Decades of research have demonstrated that the parent-child dyad and the environment of the family—which includes all primary caregivers—are at the foundation of children’s well-being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child’s brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents’ lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger.
Parenting of young children today takes place in the context of significant ongoing developments. These include a rapidly growing body of science on early childhood that has provided a more nuanced understanding of the critical periods in early childhood development and parenting. In addition, while child poverty has increased in recent years, there have been increases in funding for programs and services for families, such as early childhood education, home visiting, and income support programs, which have implications for the development of a framework for better supporting parents of young children.
In addition, the demographic characteristics of the U.S. population are changing rapidly. As of 2014, 25 percent of children ages 0-5 had at least
one immigrant parent, compared with just under 14 percent in 1990. Related in part to immigration, the racial and ethnic diversity of families has increased over the past several decades, a trend that is anticipated to continue. For example, between 2000 and 2010, the percentage of Americans identifying as black, Hispanic, Asian, or “other” increased from 15 percent to 36 percent, and the percentage of children under age 10 of Hispanic ethnicity (of any race) grew from about 19 percent to 25 percent.
There also is greater diversity in family structure as a result of increases in divorce, cohabitation, new types of parental relationships (e.g., same-sex parents), and involvement of grandparents and other relatives in the raising of young children. Between 1960 and 2015, the percentage of children and youth under age 18 who lived with two married parents (biological, nonbiological, or adoptive) decreased from approximately 85 percent to 65 percent. In 2014, 7 percent of children lived in households headed by grandparents, compared with 3 percent in 1970.
Finally, parenting is increasingly being shaped by technology and increased access to information about parenting, some of which is not based in evidence. All of the above changes have implications for how best to support the parents and other caregivers of young children.
It is against this backdrop that in fall 2014 multiple federal agencies and private foundations requested that the National Academies of Sciences, Engineering, and Medicine form the Committee on Supporting Parents of Young Children to assess the research on parenting and strategies for supporting parenting in the United States. The committee’s major tasks were to identify parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents’ use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. Based on this assessment, the committee was asked to make recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. The resulting report would serve as a roadmap for the future of parenting policy, research, and practice in the United States.
PARENTING KNOWLEDGE, ATTITUDES, AND PRACTICES
Research reviewed by the committee revealed that certain areas of knowledge and parenting practices are associated with children’s favorable developmental outcomes, although there are some limitations to this research.
In the area of parenting knowledge, the extant research suggests that parental knowledge of child development is positively associated with quality parent-child interactions and the likelihood of parents’ engagement in practices that promote their children’s healthy development. Research also indicates that parents with knowledge of evidence-based parenting practices, especially those related to promoting children’s physical health and safety (e.g., injury prevention, how to sooth a crying infant), are more likely than those without such knowledge to engage in those practices.
Parents’ attitudes about the roles of parents and others in the raising of young children, as well as about specific practices (e.g., breastfeeding, the role of parents in children’s education), contribute to some variation in practices and in the uptake of services for families among individuals and subpopulations. The committee concluded that empirical studies on parenting attitudes do not allow for the identification of core parenting attitudes consistently associated with positive child outcomes. However, the available evidence points to a need for taking parents’ attitudes and beliefs into consideration in the design and implementation of programs and services to ensure that they are sensitive to parents’ needs and to extend their reach.
The committee identified a number of parenting practices associated with positive child outcomes in the areas of physical health and safety, emotional and behavioral competence, social competence, and cognitive competence:
- contingent responsiveness (“serve and return”)—adult behavior that occurs immediately after a child’s behavior and that is related to the child’s focus of attention, such as a parent smiling back at a child;
- showing warmth and sensitivity;
- routines and reduced household chaos;
- shared book reading and talking to children;
- practices that promote children’s health and safety—in particular receipt of prenatal care, breastfeeding, vaccination, ensuring children’s adequate nutrition and physical activity, monitoring, and household/vehicle safety; and
- use of appropriate (less harsh) discipline.
Much of the research on parenting knowledge, attitudes, and practices is correlational, making it difficult to draw firm conclusions about causation. In addition, most studies are focused on mothers, with a lack of research on fathers and other caregivers (e.g., grandparents).
