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Parent and Family Skills and Information
Adolescent parents

What are the medical and psychosocial risk factors associated with adolescent mothers?

  • Poor maternal weight gain.
  • Anemia.
  • Pregnancy-induced hypertension.
  • Poverty.
  • Lack of education.
  • Inadequate family support.
  • Inadequate prenatal care/or no prenatal care.
  • Increased risk for domestic violence.
  • More likely to be single parents.
  • Less likely to finish high school.
  • Less knowledge about child development and appropriate parenting practice.
  • Higher risk of child neglect and abuse.

What are the risk factors associated with repeat pregnancies among adolescent mothers?

  • Decreased educational achievement/not returning to school within six months.
  • Increased dependence on governmental support/societal expense.
  • Increased infant mortality.
  • Low birth weight.
  • Repeat pregnancies occur in 35% of adolescent mothers within two years of the first birth.

What are the medical and psychosocial risk factors associated with infants of adolescent mothers?

Increased incidence of:

  • Low birth weight.
  • Prematurity.
  • Developmental disabilities.
  • Poorer developmental outcomes than the offspring of older mothers.
  • Deficits in cognitive and social development that can persist into adolescence.
  • Lower levels of vocalization, touch and emotional nurturing.
  • Harsh and rejecting discipline due to poor parenting skills linked with child anger, low self-esteem and social withdrawal.

What are the outcomes associated with children and young adult offspring of adolescent mothers?

  • The outcome of exposure to risks factors associated with young adolescent mothers during a child's first three or four years of life can profoundly influence the development of the nerve connections and neurotransmitter networks of the child's brain and lead to impaired brain development.
  • 33% of these children drop out of school.
  • 31% suffer from depression.
  • 16% are incarcerated.
  • 25% are at risk of adolescent parenthood.

Recommendations for Pediatricians

  • Pediatricians should provide continuity of care and a "medical home" for adolescent parents, as well as for their children. Adolescent parents need guidance, early childhood education and the teaching of basic care-giving skills. This guidance should include the adolescent mother and the infant's father, when possible.
  • The pediatrician should facilitate coordination of a multi-disciplinary and comprehensive approach to using community resources such as social services, nutrition programs, parenting classes, and medical and developmental services.
  • The pediatrician should promote breastfeeding by the adolescent mother and advocate for this practice in the school setting.
  • The pediatrician should counsel and advocate for contraceptive counseling during the pregnancy of the adolescent with an emphasis on long-acting methods coupled with condom use.
  • Pediatricians should encourage adolescent mothers to complete high school.
  • Pediatricians need to educate the adolescent mother on the importance of a healthy lifestyle for herself and infant. Education on effects of substance abuse and nicotine on the healthy growth and development of infants should be provided.
  • Risk of domestic violence should be assessed by the pediatrician during and after pregnancy visits.
  • The pediatrician should encourage and stress the importance of the adolescent parent caring for his or her own child. The adolescent parent then develops a true understanding of the demands of parenting.
  • Pediatricians should adapt their counseling to the developmental level of the adolescent. Intensive instruction on infant care, human growth and development, discipline, and stress associated with parenting can be provided through office, clinic, home visits, or school settings.
  • Pediatricians need be aware of the community resources available to the adolescent parent and their infant. These may include home visits, prenatal, and infant classes, quality child care programs and programs for children with developmental disabilities.
  • Pediatricians need to provide positive reinforcement for adolescent parents who complete high schools abstain from the use of drugs, alcohol and nicotine; continue breastfeeding; keep the child's immunizations current, and attend all well-child visits.
  • Encourage the involvement of the father in the child's life.

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Every child succeeds

Every Child Succeeds is a regional program of family support designed to ensure an optimal start for children. The program is a collaboration among three founding partners: United Way and Community Chest, Cincinnati Children's Hospital Medical Center and Cincinnati-Hamilton County Community Action Agency/Head Start. Additional partners include: Beech Acres, which coordinates training; the Health Foundation of Greater Cincinnati, which is funding the overall evaluation, and community-based service providers.

Core program strategy is home visitation and is based on one of the two models: David Old's Prenatal and Early Childhood Nurse Home Visitation as well as Healthy Families America. Both models involve two to three home visits addressing health, education and social services. Program provides long-term care that lasts from 2 1/2 to 3 years. Mothers are reached prior to birth or while at the birth hospital.

The program focuses on personal and family health, environmental safety, child development, life course development, maternal role, social supports and adequate and appropriate access to health and human services.

The outcomes of the program are:

  • Increased positive pregnancy outcomes.
  • Enhanced family functioning.
  • Increased self-sufficiency.
  • Strengthening parent-child relationships.
  • Better-adjusted, school-ready children.

