Parents are among the most important people in the lives of young children.1 From birth, children are learning and rely on mothers and fathers, as well as other caregivers acting in the parenting role, to protect and care for them and to chart a trajectory that promotes their overall well-being. While parents generally are filled with anticipation about their children’s unfolding personalities, many also lack knowledge about how best to provide for them. Becoming a parent is usually a welcomed event, but in some cases, parents’ lives are fraught with problems and uncertainty regarding their ability to ensure their child’s physical, emotional, or economic well-being.
At the same time, this study was fundamentally informed by recognition that the task of ensuring children’s healthy development does not rest solely with parents or families. It lies as well with governments and organizations at the local/community, state, and national levels that provide programs and services to support parents and families. Society benefits socially and economically from providing current and future generations of parents with the support they need to raise healthy and thriving children (Karoly et al., 2005; Lee et al., 2015). In short, when parents and other caregivers are able to support young children, children’s lives are enriched, and society is advantaged by their contributions.
To ensure positive experiences for their children, parents draw on the resources of which they are aware or that are at their immediate disposal.
1 In this report, “parents” refers to the primary caregivers of young children in the home. In addition to biological and adoptive parents, main caregivers may include kinship (e.g., grandparents), foster, and other types of caregivers.
However, these resources may vary in number, availability, and quality at best, and at worst may be offered sporadically or not at all. Resources may be close at hand (e.g., family members), or they may be remote (e.g., government programs). They may be too expensive to access, or they may be substantively inadequate. Whether located in early childhood programs, school-based classrooms, well-child clinics, or family networks, support for parents of young children is critical to enhancing healthy early childhood experiences, promoting positive outcomes for children, and helping parents build strong relationships with their children (see Box 1-1).
The parent-child relationship that the parent described in Box 1-1 sought and continues to work toward is central to children’s growth and
development—to their social-emotional and cognitive functioning, school success, and mental and physical health. Experiences during early childhood affect children’s well-being over the course of their lives. The impact of parents may never be greater than during the earliest years of life, when children’s brains are developing rapidly and when nearly all of their experiences are created and shaped by their parents and by the positive or difficult circumstances in which the parents find themselves. Parents play a significant role in helping children build and refine their knowledge and skills, as well as their learning expectations, beliefs, goals, and coping strategies. Parents introduce children to the social world where they develop understandings of themselves and their place and value in society, understandings that influence their choices and experiences over the life course.
Over the past several decades, researchers have identified parenting-related knowledge, attitudes, and practices that are associated with improved developmental outcomes for children and around which parenting-related programs, policies, and messaging initiatives can be designed. However, consensus is lacking on the elements of parenting that are most important to promoting child well-being, and what is known about effective parenting has not always been adequately integrated across different service sectors to give all parents the information and support they need. Moreover, knowledge about effective parenting has not been effectively incorporated into policy, which has resulted in a lack of coordinated and targeted efforts aimed at supporting parents.
Several challenges to the implementation of effective parenting practices exist as well. One concerns the scope and complexity of hardships that influence parents’ use of knowledge, about effective parenting, including their ability to translate that knowledge into effective parenting practices and their access to and participation in evidence-based parenting-related programs and services. Many families in the United States are affected by such hardships, which include poverty, parental mental illness and substance use, and violence in the home. A second challenge is inadequate attention to identifying effective strategies for engaging and utilizing the strengths of fathers, discussed later in this chapter and elsewhere in this report. Even more limited is the understanding of how mothers, fathers, and other caregivers together promote their children’s development and analysis of the effects of fathers’ parenting on child outcomes. A third challenge is limited knowledge of exactly how culture and the direct effects of racial discrimination influence childrearing beliefs and practices or children’s development (National Research Council and Institute of Medicine, 2000). Despite acknowledgment of and attention to the importance of culture in
the field of developmental science, few studies have explored differences in parenting among demographic communities that vary in race and ethnicity, culture, and immigrant experience, among other factors, and the implications for children’s development.
