Parents as Teachers Foundational Curriculum: Prenatal to 3 (Parents as Teachers) has been evaluated in many studies since it began in 1984; and over the years, the curriculum has been revised several times. This review presents evidence from two studies on the effectiveness of the current version of the Parents as Teachers curriculum, which was introduced in 2010. The first study is a recent evaluation of Parents as Teachers (Lahti, Evans, Goodman, Schmidt & LeCroy, 2019). The second study investigates implementation of Parents as Teachers as part of the Zurich Equity Prevention Project with Parents' Participation and Integration (ZEPPELIN) intervention (Schaub, Ramseier, Neuhauser, Burkhardt, & Lanfranchi, 2019; Neuhauser, Ramseier, Shaub, Burkhardt, & Lanfranchi, 2018).

While this report focuses on evidence for child outcomes in the school readiness domains, Parents as Teachers has also been associated with positive parenting outcomes. For more information on Parents as Teachers as a parenting curriculum, please see the Parenting Curricula for Home-Based Delivery Database. In addition, the Home Visiting Evidence of Effectiveness (HomVEE) review presents information on associations between Parents as Teachers and outcomes in maternal and child health and other domains.

Rigorous Research Design: The Parents as Teachers evaluation used a quasi-experimental design, and the ZEPPELIN study used an experimental design.

Sample and Generalizability: The Parents as Teachers evaluation included children who were enrolled in the Arizona public schools whose participated in Parents as Teachers as young children. The children were predominantly Hispanic, and most qualified for free and reduced lunch in the public schools. The ZEPPELIN study took place in Switzerland. The sample included families of children who were less than 4 months old when the study began. Families had psychosocial risk factors, and most were immigrants to Switzerland.

Fidelity of Implementation: The Parents as Teachers evaluation did not report training or fidelity information. The home visitors in the ZEPPELIN study were pediatric nurses who participated in training as parent educators and attained recertification. They had to meet fidelity requirements developed by their organization, including annual performance reports.

Parenting Outcomes: The Parents as Teachers evaluation analyzed parenting outcomes using a pre-test/post-test design without a comparison group. It found positive parenting outcomes for caregiver interactions during play, as well as for a variety of protective factors (i.e., family functioning, social support, and concrete support). While scores on nurturing and attachment were slightly higher at post-test, the difference was not significant. The ZEPPELIN study found a positive effect of Parents as Teachers on maternal sensitivity when children were 12 months old, though not when children were 24 or 36 months old.

Child Outcomes: The Parents as Teachers evaluation assessed children’s elementary math achievement, elementary reading achievement (on two measures), and English Language Learner Achievement (i.e., reading and writing in English). It found a small-medium positive effect on children’s elementary math achievement and a small positive effect on English Language Learner achievement. While there were also small positive effects on children’s elementary reading achievement, the effect only reached significance for one of the measures. The ZEPPELIN study analyzed children’s self-help skills, developmental milestones, developmental competence (in cognitive, language, and motor skills), vocabulary, nonverbal intelligence, developmental dysfunction (child behavior), and effortful control. Children who participated in Parents as Teachers had positive effects on self-help skills, developmental milestones, expressive language, vocabulary, and some aspects of developmental dysfunction and effortful control, when compared to children who did not participate in Parents as Teachers.

References: 

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. https://doi.org/10.1111/j.1365-2214.2008.00915.x

Lahti, M., Evans, C. B., Goodman, G., Schmidt, M. C., & LeCroy, C. W. (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., Shaub, S., Burkhardt, S. C. A., & Lanfranchi, A. (2018). Mediating role of maternal sensitivity: Enhancing language development in at-risk families. Infant Mental Health Journal, 39(5), 532–536.

Parents as Teachers. (2016). Evaluating an Investing in Innovations project to improve education outcomes for American Indian children. St. Louis, MO. Retrieved from https://static1.squarespace.com/static/56be46a6b6aa60dbb45e41a5/t/57eea52515d5db8fe16501ab/1475257637451/babyface_report_pat_2016.pdf

Schaub, S., Ramseier, E., Neuhauser, A., Burkhardt, S. C., & 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.