Begun in 1997, the program provides support, encouragement and information to families about each stage of a child's development for the first three years.

Since July 1999, more than 900 women in six counties have enrolled and shared their infant's development with a trained nurse or social worker.

This is a public/private partnership funded by United Way and Community Chest, the Kentucky Cabinet for Children and Families and the Hamilton County Department of Human Services.

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Fathers are involved in their children's lives in a multitude of ways that go beyond the traditional roles of "economic provider" and "playmate." The quality of father-child interactions is not as frequently studied or understood as is the quantity of father-child contact. New research is focused on new ways of thinking about father involvement and the roles that fathers play in children's lives.

Fathers can be involved with their children in more roles than the provider role. This view of father involvement is applicable to fathers who live with their children as well as those who do not. Research underscores the difference that it is important to distinguish between the quantity and quality of father involvement. If a father cannot have consistent physical contact with his child yet provides warm, stimulating and positive contact when possible, children can still benefit from father involvement.

How do social, economic and cultural factors influence a father's involvement with his child?

Socioeconomic factors:

  • National studies consistently found strong links between socioeconomic status and father involvement.
  • Fathers able to provide economically for their children are more likely to stay vested in their marriages or partnerships, and are more likely to be engaged with and nurturing of their children -- even if they live apart from their children.
  • Unemployed fathers are less likely to form families or assume responsibility for children born outside of marriage.

Cultural factors:

  • African-American fathers who do not live with their children are more likely than Non-Hispanic white or Hispanic counterparts to share in housework and child care tasks, participate in child-rearing decisions, and visit their children.
  • African-American fathers are less likely than Non-Hispanic white fathers to read to their children, but more likely than white fathers to play with them.
  • Fathering roles cross cultures. These include fathers as economic providers, protectors, caregivers and teachers.

Family Structure

  • Only 25% of African-American children and two-thirds of Non-Hispanic white children lived with both biological parents in 1992.
  • Single fathers are more likely to be African American than are married fathers.
  • Although many nonresident fathers are initially involved in their children's lives, this involvement tends to taper off over time, particularly among men never married to their child's mother.

How do fathers contribute to their child's well-being?

  • Fathers can positively influence their children's development by assuming a significant share of the child care tasks.
  • Care by fathers may be particularly influential in the first year of life.
  • A father's parenting style has implications for child well-being.
  • Higher levels of father involvement in activities with their children are associated with fewer behavior problems, higher levels of sociability and better school performance.
  • Provision of child support is related to children's cognitive development, academic achievement and behavior.


Child Trends (2000). Research Briefs: The Meaning of Father Involvement for Children;

What Do Fathers Conribute to Children's Well-Being?; How do Social, Economic, and Cultural Factors Influence Fathers' Involvement with Their Children?

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Grandparents and relative care and parenting

Why are grandparents and relatives raising children?

Many reasons account for relatives caring for children of family members. For many children, kinship family care prevents entry into out-of-home care and into the foster care system. Grandparents and relatives can often provide the quality of care a child needs when biological parents are unavailable or unwilling to care for their children. In part, the increased use of kinship family care may be due to the changes in the social service system as a result of the Welfare Reform Act (1996).

Placement with relative caregivers promotes a child's sense of family and cultural identity, maintains feelings of belonging and significant attachments and thereby assists children's well being for healthy growth and development. The opportunity for children to remain with their relatives promotes stability and permanency while maintaining important biological and family ties if health and safety can be assured.

What are key practice principles in kinship parenting?

The kinship family:

  • Develops resilience by promoting a sense of security and self-esteem in children.
  • Encourages the development of individual and family identity.
  • Increases children's connections to culture and family belief systems.
  • Provides historical family continuity.
  • Reconnects children to values and spiritual beliefs held by their family systems.
  • Is a protective factor for children's development.
  • Is a protective factor in prevention of children coming into the child welfare system, and,
  • Is an accepted permanency option.
  • The school can be an important resource for the child and grandparent.

Who are the children in the care of relatives and grandparents?

  • About 4 million children live with grandparents.
  • In two-thirds of the 2.5 million grandparent households.
  • The grandmother has no spouse.
  • The children live in poverty.
  • At least 50% of children in kinship care are children of color.
  • Non-Hispanic white children are less likely to live in the care of grandparents or relatives.
  • African-American children are most likely to live in kinship care arrangements.
  • Most children in kinship care are young and likely under 11 years.
  • Most children will not have health insurance, and health and dental issues may be present.
  • Many grandparents have difficulty acquiring legal custody of the child or foster care status because of outdated legal requirements and state laws.
  • Grandparents are often blocked from enrolling children in school, from receiving health care, food stamps and cash assistance to raise their grandchildren.
  • Older grandparents put themselves at health risk under stressful conditions.
  • Grandparents living in subsidized housing have housing problems when children move in with them.
  • Custody laws require grandparents to sue their own children to get custody of the grandchild and access to basic services.