Although studies suggest some variation in parenting knowledge, attitudes, and practices among racial/ethnic, cultural, and other subgroups of parents, more attention is needed as to whether and how these differences matter for child outcomes.
INTERVENTIONS TO SUPPORT PARENTS AND PARENTING
Scaling Effective Interventions
The committee identified a number of interventions that promote the parenting practices described above. These include well-identified formal sources of parenting support for many parents, such as well-child care, center-based child care (Head Start and Early Head Start), and home visiting programs that are largely preventive in their approach. Other interventions are targeted to specific populations of parents, such as parents of children with special needs (e.g., those with developmental disabilities) and parents facing adversities, such as mental illness, substance abuse, and intimate partner violence. Federal efforts also support parents through income assistance, nutrition assistance (e.g., the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]), health care, and housing programs. These programs aid large numbers of parents, primarily those with low incomes, in ensuring their own and their children’s physical health and safety.
Yet many families that could benefit from these interventions neither seek out nor are referred to them. To better support parents and children, then, improved referral mechanisms are needed. Millions of parents interact with health care (e.g., well-child and mental and behavioral health care), education (e.g., early care and education and formal prekindergarten to grade 3), and other community services each year. Along with improvements in workforce preparation (see Recommendations 3 and 4 below), better leveraging the services with which many parents already have ongoing connections as points of intervention and referral would help improve the reach of effective strategies.
Recommendation 1: The U.S. Department of Health and Human Services, the U.S. Department of Education, state and local agencies, and community-based organizations responsible for the implementation of services that reach large numbers of families (e.g., health care, early care and education, community programs) should form a working group to identify points in the delivery of these services at which evidence-based strategies for supporting parents can be implemented and referral of parents to needed resources can be enhanced. Based on its findings, the working group should issue guidance to service delivery organizations on increasing parents’ access to evidence-based interventions.
Research on how to bring effective parenting programs to scale is limited. Although a number of programs are effective in supporting parents, their potential for helping large numbers of families often depends on fac-
tors specific to the families served and to the organizations and communities in which they will be implemented. Additional evidence is needed to inform the creation of a system for efficiently disseminating evidence-based programs and services to the field and for ensuring that communities learn about them, are able to assess their fit with community needs, develop needed adaptations, and monitor fidelity and progress toward targeted outcomes. Findings from this research could be used in an ongoing way to inform the integration of evidence-based interventions into widely used service platforms.
Recommendation 2:1 The U.S. Department of Health and Human Services, the Institute of Education Sciences, the Patient-Centered Outcomes Research Institute, and private philanthropies should fund research focused on developing guidance for policy makers and program administrators and managers on how to scale effective parenting programs as widely and rapidly as possible. This research should take into account organization-, program-, and system-level factors, as well as quality improvement. Supports for scaling efforts developed through this research might include cost tools, measurement toolkits, and implementation guidelines.
Enhancing Workforce Competence in Delivering Evidence-Based Parenting Interventions
A professional workforce with knowledge about and competencies for implementing evidence-based interventions to support parents is essential to the successful scale-up of effective approaches. Evidence-based parenting interventions often are not available as part of either routine services for parents or services not designed specifically for parents but with the potential to benefit many parents, such as treatments for mental illness and substance abuse. One reason for this is that providers of these services often lack knowledge and competencies in evidence-based parenting interventions. Graduate training for providers of children’s services and behavioral health care (e.g., in schools of social work and nursing) currently includes limited or no coursework on evidence-based parenting programs or their core elements. A viable way to increase the availability of evidence-based parenting interventions is to build on the commonality of specific and nonspecific elements across interventions.
1 This recommendation, along with Recommendations 4, 6, and 10 were modified following the transmittal of the report to the study sponsors. In particular, the U.S. Department of Health and Human Services (HHS) was inserted to replace the names of specific agencies within HHS to allow HHS to decide the most appropriate agencies to carry out the recommendations.