In addition, the issue of poverty persists, with low-income working families being particularly vulnerable to policy and economic shifts. Although these families have benefited in recent years from the expansion of programs and policies aimed at supporting them (discussed further below), the number of children living in deep poverty has increased (Sherman and Trisi, 2014).2 Moreover, the portrait of America’s parents and children has changed over the past 50 years as a result of shifts in the numbers and origins of immigrants to the United States and in the nation’s racial, ethnic, and cultural composition (Child Trends Databank, 2015b; Migration Policy Institute, 2016). Family structure also has grown increasingly diverse across class, race, and ethnicity, with fewer children now being raised in households with two married parents; more living with same-sex parents; and more living with kinship caregivers, such as grandparents, and in other household arrangements (Child Trends Databank, 2015b). Lastly, parenting increasingly is being shaped by technology and greater access to information about parenting, some of which is not based in evidence and much of which is only now being studied closely.
The above changes in the nation’s demographic, economic, and technological landscape, discussed in greater detail below, have created new opportunities and challenges with respect to supporting parents of young children. Indeed, funding has increased for some programs designed to support children and families. At the state and federal levels, policy makers recently have funded new initiatives aimed at expanding early childhood education (Barnett et al., 2015). Over the past several years, the number of states offering some form of publicly funded prekindergarten program has risen to 39, and after slight dips during the Great Recession of 2008, within-state funding of these programs has been increasing (Barnett et al., 2015). Furthermore, the 2016 federal budget allocates about $750 million for state-based preschool development grants focused on improved access and better quality of care and an additional $1 billion for Head Start programs (U.S. Department of Education, 2015; U.S. Department of Health and Human Services, 2015). The federal budget also includes additional funding for the expansion of early childhood home visiting programs ($15 billion over the next 10 years) and increased access to child care for low-income working families ($28 billion over 10 years) (U.S. Department
2 Deep poverty is defined as household income that is 50 percent or more below the federal poverty level (FPL). In 2015, the FPL for a four-person household was $24,250 (Office of the Assistant Secretary for Planning and Evaluation, 2015).
of Health and Human Services, 2015). Low-income children and families have been aided as well in recent years by increased economic support from government in the form of both cash benefits (e.g., the Earned Income Tax Credit and the Child Tax Credit) and noncash benefits (e.g., Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program), and millions of children and their families have moved out of poverty as a result (Sherman and Trisi, 2014).
It is against this backdrop of need and opportunity that the Administration for Children and Families, the Bezos Family Foundation, the Bill & Melinda Gates Foundation, the Centers for Disease Control and Prevention, the David and Lucile Packard Foundation, the Health Resources and Services Administration, the U.S. Department of Education, the Foundation for Child Development, the Heising-Simons Foundation, and the Substance Abuse and Mental Health Services Administration (SAMHSA) requested that the National Academies of Sciences, Engineering, and Medicine empanel a committee to conduct a study to examine the state of the science with respect to parenting knowledge, attitudes, and practices tied to positive parent-child interactions and child outcomes and strategies for supporting them among parents of young children ages 0-8. The purpose of this study was to provide a roadmap for the future of parenting and family support policies, practices, and research in the United States.
The statement of task for the Committee on Supporting the Parents of Young Children is presented in Box 1-2. The committee was tasked with describing barriers to and facilitators for strengthening parenting capacity and parents’ participation and retention in salient programs and services. The committee was asked to assess the evidence and then make recommendations whose implementation would promote wide-scale adoption of effective strategies for enabling the identified knowledge, attitudes, and practices. Given the multi- and interdisciplinary nature of the study task, the 18-member committee comprised individuals with an array of expertise, including child development, early childhood education, developmental and educational psychology, child psychiatry, social work, family engagement research, pediatric medicine, public and health policy, health communications, implementation science, law, and economics (see Appendix D for biosketches of the committee members).
Conceptions of who parents are and what constitute the best conditions for raising children vary widely. From classic anthropological and human development perspectives, parenting often is defined as a primary mechanism of socialization, that is, a primary means of training and preparing children to meet the demands of their environments and take advantage
of opportunities within those environments. As Bornstein (1991, p. 6) explains, the “particular and continuing task of parents and other caregivers is to enculturate children . . . to prepare them for socially accepted physical, economic, and psychological situations that are characteristic of the culture in which they are to survive and thrive.”