What are the parenting skills and strengths in these families?

  • Grandparents are particularly well suited to promote and assist children in their efforts to find the optimal level of functioning if given sufficient and appropriate support and services.
  • Grandparents and relatives actively promote the child's interests, teach cultural pursuits, sports, hobbies and other activities to encourage self-esteem and building a sense of accomplishment for child and family identity.
  • These parents often experience added stresses of aging and health-related issues and often need additional resources from the community.
  • These families are a source of resiliency for children's development but often need services from the school and community to deal with the problems experienced by the children prior to kinship care.

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Home visiting for parent skills and parent education

Home visiting strategies are used for offering help to families in their homes. Family education and other efforts such as early educationally focused child care suggest the greatest gains can be made. Objectives of these programs include helping parents learn positive child-rearing techniques and effective coping skills, reducing stress and increasing home safety. This model of early intervention focuses on several areas:

  • To assist parents at socioeconomic disadvantage to stimulate children.
  • Low birth-weight infants.
  • Maternal and child health, focusing on both medical and cognitive, needs for child and family outcomes.
  • Treatment of choice for child abuse and neglect for both prevention and intervention.
  • The prevention of out-of-home placement for children and youth.
  • Focus on parental involvement in the relationship with child care and school settings.

Why is parent involvement important?

Parental involvement is an indispensable part of any school readiness strategy. Eight principles in developing parent skill and parent education strategies are:

  1. Families must be partners.
  2. Programs and services share leadership with families.
  3. Families need comprehensive and responsive services.
  4. Culture and home language is acknowledged and respected.
  5. Communication is necessary; talking and listening.
  6. Knowledge and skill development is provided to parents.
  7. Appropriate care and education of children is taught.
  8. Evaluation of partnership success.

Successful interventions for parent skills and parent education using home visiting have these characteristics:

  1. Are intensive, comprehensive and flexible.
  2. Requires each part of the intervention to be built on or relate to the others.
  3. Focus on the parent-child interaction and on the relationship between the parents.
  4. Address the child's physical and mental health and development (activities appropriate for the child's age).
  5. Teach appropriate discipline techniques, and appropriate behaviors modeled by home visitors.
  6. Help parents build support networks.
  7. Can be health focused, paraprofessional focus, or via special teams such as Every Child Succeeds (Cincinnati).

Family Involvement

Family involvement is perhaps the single most important social-environmental influence on children's problematic behaviors. Family behavior is the most predictive of aggressive behaviors and attitudes by children. Much research identifies parental disciplinary practices as key components in the socialization process of problem behaviors and a significant risk factor for negative problem solving and behaviors.

Hispanic families have been described as more cohesive and authoritarian in parenting behaviors (Vega, 1990), and African-American families have been described as consisting of larger kin networks of support and influence (McAdoo, 993). These findings are helpful for planning interventions.

Prosocial community or neighborhood attachment is also important to good child and family outcomes.

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Middle school curriculum on brain development, child development and the importance of a nurturing, safe and interactive home environment

At the recommendation of the parent and family skills and information task force, focus groups were conducted in three middle schools in late 2000. The goal of the focus groups was to talk with middle school students, parents, teachers and administrators to determine what they understood about this topic, what they wanted to know more about, and teaching methods for instruction. The three middle schools were Doral Middle, Mays Middle and Highland Oaks. There were an average of 30 middle school student participants in each school (10 for each grade level). Parent participation averaged 10 per school. Teachers and administrators averaged 8 per school. A facilitator led each group, and FIU graduate students served as observers and recorders.

Each focus group began with a brief introduction of This communities early childhood initiative, the task forces and the priorities. As an introduction to the topic, a TV clip, "From the Beginning", by Diane Sawyer was shown.

Each group were asked these questions:

For students:

  • After viewing the video, what do you think middle school students need to know about brain development? Is it important? Why?
  • Do you think middle school students should be learning about brain development in babies and children? Why or why not?
  • What are the important things you want to know about yourself and others?
  • What would you like to know/learn about interacting with others?
  • What are some things you would like to know about relationships with families?