Zigler, E., Pfannenstiel, J. C., & Seitz, V. (2008). The Parents as Teachers program and school success: A replication and extension. Journal of Primary Prevention, 29(2), 103–120. https://link.springer.com/article/10.1007/s10935-008-0132-1

Home Visiting Practices and Interactions: Parents as Teachers consistently promotes home visiting practices and interactions that research has shown to be effective in engaging parents and families. The curriculum provides comprehensive resources to support home visitors in building trusting and positive relationships with families, particularly through the introductory materials. For example, "The Parent Educator's Role in the Personal Visit" includes specific strategies for how home visitors can create equal partnerships with families. The curriculum also suggests many strategies for effective communication with families (e.g., active listening, open-ended questions). Various materials, including "The Strengthening Families Approach," encourage home visitors to adopt a strength-based perspective and point out what families are doing well in relation to the identified "protective factors." Parents as Teachers also offers specific guidance for how to follow the family's lead to jointly plan home visits (e.g., the "Foundational Personal Visit Plans" offer prompts for home visitors to collaborate with the family).

Parenting Practices: The curriculum consistently promotes parenting practices that research has shown to be effective in supporting children's development and learning. It emphasizes the importance of sensitive, responsive interactions to build secure attachment relationships with children. Various resources (e.g., "Ways to Build Attachment with Your Baby," "Attachment Is Good for Your Baby's Brain," "Attachment and Brain Development") highlight strategies to nurture children through responsive interactions with parents. Parents as Teachers also provides various resources for parents on how to use routines as opportunities to foster learning (e.g., "Recognizing, Creating, and Adapting Routines"). It supports parents in building children's social and emotional development, problem-solving skills, emerging mathematical thinking, and physical development. In addition, it supports families to promote a language and literacy-rich environment (e.g., through shared read-alouds, strategies to support different aspects of language development).

Scope: The curriculum clearly identifies five developmental domains: Language, Cognitive, Motor, Social-Emotional, and Approaches to Learning. Each "Activity Page" includes specific skills, behaviors, and concepts from the domains that children might be working on as they engage in the activity. Additionally, the "Milestones" and "Child Development Charts" include these domains as the overarching areas of child development.

Sequence: The curriculum provides a sequence of learning experiences that supports children as they build knowledge and skills in each of the ELOF domains. In a series of handouts ("Your Baby's Social-Emotional Development," "Your Baby's Cognitive Development," "Your Baby's Motor Development," and "Your Baby's Language Development"), the curriculum provides specific strategies to support children's learning and development at different age levels (birth to 36 months). The curriculum offers multiple related opportunities for children to explore or learn concepts or skills in all domains. Additionally, Parents as Teachers gives specific guidance on how to individualize sequences of learning experiences based on children's interests, strengths, and needs (e.g., "Reviewing the milestones, assessments, and previous personal visit record and considering the interests, preferences, and culture of the family allow you to choose an activity page that best suits the family's needs for that visit.").

Alignment with the ELOF: A thorough review of all the curriculum materials indicates that Parents as Teachers is fully aligned with the ELOF domains and sub-domains. The curriculum materials, including learning experiences, learning goals, parenting practices, and guidance for supporting parents, support children across the ELOF sub-domains.

Learning Goals: Parents as Teachers specifies measurable, developmentally appropriate goals for children's learning and development that are consistently supported by the learning experiences. "Child Development Charts" identify goals for children in four domains—Language, Cognitive, Motor, and Social-Emotional—for every few months from birth to 36 months. In addition, in the "Goal Setting" resource, the curriculum provides specific guidance on how to engage families in identifying individual goals for their children's learning and development.

Ongoing Observation: A variety of resources in the curriculum describe a process for observing and discussing children's development and using this information for home visit planning. For example, "Be an observer of your child" describes specific strategies for families to use as they observe their child (e.g., "Take time to just watch your baby. You'll soon see changes in the sounds she makes, the way she notices her surroundings, and the way she holds and moves her body."). The "What's Special About this Age?" series of resources for every few months of development provides prompts for each of the milestones to guide observation (e.g., "Look for your baby to..."). In addition, the "Foundational Personal Visit Plans" offer opportunities for parents to share and discuss their observations of children.