Attachment security is a central aspect of development that has been
defined as a child’s sense of confidence that the caregiver is there to meet his or her needs (Main and Cassidy, 1988). All children develop attachments with their parents, but how parents interact with their young children, including the extent to which they respond appropriately and consistently to their children’s needs, particularly in times of distress, influences whether the attachment relationship that develops is secure or insecure. Young chil-
dren who are securely attached to their parents are provided a solid foundation for healthy development, including the establishment of strong peer relationships and the ability to empathize with others (Bowlby, 1978; Chen et al., 2012; Holmes, 2006; Main and Cassidy, 1988; Murphy and Laible, 2013). Conversely, young children who do not become securely attached with a primary caregiver (e.g., as a result of maltreatment or separation) may develop insecure behaviors in childhood and potentially suffer other adverse outcomes over the life course, such as mental health disorders and disruption in other social and emotional domains (Ainsworth and Bell, 1970; Bowlby, 2008; Schore, 2005).
More recently, developmental psychologists and economists have described parents as investing resources in their children in anticipation of promoting the children’s social, economic, and psychological well-being. Kalil and DeLeire (2004) characterize this promotion of children’s healthy development as taking two forms: (1) material, monetary, social, and psychological resources and (2) provision of support, guidance, warmth, and love. Bradley and Corwyn (2004) characterize the goals of these investments as helping children successfully regulate biological, cognitive, and social-emotional functioning.
Parents possess different levels and quality of access to knowledge that can guide the formation of their parenting attitudes and practices. As discussed in greater detail in Chapter 2, the parenting practices in which parents engage are influenced and informed by their knowledge, including facts and other information relevant to parenting, as well as skills gained through experience or education. Parenting practices also are influenced by attitudes, which in this context refer to parents’ viewpoints, perspectives, reactions, or settled ways of thinking with respect to the roles and importance of parents and parenting in children’s development, as well as parents’ responsibilities. Attitudes may be part of a set of beliefs shared within a cultural group and founded in common experiences, and they often direct the transformation of knowledge into practice.
Parenting knowledge, attitudes, and practices are shaped, in part, by parents’ own experiences (including those from their own childhood) and circumstances; expectations and practices learned from others, such as family, friends, and other social networks; and beliefs transferred through cultural and social systems. Parenting also is shaped by the availability of supports within the larger community and provided by institutions, as well as by policies that affect the availability of supportive services.
Along with the multiple sources of parenting knowledge, attitudes, and practices and their diversity among parents, it is important to acknowledge the diverse influences on the lives of children. While parents are central to children’ development, other influences, such as relatives, close family friends, teachers, community members, peers, and social institutions, also
contribute to children’s growth and development. Children themselves are perhaps the most essential contributors to their own development. Thus, the science of parenting is framed within the theoretical perspective that parenting unfolds in particular contexts; is embedded in a network of relationships within and outside of the family; and is fluid and continuous, changing over time as children and parents grow and develop.
In addition, it is important to recognize that parenting affects not only children but also parents themselves. For instance, parenting can enrich and give focus to parents’ lives; generate stress or calm; compete for time with work or leisure; and create combinations of any number of emotions, including happiness, sadness, fulfillment, and anger.
As attention to early childhood development has increased over the past 20 years, so, too, has attention to those who care for young children. A recent Institute of Medicine and National Research Council report on the early childhood workforce (Institute of Medicine and National Research Council, 2015) illustrates the heightened focus not only on whether young children have opportunities to be exposed to healthy environments and supports but also on the people who provide those supports. Indeed, an important responsibility of parents is identifying those who will care for their children in their absence. Those individuals may include family members and others in parents’ immediate circle, but they increasingly include non-family members who provide care and education in formal and informal settings outside the home, such as schools and home daycare centers.
Throughout its deliberations, the committee considered several questions relevant to its charge: What knowledge and attitudes do parents of young children bring to the task of parenting? How are parents engaged with their young children, and how do the circumstances and behaviors of both parents and children influence the parent-child relationship? What types of support further enhance the natural resources and skills that parents bring to the parenting role? How do parents function and make use of their familial and community resources? What policies and resources at the local, state, and federal levels assist parents? What practices do they expect those resources to reinforce, and from what knowledge and attitudes are those practices derived? On whom or what do they rely in the absence of those resources? What serves as an incentive for participation in parenting programs? How are the issues of parenting different or the same across culture and race? What factors constrain parents’ positive relationships with their children, and what research is needed to advance agendas that can help parents sustain such relationships?