Recommendation 3: The U.S. Department of Health and Human Services should continue to promote the use of evidence-based parenting interventions. In so doing, it should support research designed to further operationalize the common elements of effective parenting interventions and to compare the benefits of interventions based on the common elements of effective parenting programs with the specific evidence-based programs from which the elements originated. These efforts also should encompass (1) development of a common terminology for describing common elements and creation and testing of corresponding training materials; (2) development of an open-source curriculum, fidelity-checking strategies, and sustainability strategies for use in educating health and human service professionals in the delivery of evidence-based parenting interventions; and (3) creation of a variety of incentives and training programs to ensure knowledge of effective parenting interventions among professional groups working with young children and their families.
Enhancing Workforce Knowledge and Competence in Parent Engagement
Parents’ engagement in young children’s learning is associated with improvements in children’s literacy, behavior, and socioemotional well-being. Parent engagement is a process that can be facilitated by provider skills in communication and joint decision making with diverse families about their children’s education, but programs designed to prepare individuals to work with young children do not always include evidence-informed strategies for creating successful partnerships with families. Despite growing recognition that partnerships with families contribute to the success of early childhood programs and schools in preparing children for academic success, as well as an emphasis on family engagement in statutes and policies, programs designed to prepare teachers and providers often do not include professional development related to working with parents.
Recommendation 4: The U.S. Department of Health and Human Services and the U.S. Department of Education should convene a group of experts in teaching and research and representatives of relevant practice organizations and research associations to review and improve professional development for providers who work with families of young children across sectors (e.g., education, child welfare, health). Professional development should be evaluated as to whether its core elements include best practices in engagement of and joint decision making with parents, across diverse family structures with other parental caregivers, as well as evidence-informed programs that support parents. The expert group should identify appropriate courses to address issues
of parents and develop appropriate course plans and frameworks for professional development where they are lacking. Courses and coursework on parent engagement for educators of young children should be aligned with the knowledge and competencies outlined in the 2015 Institute of Medicine and National Research Council report Transforming the Workforce for Children Birth through Age 8.
Developing and Disseminating Best Practices in Parent Engagement
Studies have documented the effectiveness of joint decision making (parents as partners) and other approaches to parent-teacher collaboration in education. Accordingly, the Elementary and Secondary Education Act requires that school districts develop and implement parent engagement policies designed to bolster student outcomes. Yet despite the availability of evidence-based approaches for increasing parent engagement in children’s learning and thereby improving child development outcomes, limited official guidance is available on how to do so. In addition to obstacles related to workforce preparation, the implementation and sustained use of best practices in parent engagement are limited by a dearth of official guidance at the local, state, and federal levels, as well as a lack of attention to how families’ culture and language may moderate the effectiveness of school districts’ engagement plans.
Recommendation 5: The U.S. Department of Health and Human Services and the U.S. Department of Education should convene experts in parent engagement to create a toolbox of evidence-informed engagement and joint decision-making models, programs, and practices for implementation in early education settings. The U.S. Department of Health and Human Services and the U.S. Department of Education should disseminate this toolbox to support state and district adherence to requirements for parent engagement such as those described in the Elementary and Secondary Education Act, as well as to support the effective use of parenting interventions by health, behavioral health, and community programs with which parents and their children often have sustained and important connections. Toolbox development and dissemination efforts should include parents from diverse language and cultural backgrounds.
Elements of Effective Interventions
The committee identified features and practices of parenting interventions that appear to influence success in engaging parents and increasing their use of effective parenting practices and in promoting parents’ par-
ticipation and retention in programs and services. No single approach will yield the same positive results for all parents; rather, the diversity of parent beliefs, needs, and resources requires a menu of approaches. Nonetheless, the committee found a number of elements to be successful across a wide range of programs and services for parents:
- viewing parents as equal partners in determining the types of services that would most benefit them and their children;
- tailoring interventions to meet the specific needs of families;
- integrating and collaborating in services for families with multiple service needs;
- creating opportunities for parents to receive support from peers to encourage engagement, reduce stigma, and increase the sense of connection to other parents with similar circumstances;
- addressing trauma, which affects a high percentage of individuals in some communities and can interfere with parenting and healthy child development;
- making programs culturally relevant to improve their effectiveness and participation across diverse families; and
- enhancing efforts to involve fathers, who are underrepresented in parenting research.