Standardized and Structured Assessment Instruments: Parents as Teachers provides a structured “Milestones by School Readiness Domain” checklist tool to assess children’s development. The tool, as confirmed by the publisher, has not been tested for validity or reliability. “Guidance for Ongoing Surveillance Using the Milestones by School Readiness Domain” describes the importance of parents and home visitors regularly observing children and using the data they collect to inform home visit planning. The curriculum does not provide further guidance for how home visitors and families select and use standardized and structured child assessment instruments.

Relationships with Parents and Families: Parents as Teachers offers specific guidance, integrated throughout the curriculum materials, on how to build positive relationships with families. For example, "The Parent Educator's Role in the Personal Visit" provides specific strategies for how home visitors can build and sustain positive relationships with families. It describes three roles for home visitors: partners, facilitators, and reflectors. "When utilizing these first two roles, parent educators create time, space, and a safe atmosphere in which families are able to wonder and consider. As reflectors, parent educators use evidence-based practices to prompt reflections and generate awareness." In addition, the curriculum provides a variety of materials for both home visitors and families on how to support the home visitor-family relationship (e.g., "Welcome to Parents as Teachers," "The Strengthening Families Approach").

Responsive Interactions with Parents and Families: The curriculum provides specific guidance on how to engage in responsive interactions with diverse families. "Facilitating," a section of "The Parent Educator's Role in the Personal Visit," describes strategies for supporting responsive interactions with families (e.g., "Observing, listening and learning," "Gaining parents' perspectives," "Responsiveness and flexibility"). In addition, each home visit begins with "Connect, Reflect, and Agree," which provides time for home visitors and families to spend time getting to know one another, reflecting on what has been happening with the child, and agree on what will happen during the visit.

Peer Support: The curriculum offers specific guidance for how to bring families together to facilitate peer support through "Group Connections," a series of resources on group socializations. "Group Connections" provides a planning guide for group socializations, as well as suggestions for partnering with families to plan events.

Professional Development: Parents as Teachers offers comprehensive, standardized initial and ongoing training. A three-day "Foundational Training" is required in order to purchase and use the curriculum. A variety of follow-up trainings (e.g., "Interactions Across Abilities," "Diversity in Families") are offered at an additional cost, both online through the Knowledge Studio and in person. The curriculum developers also offer customized trainings to address individual program needs.

Curriculum Materials to Support Implementation: The curriculum provides comprehensive materials and guidance to facilitate understanding and implementation of the curriculum. Parents as Teachers offers a myriad of well-organized resources with clear instructions on how to use them. For example, the introduction to the curriculum provides a theoretical foundation and tools to orient the home visitor to the materials. The eight "Foundational Personal Visit Plans" provide a framework for the first few home visits. Materials also include a specific process for guiding the next home visit plans. In addition, the sections on "Parenting Behaviors" and "Development-Centered Parenting" offer resources and activities for home visitors and parents on different parenting topics. The "Parent-Child Interactions" section includes activities for parents and children to do together, and the "Family Well-Being" section provides resources for home visitors and parents on supporting family development. Each resource in the curriculum is labeled with the intended audience (e.g., parent educator and/or parent) and includes specific instructions for use.

• Fidelity Tool: Parents as Teachers does not offer a fidelity tool to monitor curriculum implementation.

Family-Child Relationship: Parents as Teachers offers specific guidance, integrated throughout the curriculum materials, on how home visitors facilitate nurturing relationships between families and children. Various resources in the curriculum provide tools, information, and specific strategies for home visitors to support the family-child relationship. For example, "The Importance of Parent-Child Interaction," a resource for home visitors, describes how different types of interaction support children's development in the first three years. It offers strategies to support parents in these interactions. In addition, the curriculum outlines a specific process for home visitors to use during home visits to support the family-child relationship (e.g., "Parent Educator's Role in the Personal Visit" is a resource for home visitors that describes the home visitor's and the family's roles in detail).