For parents, teachers and administrators:

  • After viewing the video, what do you think middle school students need to know about brain development? Is it important? Why?
  • Do you think middle school students should be learning about brain development in babies and children? Why or why not?
  • What would you like middle school students to learn about themselves, others and interactions?
  • How would you like middle school students to learn about themselves, others and interactions?
  • What should middle school students need to learn about families and relationships?
  • What are the ways that students should learn about these topics?

Recommendations for Middle School Curriculum


  • Consensus on the need for such instruction in middle school.
  • High agreement that the content provided greater information on understanding themselves and their families.
  • All children and parents thought it would be most helpful in understanding how to get along with others and toward understanding their family relationships.
  • Children and parents wanted the curriculum delivered and administered by persons external to the school system; administrators and teachers wanted the curriculum administered and delivered by persons internal to the school system.
  • Children wanted a consistent time during the week where they had opportunities to talk, share and learn about their own development and behavior.


  • Extremely positive that the content should address brain development and influences on brain development and learning.
  • High interest was expressed in how their own development influenced their behavior and interactions among peers and family.
  • Content should emphasize that spending time in quality interactions with adults and siblings impacts development and ability to learn.
  • Content should be presented via videos, speakers, interactive group sessions and role-play.
  • Content should be culturally based and incorporate family rituals, traditions and beliefs.

Some examples of student comments:

Regarding Learning About Brain Development:

Yes, not because the students are parents, but because maybe their parents didn't read to them and they have younger brother and sisters and they could take this information home to their parents and teach them what to do. Maybe students could even go home and read to a brother and sister so things could be easier for them.

Important things about yourself and others:

How to remember things. Why other kids learn easier than I do. What I physically can do. Why can't I do the same with learning?

Interactions with others:

I want to know how others think, grow up and get to be a certain way.


How to get along with my father? How can I talk to him without him getting angry with me? How can I express my feelings and get him to understand and accept me the way I am?

Why do my parents act as though they don't know what I'm talking about when I am trying to explain myself or my feelings to them?


The format design must be highly interactive and use a technology component such as video. The curriculum must focus on both the biological and social development of the developing child. The nature and nurture relationship between the children and their families must be emphasized throughout. If the public school system cannot accommodate this type of instruction, then the most appropriate organization would be those serving school-age children ages 10-13. A grant should be secured to develop, pilot and evaluate the course.

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Parent education models for families with pre-school behavior problems

These programs have not been tested for empirical evidence of effectiveness, but are identified by experts as promising. Formative and or process evaluations may have been completed but not outcome evaluations.

Program Name

Strengthening Multi-Ethnic Families and Communities

Key Components

  • Integrated various prevention and intervention strategies geared toward reducing violence against self, the family and community.
  • Target population is ethnic and culturally diverse parents with children 3-18 year who are interested in raising children with a commitment to leading a violence-free life style.
  • Short-term objectives are to increase parent sense of competence, positive parent/child interactions, child social competency skills and more parental involvement in community activities.
  • Curriculum includes five components: Cultural/Spiritual, Rites of Passage, Positive Discipline, Enhancing Relationships and Community Involvement.
  • Materials are available in English, Spanish, Vietnamese and Korean.
  • The program helps with child-rearing challenges, encourages family bonding, promotes pride in cultural heritage, supports community bonding and reduces life-threatening risks to children.


Marilyn L. Steele, Ph.D
1220 S. Sierra Bonita Ave.
Los Angeles, Calif. 90019
Tel: 323-936-0343
Fax: 323-936-7130
Email: dr_mls@earthlink.net

Program Name

Nurturing Parenting Program

Key Components

  • Designed to build nurturing skills as alternative to abusive parenting and child-rearing attitudes and practices.
  • Seeks to stop the generational cycle of child abuse by building nurturing parenting skills, reducing the rate of recidivism, reducing the rate of juvenile delinquency and alcohol abuse and lowering the rate of teenage pregnancies.
  • Parents and children attend separate groups that meet concurrently with cognitive and affective activities designed to build self-awareness, positive self-esteem and empathy, teach alternatives to yelling and hitting, enhance family communication and awareness of needs.
  • Programs address specific age groups (infants, pre-school, school-age and teens), cultures (Hispanic, Southeast Asian, African American).
  • Significant increases were found in parenting attitudes and children, personality characteristics in both children and parents and family interaction patterns.