On the effectiveness of monetary incentives in improving parents’ participation and retention in programs and services, the committee found mixed results. More recent research suggests that while monetary incentives may enhance parents’ initial interest in parenting programs, they do not necessarily improve attendance over time. This outcome may reflect the fact that monetary incentives do little to address some of the most common barriers to participation cited by parents, such as irregular work schedules and a lack of transportation or child care. Preliminary experimental studies on the use of conditional cash transfers to incentivize low-income families’ engagement in behaviors that can enhance their well-being show an association between receipt of cash transfers and improvements in some economic outcomes such as reduced poverty, food insecurity, and housing hardships and increased employment. However, further work is needed to confirm these findings.
Some studies show that interventions incorporating the use of motivational techniques (e.g., motivational interviewing) in combination with other supportive strategies improve attendance and retention in programs and services for some individuals. Yet, there is a lack of research focused specifically on parents and identifying for which populations of parents these techniques are most effective.
COMMUNICATING EVIDENCE-BASED PARENTING INFORMATION
As noted above, parents with knowledge of child development compared with parents without such knowledge have higher-quality interactions with their young children and are more likely to engage in parenting practices associated with children’s healthy development. Moreover, parents with knowledge of parenting practices that lead to healthy outcomes in children, particularly practices that facilitate children’s physical health and safety, have been found to be more likely to implement those practices. Although simply knowing about parenting practices that promote healthy child development or the benefits of a particular parenting practice does not necessarily translate into the use of such practices, awareness is foundational for behavior that supports children.
When designed and executed carefully in accordance with rigorous scientific evidence, public health campaigns are a potentially effective low-cost way to reach large and heterogeneous groups of parents. Moreover, information and communication technologies now offer promising opportunities to tailor information to the needs of parents based on their background and social circumstances. Several important ongoing efforts by the federal government and private organizations (e.g., the Centers for Disease Control and Prevention, ZERO TO THREE) communicate information to parents on developmental milestones and parenting practices grounded in evidence. Yet inequalities exist in how such information is generated, manipulated, and distributed among social groups, as well as at the individual level in the ability to access and take advantage of the information. Parenting information that is delivered via the Internet, for example, is more difficult to access for some parents, including linguistic minorities, families in rural areas, and parents with less education.
Recommendation 6: The U.S. Department of Health and Human Services and the U.S. Department of Education, working with state and local departments of health and education and private partners, including businesses and employers, should lead an effort to expand and improve the communication to parents of up-to-date information on children’s developmental milestones and parenting practices associated with healthy child development. This effort should place particular emphasis on communication to subpopulations that are often underserved, such as immigrant families; linguistic, racial, and ethnic minorities; families in rural areas; parents of low socioeconomic status; and fathers. Given the potential of public health campaigns to promote positive parenting practices, this effort should draw on the latest state of the science of such campaigns. The effectiveness of communication
efforts also should be evaluated to enhance their success and to inform future efforts.
ADDRESSING GAPS IN RESEARCH
The committee identified a number of interventions that show promise in supporting parenting knowledge, attitudes, and practices for specific groups of parents and children. Further research is needed to understand whether and how these interventions should be scaled up to serve all parents who would benefit from them.
To best guide policy and practice, it is important that such research focus on major gaps in current knowledge and that it use those methodologies most likely to produce evidence that can inform policy or practice. These gaps include interventions previously subjected to rigorous evaluation but not tested in diverse populations; interventions that may have been limited by their mother-only focus; and interventions focused on parents needing services for personal issues, such as mental illness.