Active Exploration and Play: The curriculum provides specific guidance on how families engage children in ongoing active exploration and play throughout the curriculum. Many "Activity Pages" (e.g., "Outdoor Exploration: Discovering and Observing," "Baby Discovery Jug: Dropping and Retrieving") suggest opportunities for families to support children in exploring open-ended materials, playing, and discovering new concepts. In addition, a variety of "Parent Handouts" and "Parent Educator Resources" (e.g., "The Value of Play," "Play Is Learning," "Feeling Safe While Exploring and Taking 'Good' Risks") provide strategies and information on how to support active exploration and play.

Interactions that Extend Children's Learning: Parents as Teachers provides specific guidance embedded throughout curriculum materials for how parents and families can extend children's exploration, thinking, and communication, particularly through the "Continued Learning" call-out boxes on the "Activity Pages." "Continued Learning" offers specific suggestions for parents to extend children's learning from the activities, such as asking open-ended questions and providing supportive language and ideas.

Individualization: The curriculum provides specific guidance embedded throughout materials on how to collaborate with families to develop caregiving routines and learning experiences that are responsive to children and families. "The Benefits of Activity Pages" describes specific strategies for adapting the "Activity Pages" for children with disabilities, suspected delays, or other special needs. "The Personal Visit Planning Guide" also includes information on how to adapt activities based on a family's interests, strengths, and culture.

Environment: In several resources for home visitors and families (e.g., "Space and Structure for Your Little Explorer," "Designing and Guiding as Your Child Grows," "Safe and Healthy Home Environments"), Parents as Teachers provides specific guidance for how to set up a home environment that supports exploration and development. However, the curriculum offers limited guidance on how to make the home environment accessible for a child with a disability, suspected delay, or other special need.

Learning Materials: Parents as Teachers includes many resources with specific guidance on using developmentally appropriate learning materials found in the home to foster open-ended exploration and inquiry. For example, "Making the Most of Toys" describes how open-ended materials that are often found in the home offer opportunities for different kinds of exploration that support children's learning. The curriculum provides limited guidance on how to incorporate learning materials that are accessible to children with disabilities, suspected delays, or other special needs.

Routines: Parents as Teachers provides a variety of resources throughout the curriculum with specific guidance on how to support early routines that are responsive to children and foster learning (e.g., "Your Baby's Sleep Routines," "Reasons to Read to Your Baby"). The section "Recognizing, Creating, and Adapting Routines" describes the importance of and strategies for creating individualized routines for children (e.g., considering a baby's temperament before implementing a routine) and offers tips for collaborating with parents around routines.

Interactions: In several resources throughout the curriculum, Parents as Teachers provides specific guidance on engaging in culturally responsive interactions with diverse children and families. "Three Steps to Cultural Competence" includes detailed information on and strategies for how home visitors can reflect on their own culture, as well as how culture may affect interactions with diverse families (e.g., "Partner with families to find culturally appropriate applications of information or solutions to problems"). In addition, "Human Diversity, Cultural Competence, and Parent Education" offers strategies for home visitors to consider when working with diverse families (e.g., "When disagreements arise, rather than seeking solely to educate the parents, parent educators should facilitate a mutual sharing of information.").

Learning Experiences: The curriculum provides specific guidance in a variety of curriculum materials on how to collaborate with families to plan or adapt learning experiences based on families' traditions, cultures, values, and beliefs. For example, "Human Diversity, Cultural Competence, and Parent Education" gives suggestions for making learning experiences responsive to a family's culture (e.g., using materials from the home, "considering family values when facilitating problem-solving or goal-setting"). In addition, throughout various activities in the curriculum, prompts are offered for home visitors to ensure that families' beliefs, traditions, and cultures are incorporated into learning experiences (e.g., in the introduction of "Developmental Topics," home visitors are offered prompts to consider a family's cultural perspective on parenting).

Linguistic Responsiveness: Throughout the curriculum materials, including resources for home visitors and parent handouts, Parents as Teachers provides specific guidance on how home visitors can intentionally support parents and families in using their home language as well as in providing experiences that expose children to English. For example, "Bilingual Families: A Special Advantage" describes the developmental benefits that children gain when they are spoken to in their home language (e.g., "cognitive advantages," "better selective attention"). A parent handout, "Your Toddler Knows Two Languages," describes what to expect of children who are DLLs. It offers strategies to support children in their language development. In addition, some activities include prompts to explore the home language (e.g., "Helping Parents Share Music with Their Child").