Stephen Bavolek, Ph.D.
27 Dunnwoody Court
Arden, N.C. 28704
Tel: 828-681-8120
Fax: 828-681-8620
Email: fdr@familydev.com

Program Name

Effective Black Parenting

Key Components

  • Cognitive-behavioral program created to meet the specific needs of African-American parents.
  • Seeks to foster effective parent communication, healthy African-American identity, extended family values, child growth and development, substance abuse, juvenile delinquency, gang violence, learning disorders, behavior problems and emotional disturbances.
  • Program is appropriate for all socio-economic status levels and geared for parents of children 2-12 years.
  • African-American educators and mental health professionals teach a series of basic child management skills using African proverbs, African- American linguistic forms and emphasizing African- American achievement and competence.
  • Findings shows significant decrease in parental rejection, increase in the quality of family relationships, and in child behavior outcomes.


Kerby T. Alvy, Ph.D.
Executive Director
Center for Improvement of Child Caring
11331 Ventura Blvd./ Suite 103
Studio City, Calif. 91604
Tel: 800-325-2422
Fax: 818-753-1054
Email: cicc@flash.net

Program Name

Los Ninos Bien Educados Program

Key Components

  • Program built around value of raising children to be "bien educados," e.g., well-educated in a social and personal sense.
  • Developed especially for Spanish-speaking and Hispanic-origin parents with a focus on building parent skills that are respectful of the unique traditions and customs of Hispanic families and sensitive to the variety of adjustments that are made to acculturate to life in the United States.
  • Based on child-rearing research with Hispanic families and recommendations from Hispanic educators and mental health professionals.
  • Content includes teaching basic child development to help parents with age appropriate expectations.
  • Skills are taught with "dichos" or Spanish sayings to help put them in a familiar context.
  • Program is designed to be taught in English and Spanish.
  • Used nationwide and has been the centerpiece in parent involvement programs in numerous school districts.


Kerby T. Alvy, Ph.D.
Executive Director
Center for Improvement of Child Caring
11331 Ventura Blvd./ Suite 103
Studio City, Calif. 91604
Tel: 800-325-2422
Fax: 818-753-1054
Email: cicc@flash.net

Program Name

Making Parenting a Pleasure

Key Components

  • Universal group-based parenting education and support program for parents with children 0-6 years.
  • Program is grounded in best practice principles of the Family Resource Coalition of America, adult learning principles and research.
  • Content was developed in areas parents identified as most important to them: Dealing with stress, understanding normal child development, gaining positive guidance skills, communication skills and wanting to develop feelings of competence as parents.
  • Designed for a wide spectrum of socioeconomic, educational, cultural, ethnic, religious and geographic conditions.
  • Curriculum and all training stress the importance of adapting the curriculum to the needs of the group in terms of pace, language and style.
  • Parents participating in this program who reported having extreme difficulty in managing their child due to their disciplinary practices scored significantly better after program participation.


Minalee Saks,
Executive Director
86 Centennial Loop
Eugene, Ore. 97401
Tel: 541-484-5316
Fax: 541-484-1449
Email: birthto3@efn.org

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Parents as teachers

Parent as Teachers (PAT) is an international family education and support program that begins prenatally -- the onset of learning -- and extends to age 5. The program's primary goal is to help families lay a strong foundation for children's success in school and in life. The program provides screening of children for early detection of developmental health, hearing and vision problems, and helps communities by building a strong partnership between parents and schools. The program meets the needs of broadly diverse families, cultures and special populations including teen parents, parents of children with special needs and families facing critical issues. The program also is adapted for center-based providers.

How does the program work?

The program provides these services: 1) PAT-certified parent educators help parents understand and have appropriate expectations for each stage of their child's development; 2) "Born to Learn" brings the latest neuroscience research findings to parents, offering practical ideas on ways to encourage learning and interact with their children; 3) parents meet to enhance their parenting knowledge, gain insights and share experiences; 4) periodic screenings of overall development, health, hearing and vision provide early detection, and 5) families are helped to access other community services beyond the scope of PAT.

How are staff trained?

To implement a PAT program requires established funding and a supervisor with at least one parent educator. Each parent educator must attend the complete training institute, pass the daily assessments and submit an approved implementation plan. The major cost of implementing a PAT program is the salary and travel of the parent educators. Most PAT parent educators work part-time serving 20 families with monthly visits and additional visits as needed. PAT parent educators use, and encourage families to use, resources readily available in the home for parent-child activities.

What has been the research conducted on this program?

Independent evaluations of PAT program show that children at age 3 are significantly more advanced in language, social development, problem-solving and other cognitive abilities than comparison children. PAT children score higher on kindergarten readiness tests and on standardized measures of achievement in the early grades. PAT participants are more involved in their children's schooling, read more to their children and are more confident as parents.