More research also is needed on cases in which parenting interventions have been layered onto another intervention and (1) their unique benefit (separate from that of the primary intervention) has not been adequately assessed, or (2) the parenting component was found to have no impact. Examples of parenting interventions that fall into one or both of these categories are enhanced anticipatory guidance, which can be provided as part of well-child care; parenting interventions delivered in conjunction with treatment for parents who have mental illness or substance abuse or are experiencing interpersonal violence; parenting interventions delivered using new information and communication technologies; and parenting components in Head Start, Early Head Start, and WIC. Although evaluation of these layered parenting interventions has been limited, many of them have shown promising initial findings and are supported by sizable public and private investment; thus it is important for both research and practice to optimize opportunities to learn from these investments and build on this existing work. Each of the above examples offers multiple opportunities for researchers to learn from practitioners and for practitioners to work with researchers to identify possibilities for improving both research and interventions and engaging parents.
To generate research that would produce policy-relevant findings, the federal government could sponsor a relatively small number of studies involving large and diverse samples. Most likely to produce findings that would be cumulative and translatable into policy and practice would be a research agenda based on selected parenting behaviors clearly related to child outcomes, entailing studies that would utilize the same small number of measures and instruments. This research also could focus on evaluating
the cost of programs and avenues through which evidence-based programs could be funded.
The evidence-based process used by HHS to design, fund, and implement the Maternal, Infant, and Early Childhood Home Visitation (MIECHV) Program could serve as a model for future research and practice aimed at improving programs designed to support parents and parenting knowledge, attitudes, and practices associated with positive child outcomes. MIECHV began with a systematic review of the evidence, followed by a state competition for funding that required the use of a consistent small set of performance measures, rigorous local evaluation, and participation in a national evaluation. The Health Resources and Services Administration also has implemented collaborative improvement and innovation networks to facilitate ongoing learning and improve models for supporting parenting knowledge, attitudes, and practices in the areas of home visiting and infant mortality prevention that could inform the refinement and implementation of other types of parenting supports.
Recommendation 7: The secretary of the U.S. Department of Health and Human Services and the secretary of the U.S. Department of Education should launch a national effort to address major gaps in the research-to-practice/practice-to-research pipeline related to parenting. This effort should be based on an assessment aimed at identifying the gaps in knowledge that if filled would most advance parenting-related policy and practice. The effort should include (1) systematic review of the evidence for the selected areas; (2) further development and testing of the most promising interventions; (3) research on newly developed and existing interventions conducted through collaborative improvement and innovation networks; and (4) rigorous efficacy, effectiveness, and implementation studies of promising programs and policies. In funding decisions, priority should be given to examining interventions delivered in the context of services that reach large numbers of families, such as prenatal care, well-child care, Head Start and Early Head Start, and parent engagement in the early grades.
Three important areas of need for additional research are described in Recommendations 8, 9, and 10 below, all of which address populations of parents on which relatively little evidence-based research has been conducted and for which few evidence-based interventions have been developed.
Strengthening the Evidence on Parents with Special Needs
Many parents in the United States cope with personal challenges, such as mental illness, substance abuse, or intimate partner violence, as well as
the associated stigma, that can reduce their ability to use effective parenting practices and their access to and participation in evidence-based parenting interventions. Relatively little is known about how best to support parents and parenting practices grounded in evidence for families with such special needs. Research is needed to realize the potential of available interventions that show promise for parents with special needs, as well as to develop new interventions that reflect emerging knowledge of how to support these parents. The strengths of evidenced-based training in parenting skills offer a foundation for improving existing and developing new interventions that can serve greater numbers of families with special needs, including by providing a setting of trust in which parents can reveal their needs.
Recommendation 8: The U.S. Department of Health and Human Services and the U.S. Department of Education, in coordination with private philanthropies, should fund research aimed at evaluating existing interventions that have shown promise and designing and evaluating new interventions for parents with special needs. The design of new interventions should be informed by elements of successful programs, which include treating parents as equal partners, tailoring interventions to meet families’ needs, making programs culturally relevant, ensuring service integration and collaboration for families with multiple needs, providing opportunities for peer support, addressing trauma, and targeting both mothers and fathers. Funders should incentivize the use of state and local data to support this research.
Strengthening the Evidence on Fathers
Children’s development is shaped by the independent and combined effects of myriad influences, especially their mothers and fathers and the interactions between them. During the early years, parents are the most proximal—and most important—influence on children’s development.
