | Not statistically significant, p = 0.08 | footnote142The <em>p</em>-values are study reported. |
Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
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High | Contingent Responsiveness | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.77 | Coefficient = 0.99 | Not Reported | Study reported = 0.93 | Statistically significant, p < 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Harshness of Voice Tone | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.07 | Coefficient = 0.12 | Not Reported | Study reported = 0.28 | Statistically significant, p = 0.02 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Labeling Actions | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = -8.94 | Coefficient = -9.20 | Not Reported | Study reported = 0.63 | Statistically significant, p < 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Labeling Objects | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = -5.47 | Coefficient = -5.86 | Not Reported | Study reported = 0.71 | Statistically significant, p < 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Maintaining Infant Foci of Attention | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 13.21 | Coefficient = 12.40 | Not Reported | Study reported = 0.36 | Not statistically significant, p = 0.08 | footnote142The <em>p</em>-values are study reported. |
High | Physical Intrusiveness | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.44 | Coefficient = 0.51 | Not Reported | Study reported = 0.50 | Statistically significant, p = 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Redirecting Infant Foci of Attention | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 1.14 | Coefficient = 1.57 | Not Reported | Study reported = 1.31 | Statistically significant, p < 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
High | Verbal Encouragement | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.67 | Coefficient = 0.24 | Not Reported | Study reported = 0.71 | Statistically significant, p < 0.01 | footnote142The <em>p</em>-values are study reported. |
High | Verbal Scaffolding | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.41 | Coefficient = -0.08 | Not Reported | Study reported = 0.79 | Statistically significant, p < 0.01 | footnote142The <em>p</em>-values are study reported. |
High | Warm Sensitivity | FavorableUnfavorable or ambiguousNo Effect |
PALS I vs. DAS | 12 months | 241 mother/child dyads | Coefficient = 0.74 | Coefficient = 0.90 | Not Reported | Study reported = 0.49 | Statistically significant, p < 0.01 | footnote141Lower parameter value indicates a better score. The <em>p</em>-values are study reported. |
Outcome measure summary
Outcome measure | Description of measure | Data collection method | Properties of measure |
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Negative Affect (With Examiner) |
The frequency with which an infant displayed signs of irritation such as whining, fussing, and crying when interacting with the examiner. | Videotaped observation | Interrater reliability = 0.76 |
Social Skills: Cooperation |
The frequency with which an infant attempted to respond to his/her mother's request for an action or verbalization. | Videotaped observation | Interrater reliability = 0.62 |
Outcome measure | Description of measure | Data collection method | Properties of measure |
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Contingent Responsiveness |
The degree to which a mother responded promptly and appropriately to her infant's cues was rated on a five-point scale. | Videotaped observation | Interrater reliability = 0.74 |
Harshness of Voice Tone |
The degree to which the mother used a harsh and/or impatient tone with her infant, rated on a five-point scale. | Videotaped observation | Interrater reliability = 0.70 |
Labeling Actions |
The frequency with which a mother provided the specific names of actions during the interaction. | Videotaped observation | Interrater reliability = 0.70 for the labeling one action and 0.75 for the labeling of more than one action |
Labeling Objects |
The frequency with which a mother provided the specific names of objects during the interaction. | Videotaped observation | Interrater reliability = 0.77 for both the labeling of one object and the labeling of more than one object |
Maintaining Infant Foci of Attention |
The frequency with which the mother's behavior helped to sustain her child's current activity. | Videotaped observation | Interrater reliability = 0.81 |
Physical Intrusiveness |
The degree of abruptness in physical interactions such as moving the infant, and physical expressions of impatience. | Videotaped observation | Interrater reliability = 0.45 |
Redirecting Infant Foci of Attention |
The frequency with which the mother's interaction was unrelated to her child's current activity in an attempt to redirect the child's attention. | Videotaped observation | Interrater reliability = 0.77 |
Verbal Encouragement |
The frequency with which a mother praised her infant's efforts. | Videotaped observation | Interrater reliability = 0.78 |
Verbal Scaffolding |
The frequency with which a mother provided verbal hints and prompts. | Videotaped observation | Interrater reliability = 0.64 |
Warm Sensitivity |
The degree to which the mother was warm and sensitive in her interactions with her infant (e.g., accepting of the infant's needs and interests), rated on a five-point scale. | Videotaped observation | Interrater reliability = 0.74 |