David Walker
President and CEO
Parents as Teachers National Center, Inc.
10176 Corporate Square Drive/ Suite 230
St. Louis, Mo. 63132
Tel: 314-432-4330
Email: patnc@patnc.org

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Promising parent education programs

The early onset of antisocial and aggressive problems in the very young child accounts for a third to half of referrals. These high rates of behavioral problems in the young child negatively impact the child and others such as their family, siblings, peers and caregivers. Of pre-school children with conduct problems (aggression and noncompliance), only about 20% will have received services for their difficult behaviors. Early aggression and noncompliance problems in the home predict similar school problems. Due to the considerable influence of the family on the very young child, home-based family-oriented models of intervention are essential in improving child conduct problems in pre-schoolers; thus, these children will be better prepared to learn in pre-school and other early care programs and be more ready to learn at entry into school.

What are the assumptions of home-based strategies for families with pre-school conduct problems?

Parent-training or parent education strategies with a behavioral focus, for families of children with conduct problems, has substantial empirical support. Parenting practices and family environment play an important role in the escalation of pre-school conduct difficulties. Coercive parenting practices and poor supervision account for about half the conduct problems displayed in fifth grade. Other risk factors include community stressors, such as poverty, unemployment, single parenting, and lack of education by parents. Home-based family strategies are highly recommended.

Assumptions of Parent Education Models

  • Conduct problems in young children are formed and maintained by the family environment.
  • Parents unknowingly reinforce noncompliant child behaviors or ignore the behaviors they wish to see in the child.
  • Coercive parent-child cycles emerge from parenting patterns such as child disruption and harsh parenting practices.

Content of Parent Education Models

Parents are taught how to demonstrate their influence more effectively and are trained to implement the procedures in the home. Parents are taught these skills:

  1. How to specify goals for behavioral change.
  2. How to track target behaviors.
  3. How to reinforce prosocial conduct through attention, praise and a point system.
  4. How to employ alternative discipline methods, such as differential attention, time out from reinforcements, response cost, and the removal of privileges.

For parents of school-age children, in addition to the above skills, parents are taught how to supervise children and to implement problem-solving, negotiation and contracting strategies.

How is the educational material presented?

  • Instruction.
  • Interactive discussion.
  • Modeling.
  • Role play.
  • Feedback.

What are the best practices available?

Models of Parent Education

  1. Videotape Modeling - The best curriculum is "The Incredible Years training series" by C. Webster-Stratton. Family Strengthening.
    • Exemplary approach to parent education.
    • Targets parents with children ages 2 to 10 using modeling theory.
    • Techniques are modeled through brief vignettes on videotape in a discussion group or individually self-administered.
    • 10 weeks for two hours for groups, or 24 self-administered sessions
    • Significant improvement is shown in maternal parenting stress, in increased parental praise statements to child, and reduced intensity of child problems.
    • Individually administered videotape series appears to have the most overall benefits and was cost effective. Fathers engaged better in this strategy.
    • At the end of three years of follow-up, positive results in reduced child behavior problems and increased prosocial behaviors were seen using both approaches; however, the combination of videotape and group discussion shows greater effectiveness in reducing child behaviors problems.
    • Content of curriculum can focus on parent, teacher and child, in home, work, community, home-school connection or school.
      1. Child and parent problem-solving.
      2. Communication skills.
      3. Interpersonal skills.
      4. Academic skills.
      5. Classroom management skills.
      6. Social skills.
      7. Classroom behavior.
      8. Parenting skills.
    • Combined parent and child training intervention are recommended with teacher training programs, rather than child training only, or parent training only.
  2. Live Parent Training Approaches
    • A great deal of research has occurred using live supervision with a one-way mirror, where the parent is coached, provided feedback, and taught to identify and provide attention and praise for appropriate children's behaviors.
    • Intervention shows lasting impact.
    • Parents indicate decreased stress and improved control and management of children's behaviors over time.
  3. Parent Training Only Programs
    • The focus of all research for conduct problems in pre-schoolers is behavioral, and both group and individuals approaches are found to be effective.
      • Parents report high satisfaction with approach.
      • The training is brief and time limited.
      • Improvement occurs rapidly (10-12 sessions).
      • Treatment manuals and training materials are plentiful and available.
      • Most approaches can be competently provided by well-trained paraprofessionals (who are more effective with younger children than adolescents).
      • Behavioral approaches are less expensive than other approaches.
      • However, about 30% to 46% of families do not respond; thus supplemental intervention for children with more serious problems is needed, e.g., interventions to address lack of social support, marital problems, and maternal depression. Interventions also must consider problem-solving and communication skills deficits in both parents and children.
      • Parent training led to improved parent-child interactions.
  4. Social Adjustment Models
    • Used where deficits or stressors impact the parent's abilities to parent in competent ways, e.g., marital distress and lack of support from partner, particularly when family violence is the issue.
    • The focus is modifying underlying cognitive beliefs and affective pattern needed to impact parenting practices positively.
    • Partners need to be involved; gains are modest at the six-month follow-up. To maintain gains, marital relationship must be given attention.
    • Partners are needed for social support and gains in parenting.
  5. Child-Focus Model
    • Useful for social skills, problem-solving and self-control for school-age children; child's level of cognitive development determined the outcome.
    • Child training when used with parent training interventions is best and most useful approach. The Webster-Stratton model offered advantages over either child-cognitive behavioral or parent training alone.
    • Cognitive behavioral training produced gains in problem-solving and conflict management with peers.