Substantial evidence shows that young children have optimal developmental outcomes when they experience nurturing relationships with both fathers and mothers. Research also demonstrates that children benefit when the parents who are living in the same household are supportive of each other and are generally consistent in their expectations for the child and in their parenting behaviors. Further, there is evidence that when parents live apart, children generally benefit if they have supportive relationships with each parent, at least in those cases in which the parents do not have negative relationships with each other. In contrast, children are placed at risk when their parents experience conflict or when they have very different expectations for the child, regardless of whether the parents are living together or
apart. Yet despite the importance of the father-child relationship, fathers continue to be underrepresented in research on parenting and parenting support. Moreover, very few interventions aimed at improving mother-child relationships also target father-child or mother-father-child relationships, whether the parents are living together or apart. When parents are living apart, fatherhood programs typically focus on building fathers’ economic capacity to parent, such as through employment or counseling, rather than on fostering father-child relationships that can promote development.
More research is needed on how to design parenting programs so they better engage fathers and enhance the parenting of both parents. Few studies have evaluated how the dyadic and reciprocal interactions between fathers and mothers and between fathers and their children affect children’s development. Research is needed to identify promising interventions for fathers and mothers both in their individual relationships with their children and in their co-parenting role.
Research also is needed to understand how nonresident fathers can establish long-lasting warm and nurturing relationships with their children. Although steps have been taken to increase evidence-based and empirically rigorous evaluations of fathering programs serving noncustodial fathers (e.g., the federally funded Fatherhood Research and Practice Network), these studies are still in their early stages and may be minimally focused on changes in child outcomes.
Recommendation 9: The U.S. Department of Health and Human Services, in coordination with the U.S. Department of Education and other relevant federal agencies, private philanthropies and foundations, researchers, and research associations focused on children and families, should increase support for studies that can inform the development and improvement of parenting interventions focused on building parents’ capacity to parent both individually and together. Such studies should be designed to identify strategies that can improve fathers’ knowledge and use of parenting practices associated with positive child outcomes, and should examine the unique and combined effects of individual and co-parenting practices, with special attention to building strong relationships between parents and within diverse parenting relationships. The research should focus not only on adult but also on child outcomes, and should be designed to shed light on the specific ways in which greater investments in co-parenting can lead to better outcomes for children. Existing efforts to provide parenting support for both mothers and fathers should be reinforced and expanded in such programs as the Maternal, Infant, and Early Childhood Home Visitation Program, Head Start, and Early Head Start.
Strengthening the Evidence on Diverse Populations
The U.S. population of young children and their parents is demographically, culturally, linguistically, and socially diverse. As noted above, although research suggests that some parenting knowledge, attitudes, and practices vary across groups, little is known about whether and how these differences matter for children’s development. Moreover, relatively little is known about how engagement with, acceptance of, retention in, and the efficacy of interventions for parents vary across culturally and linguistically diverse subgroups. Finally, despite increasing diversity in family structure, data are lacking on how parenting, engagement in interventions and services, and efficacy of services may vary for diverse family forms, kinship providers (e.g., grandparents), stepparents, and other adults assuming parental roles (e.g., foster or adoptive parents). Filling these gaps would improve the ability of evidence-based programs and policies to support the needs of the range of families and children while addressing the needs of parents from historically marginalized and underrepresented populations.
Recommendation 10: The U.S. Department of Health and Human Services and the U.S. Department of Education should launch a multipronged effort to support basic research on parenting and applied research on parenting interventions across diverse populations and family forms. Basic research should include the identification of (1) key constructs and measures related to successful parenting among different populations; (2) important gaps in knowledge of how parenting practices and parent-child interactions affect child outcomes in culturally, ethnically, and socially diverse groups; and (3) constraints that produce disparities in access to and utilization of resources that support parenting across groups and contribute to negative outcomes for parents and children. Applied intervention research should include the formation of a collaborative improvement and innovation network to develop new and adapt existing interventions for diverse groups, and support for rigorous efficacy, effectiveness, and implementation studies of the most promising programs and policies conducted in a manner consistent with Recommendation 7 above.