The committee also considered research in the field of neuroscience,
which further supports the foundational role of early experiences in healthy development, with effects across the life course (Center on the Developing Child, 2007; National Research Council and Institute of Medicine, 2009; World Health Organization, 2015). During early childhood, the brain undergoes a rapid development that lays the foundation for a child’s lifelong learning capacity and emotional and behavioral health (see Figure 1-1). This research has provided a more nuanced understanding of the importance of investments in early childhood and parenting. Moreover, advances in analyses of epigenetic effects on early brain development demonstrate consequences of parenting for neural development at the level of DNA, and suggest indirect consequences of family conditions such as poverty that operate on early child development, in part, through the epigenetic consequences of parenting (Lipinia and Segretin, 2015).
This report comes at a time of flux in public policies aimed at supporting parents and their young children. The cost to parents of supporting their children’s healthy development (e.g., the cost of housing, health care, child care, and education) has increased at rates that in many cases have offset the improvements and increases provided for by public policies. As noted above, for example, the number of children living in deep poverty has grown since the mid-1990s (Sherman and Trisi, 2014). While children represent approximately one-quarter of the country’s population, they make up 32 percent of all the country’s citizens who live in poverty (Child Trends Databank, 2015a). About one in every five children in the United States is now growing up in families with incomes below the poverty line, and 9 percent of children live in deep poverty (families with incomes below 50%
of the poverty line) (Child Trends Databank, 2015a). The risk of growing up poor continues to be particularly high for children in female-headed households; in 2013, approximately 55 percent of children under age 6 in such households lived at or below the poverty threshold, compared with 10 percent of children in married couple families (DeNavas-Walt and Proctor, 2014). Black and Hispanic children are more likely to live in deep poverty (18 and 13%, respectively) compared with Asian and white children (5% each) (Child Trends Databank, 2015a). Also noteworthy is that child care policy, including the recent increases in funding for low-income families, ties child care subsidies to employment. Unemployed parents out of school are not eligible, and job loss results in subsidy loss and, in turn, instability in child care arrangements for young children (Ha et al., 2012).
As noted earlier, this report also comes at a time of rapid change in the demographic composition of the country. This change necessitates new understandings of the norms and values within and among groups, the ways in which recent immigrants transition to life in the United States, and the approaches used by diverse cultural and ethnic communities to engage their children during early childhood and utilize institutions that offer them support in carrying out that role. The United States now has the largest absolute number of immigrants in its history (Grieco et al., 2012; Passel and Cohn, 2012; U.S. Census Bureau, 2011), and the proportion of foreign-born residents today (13.1%) is nearly as high as it was at the turn of the 20th century (National Academies of Sciences, Engineering, and Medicine, 2015). As of 2014, 25 percent of children ages 0-5 in the United States had at least one immigrant parent, compared with 13.5 percent in 1990 (Migration Policy Institute, 2016).3 In many urban centers, such as Los Angeles, Miami, and New York City, the majority of the student body of public schools is first- or second-generation immigrant children (Suárez-Orozco et al., 2008).
Immigrants to the United States vary in their countries of origin, their reception in different communities, and the resources available to them. Researchers increasingly have called attention to the wide variation not only among but also within immigrant groups, including varying premigration histories, familiarity with U.S. institutions and culture, and childrearing
3 Shifting demographics in the United States have resulted in increased pressure for service providers to meet the needs of all children and families in a culturally sensitive manner. In many cases, community-level changes have overwhelmed the capacity of local child care providers and health service workers to respond to the language barriers and cultural parenting practices of the newly arriving immigrant groups, particularly if they have endured trauma. For example, many U.S. communities have worked to address the needs of the growing Hispanic population, but it has been documented that in some cases, eligible Latinos are “less likely to access available social services than other populations” (Helms et al., 2015; Wildsmith et al., 2016).