  • Efforts to involve fathers of children and mothers' partners in parent training for maximum social support are important.
  • For child conduct problems behavioral parent training has received a great deal of empirical support and should be offered as a first-line treatment for children and their families.
  • Early screening for conduct problems is essential and may predict more chronic problems.
  • Assessment can take place in health settings, at the school and in child care facilities.
  • Early screening and interventions in mental health and community settings for chronic conduct problems and for child functioning are important at developmental transitions. Interventions should be offered at these points.
  • Other issues to assess and provide intervention for in conduct problems of children are family and marital distress and attachment/relationship problems.
  • Follow-up is critical in children where early aggression and conduct problems are identified.
  • Stressors of poverty (inadequate housing, unemployment, residence in high-crime areas) negatively impact effective parenting as well as follow-through for treatment.
  • Poverty is associated with lack of availability, accessibility and use of mental health services.
  • Attention is needed for minority children who often live below the poverty line and are at increased risk for not obtaining services.
  • Practitioners and curricula need to be sensitized to the values, norms and parenting practices of different minorities groups so training programs will be relevant.
  • There is a lack of information on parent training with parents of pre-schoolers on racial differences.

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Promoting healthy child developmental outcomes in high-risk environments

What are the characteristics of programs found to reduce psychological symptoms or related behaviors in young children?

Researchers, practitioners and policymakers have developed the following conclusions (Panel on High-Risk Youth, National Research Council, 1993) about the necessary intensity and comprehensiveness of programming to prevent psychopathology and promote positive development, especially with children and adolescents growing up in high-risk environments:

  1. Short-term preventive interventions produce time-limited benefits, at best, with at-risk groups whereas multi-year programs are more likely to foster enduring benefits.
  2. Preventive interventions may effectively operate throughout childhood when developmentally appropriate risk and protective factors are targeted. However, given the resistance to treatment of serious conduct problems, ongoing intervention starting in the pre-school and early elementary years may be necessary.
  3. Preventive interventions are best directed at risk and protective factors rather than a specific categorical problem. It is both feasible and cost-effective to target multiple negative outcomes in the context of a coordinated set of programs.
  4. Interventions must be aimed at multiple domains, changing institutions and environments as well as individuals.
  5. Prevention programs that focus independently on the child are not as effective as those that simultaneously "educate" the child and instill positive changes across both the school and home environments. Successful programs focus not only on the child's behavior, but also on the teacher's and family's behavior, the relationship between the home and school, and the needs of schools and neighborhoods to support healthy norms and competent behavior.
  6. There is no single program component that can prevent multiple high-risk behaviors. A package of coordinated, collaborative strategies and programs is required in each community. For school-age children, the school ecology should be a central focus of intervention.
  7. For sustainability, prevention programs need to be integrated with systems of care and treatment.
  8. Programs and communities must develop common conceptual models, common language, and procedures that maximize the effectiveness of programs at each level of need.
  9. School and child care settings are seldom delivering comprehensive interventions that combine both primary prevention and secondary prevention and treatment.


Catalano, R. F., Berglund, M. L., Ryan, J. A. M., Lonczak, H. C., & Hawkins, J. D. (1998). Positive youth development in the United States: Research findings on evaluations of positive youth development programs. (NICHD Publications). Washington, D.C.: U.S. Department of Health and Human Services. Department of Health and Human Services. (1991). Healthy People 2000. Washington, D.C.: Government Printing Office, DHHS Pub. No. (PHS) 91-50212.

Panel on High-Risk Youth, National Research Council. (1993). Losing generations: Adolescents in high-risk settings. Washington, D.C.: National Academy Press.

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Promoting positive development in children

As a nation, what do we want from our children? Naturally, we want then to avoid drugs, violence and crime, and we don't want them to drop out of school or become teen parents. But most parents want something more for their children than simply avoiding serious problems. They want children who are happy and emotionally healthy, who have positive relationships with other people, and who contribute to the community.

