The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

Home visiting has broad appeal as a delivery mechanism for providing many kinds of child and family services. Visiting families in their homes can give visitors a holistic view of each child and family, which can help the visitors tailor services to meet family needs. Home visits also can accommodate families' schedules, encouraging the participation of families that might be unable to attend programs with more structured and less individualized schedules. The Parents as Teachers (PAT) program is an example of a widely implemented, universal-access home visiting program that emphasizes positive parenting behavior as the vehicle to achieve developmental benefits for children. Major goals of PAT include increasing parents' knowledge of child development, preparing young children for success in school, and increasing parents' feelings of competence and confidence.¹

To achieve its goals, the PAT program uses individual, home-based instruction and group interactions to inform parents about principles of child development and good parenting practices. Trained and certified parent educators use a standard curriculum in the home visits, which can begin prenatally. The curriculum emphasizes different developmental stages through the first three years of life. Additional curricular materials (developed after the demonstration projects described in this article were begun) meet the particular needs of parents of three- to five-year-olds, parents who are teenagers, and parents whose children attend child care centers. Improved knowledge is expected to help parents feel competent in their roles and to provide the environments and personal interactions with their children that will support positive child development. Healthy, well-developed children who are ready for school are the ultimate intended result.

PAT has enjoyed wide implementation and rapid growth. Begun in Missouri in 1981, the program has expanded to serve more than 500,000 families in more than 2,000 sites in 49 states and six foreign countries.² (See Appendix B in this journal issue for an additional description of PAT.) In addition to the general appeal of home visiting as a service approach, the popularity of PAT is due in part to the inherent attractiveness of its basic premises: "that babies are born learning and that parents are their first and most influential teachers."³ Also, the use of parent educators with a wide range of backgrounds and the provision of, for the most part, monthly services make PAT a relatively inexpensive program model to implement⁴ compared with interventions that rely on nurses ⁵ or that have centerbased, child-focused components in broader two-generation program models.⁶

In 1990, the California legislature provided statutory authorization for a grant program to implement PAT in selected counties in the state,⁷ and articulated the specific intention that it should be targeted to families with parents who had limited English proficiency and to those with parents who were teenagers. Although quasi-experimental studies of PAT in Missouri had indicated benefits for children, the effectiveness of PAT for these particular groups had not been demonstrated. (See Appendix B in this journal issue for a description of other research studies concerning PAT.) Two research studies were launched to evaluate PAT's effectiveness with these populations: the Northern California (Salinas Valley) PAT Demonstration, which focused on Latino families; and the Teen PAT Demonstration.⁸ Evaluations of both demonstrations were conducted by SRI International.

These demonstrations were designed to specifically address the question of targeting PAT to limited English proficient and teen parent families, and also to overcome general weaknesses in the research base of PAT. An expert panel ⁹ called together to review PAT and related research¹⁰ identified the following limitations to the research base and corresponding future research needs:

• More rigorous research designs. Much of what is known about PAT results from quasi-experimental research¹¹ and research with small samples,¹² a state of research common to the home visiting arena more broadly.¹³ Given PAT's expansion, experimentally based results are needed to have the required credibility to influence the national policy arena.

• Research regarding PAT's effectiveness for low-income, minority, and at-risk families. Many of the studies of PAT's effectiveness have been conducted with working- or middle-class white families and/or in nonurban areas.¹⁴ Although generally positive, these results do not provide evidence of PAT's effectiveness for low-income and minority families or for those at risk of poor outcomes. Addressing this gap in the knowledge base regarding PAT overlaps well with determining whether targeting PAT to teen parents and those with limited English proficiency is warranted by its effectiveness with those groups.

• Research regarding the dimensions of program effectiveness. Replicating effective program dimensions requires understanding what it is about the programs that works. Are there thresholds of service intensity that must be met for programs to be effective? To what extent does impact relate to staff characteristics, quality, and training? The expert panel identified the need to illuminate the "black box" of the PAT program so that the contribution of its various elements is understood.

This article reports the results of the Salinas Valley PAT and Teen PAT Demonstrations. Each of the demonstrations is described, including a review of the program model, enrolled families, and the extent to which families were lost to the demonstrations through attrition. Then findings for the full sample of families in each demonstration are presented. Following this is a discussion of the effectiveness of targeting parents with limited English proficiency, using data from the Salinas Valley PAT Demonstration to focus explicitly on results for families with Latina mothers and distinguishing those who spoke primarily Spanish from those who were primarily English speakers or bilingual. Finally, variations in exposure to PAT among enrolled families and the relationship of these variations to outcomes for parents and children are considered.