Resources and Referrals: Parents as Teachers provides specific guidance on referring families with a child with a disability, suspected delay, or other special need to resources in the community. "Difference and Delays in Development" describes the referral process in detail (e.g., gathering observations, screening, referring a child to a health care provider or early intervention system, eligibility for services determined by a "multi-transdisciplinary team"). It also discusses the importance of collaborating with other early intervention professionals if a child has an identified disability.

Learning Environment: The curriculum provides limited guidance on ensuring that the home environment and learning materials are accessible to children with disabilities, suspected delays, or other special needs. "The Benefits of Activity Pages" briefly mentions the importance of appropriate materials for a child with a disability, but no guidance is provided on adapting the home learning environment within this curriculum. The publisher offers a separate curriculum, Interactions Across Abilities: Supporting Families of Children with Special Needs, with more guidance on individualization for children with disabilities, suspected delays, or other special needs.

Parenting Practices and Interventions: Parents as Teachers offers general guidance on how to adapt the curriculum's learning experiences for a child with a disability, suspected delay, or other special need. "Supporting Learning in the Early Years" includes a section called "Adapting Activities" that provides strategies for how families can adapt activities to a child's developmental level (e.g., "parents might demonstrate different ways to do a new skill, offer other materials, or guide their child's hand or body so she feels successful"). However, many of the activities in the curriculum do not include specific adaptations for a child with a disability, suspected delay, or other special need. The publisher offers a separate curriculum, Interactions Across Abilities: Supporting Families of Children with Special Needs, with more guidance on individualization for children with disabilities, suspected delays, or other special needs.

Individualization Based on Interests: The curriculum provides specific guidance embedded throughout the materials on how to individualize both the overall home visit and the learning experiences based on children's interests. For example, the "Personal Visit Planning Guide" offers guidance on adapting activities based on a child's interests (e.g., "Based on the interests of the child or culture of the family, parent educators may adapt a parent-child activity by substituting some materials."). In addition, "Supporting Learning in the Early Years" highlights strategies for adapting activities based on a child's interests.

Individualization Based on Strengths and Needs: Parents as Teachers provides specific guidance on how to tailor home visits to be responsive to individual children's strengths and needs. For example, "The Benefits of Activity Pages" includes specific strategies for adapting activities based on the child's strengths and needs (e.g., "Consider the child's current developmental level and choose an activity that interests the child in order to enhance existing skills and encourage emerging ones."). Additionally, "Supporting Learning in the Early Years" describes a process of observing children to meet them where they are developmentally and adapting activities accordingly. Moreover, many of the "Activity Pages" describe scaffolding strategies to support children at varying levels of development.

Family Goals: Parents as Teachers includes a comprehensive process for setting family-level goals. The "Goal Setting" section provides information on creating SMART (specific, measurable, attainable, realistic, timely) goals; a process for evaluating progress; and reflection questions to support the process. Additionally, this section offers strategies for home visitors on how to intentionally engage families in this process (e.g., "Through your relationship, you are in a position to partner and collaborate with parents by responding to their identified needs, reframing those needs as goals, and facilitating conversations around how they can achieve their goals and what might be getting in the way.").

Ongoing Assessment of Progress Toward Family Goals: The curriculum describes a specific process for checking in on family goals, along with various tools to support families and home visitors in the process. The parent worksheet "Goal Setting: Begin with the End in Mind" provides specific prompts for families to reflect on, a proposed timeline for goals, action steps needed to achieve goals, information about the resources required, and space for check-ins and progress made. The "Goal Tracking Sheet" is a separate tool for home visitors and includes prompts to record family goals, along with check-in timelines and notes.

Resources and Referrals: Parents as Teachers provides specific guidance for referring families to resources in the community, particularly in the "Strengthening Families Approach" section of the introductory materials. "Protective Factor 4: Concrete support in times of need" describes the importance of connecting families with resources in the community they might need. It offers specific examples and prompts home visitors can use in conversations with families. The goal-setting process also includes prompts for home visitors to ensure families are connected to resources.