While parents hold these desires for their individual children, our collective aspirations for children appear limited to avoiding problems. There is little focus on how to promote positive youth development.

Child Trends, a non-profit research center for children and families, drew from opinions expressed in a national survey and polls from a perceived cultural consensus about characteristics and activities that are instrinsically valuable, and from research that finds associations among certain child and youth characteristics and later positive outcomes.

Parent and Child Relationships:

  • Close parent-child relationships are an important indicator of positive youth development. Youth who disconnect from parental influence are at particular risk for delinquent activities and psychological problems.
  • Closeness to both biological parents is an important measure of positive development.

Sibling Relationships:

  • Positive sibling relationships early in life are associated with higher quality social skills with peers.
  • Friendly behavior toward a younger sibling by an older sibling was associated with the younger sibling's development of relatively mature behavior in both conflictual and cooperative situations.
  • Strong sibling relationships are a source of fun, satisfaction and support while children are young and represent a source of social support over the course of life.

Peer Relationships:

  • Social interactions with peers build on and refine rules and norms of social interaction that children first encounter in their families.
  • Peer relationships can provide cognitive, social and physical stimulation through joint activities and conversations.
  • Children who have poor peer relationships are at risk for later-life difficulties, especially school dropout and criminal behavior.
  • Good friendships are one of life's pleasures and can buffer against mental problems and destructive behaviors.

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The incredible years: Parents, children and teachers training series

The Incredible Years: Parents and Children Training Series was designed as prevention/intervention programs for parents and teachers of children ages 3-12 years. The initial goal is to increase parent and teacher competencies in positive communication, child-directed play skills, consistent and clear limit setting and nonviolent discipline strategies. Goals for children include strengthening social and academic competence, reducing behavior problems and increasing positive interactions with peers, teachers and parents. The long-range goals are:

1) develop comprehensive treatment programs for young children with early conduct problems and 2) develop cost-effective, community-based, universal prevention programs that all families and teachers of young children can use to promote social competence.

How does the program work?

There are three components of training:

  • The first is the BASIC Training Program, offered to parent in groups to foster support, problem solving and self-management. The BASIC program topics include: play, helping children learn, the value of praise and encouragement, use of incentives to motivate children, effective limit setting and handling misbehavior. One version of the BASIC program is for young children 2-7 years; the other is for school-age children 5-12 years.
  • The second component is the ADVANCED Parent-Training Program with children 4-10 years. It supplements the BASIC training that addresses other family risk factors such as depression, marital discord, poor coping skills, poor anger management and lack of support.
  • EDUCATION Parent Training Program is the third component and supplements either the early childhood or school-age BASIC program by focusing on ways to foster children's academic competence. It is designed to teach parents to strengthen their children's reading and academic readiness and promote strong connections between home and school.

Is there a children's component to this model?

The Incredible Years has a children's program, Dina Dinosaur's Social Skills and Problem-Solving Curriculum, designed to teach groups of children friendship skills, appropriate conflict-management strategies, successful classroom behaviors and empathy skills. This can be used as a "pull out" for small groups of children with conduct problems or as a classroom-based preventive program designed to be delivered to all students two or three times a week in 20-minute circle discussions. Video vignettes stimulate children's discussions and role-playing and practice activities.

How are teachers trained?

Teacher training is offered to groups of teachers and can be delivered in a week-long workshop or shorter periods each week. Videotaped vignettes of teachers managing common and difficult situations in the classroom stimulate discussion and problem-solving.

What has been the research conducted on this program?

The Incredible Years Parent, Child and Teacher Training Programs have been researched and extensively field-tested in randomized trials over the past 18 years with more than 1,000 families with young children who have aggressive behavior problems. The BASIC program also been evaluated with more than 700 high-risk Head Start families as a prevention program, The Teacher Training Program has been evaluated in two independent, randomized trials with Head Start teachers as well as in studies with teachers of students in kindergarten through grade three. Parents and teachers were able to significantly reduce children's problem behaviors and increase their social competence and academic engagement.

Special Considerations:

It is essential to be able to offer transportation, child care and dinners, particularly when working with low-income families. Programs need to be offered at a variety of times of day and evening in order to accommodate parent work schedules.

This powerful and comprehensive program has demonstrated results in these areas:

  • Improving family relations.
  • Expanding parental knowledge of appropriate child rearing.
  • Enhancing children's protective factors.

Carolyn Webster-Stratton, Ph.D.
University of Washington
1411 Eighth Ave. W.
Seattle, Wash. 98119
Fax: 206-285-7565

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