strategies (Crosnoe, 2006; Fuller and García Coll, 2010; Galindo and Fuller, 2010; Suárez-Orozco et al., 2010; Takanishi, 2004). Immigrants often bring valuable social and human capital to the United States, including unique competencies and sociocultural strengths. Indeed, many young immigrant children display health and learning outcomes better than those of children of native-born parents in similar socioeconomic positions (Crosnoe, 2013). At the same time, however, children with immigrant parents are more likely than children in native-born families to grow up poor (Hernandez et al., 2008, 2012; National Academies of Sciences, Engineering, and Medicine, 2015; Raphael and Smolensky, 2009). Immigrant parents’ efforts to raise healthy children also can be thwarted by barriers to integration that include language, documentation, and discrimination (Hernandez et al., 2012; Yoshikawa, 2011).
The increase in the nation’s racial and ethnic diversity over the past several decades, related in part to immigration, is a trend that is expected to continue (Colby and Ortman, 2015; Taylor, 2014). Between 2000 and 2010, the percentage of Americans identifying as black, Hispanic, Asian, or “other” increased from 15 percent to 36 percent of the population (U.S. Census Bureau, 2011). Over this same time, the percentage of non-Hispanic white children under age 10 declined from 60 percent to 52 percent, while the percentage of Hispanic ethnicity (of any race) grew from about 19 percent to 25 percent (U.S. Census Bureau, 2011); the percentages of black/African American, American Indian/Alaska Native, and Asian children under age 10 remained relatively steady (at about 15%, 1%, and 4-5%, respectively); and the percentages of children in this age group identifying as two or more races increased from 3 percent to 5 percent (U.S. Census Bureau, 2011).
The above-noted shifts in the demographic landscape with regard to family structure, including increases in divorce rates and cohabitation, new types of parental relationships, and the involvement of grandparents and other relatives in the raising of children (Cancian and Reed, 2008; Fremstad and Boteach, 2015), have implications for how best to support families. Between 1960 and 2014, the percentage of children under age 18 who lived with two married parents (biological, nonbiological, or adoptive) decreased from approximately 85 percent to 64 percent. In 1960, 8 percent of children lived in households headed by single mothers; by 2014, that figure had tripled to about 24 percent (Child Trends Databank, 2015b; U.S. Census Bureau, 2016). Meanwhile, the proportions of children living with only their fathers or with neither parent (with either relatives or non-relatives) have remained relatively steady since the mid-1980s, at about 4 percent (see Figure 1-2). Black children are significantly more likely to live in households headed by single mothers and also are more likely to live in households where neither parent is present. In 2014, 34 percent of black
children lived with two parents, compared with 58 percent of Hispanic children, 75 percent of white children, and 85 percent of Asian children (Child Trends Databank, 2015b).
From 1996 to 2015, the number of cohabiting couples with children rose from 1.2 million to 3.3 million (Child Trends Databank, 2015b). Moreover, data from the National Health Interview Survey show that in 2013, 30,000 children under age 18 had married same-sex parents and 170,000 had unmarried same-sex parents, and between 1.1 and 2.0 million were being raised by a parent who identified as lesbian, gay, or bisexual but was not part of a couple (Gates, 2014).
More families than in years past rely on kinship care (full-time care of children by family members other than parents or other adults with whom children have a family-like relationship). When parents are unable to care for their children because of illness, military deployment, incarceration, child abuse, or other reasons, kinship care can help cultivate familial and community bonds, as well as provide children with a sense of stability and belonging (Annie E. Casey Foundation, 2012; Winokur et al., 2014). It is estimated that the number of children in kinship care grew six times the rate of the number of children in the general population over the past decade (Annie E. Casey Foundation, 2012). In 2014, 7 percent of children lived in households headed by grandparents, as compared with 3 percent in 1970 (Child Trends Databank, 2015b), and as of 2012, about 10 percent of American children lived in a household where a grandparent was present (Ellis and Simmons, 2014). Black children are twice as likely as the overall population of children to live in kinship arrangements, with about 20 percent of black children spending time in kinship care at some point
during their childhood (Annie E. Casey Foundation, 2012). Beyond kinship care, about 400,000 U.S. children under age 18 are in foster care with about one-quarter of these children living with relatives (Child Trends Databank, 2015c). Of the total number of children in foster care, 7 percent are under age 1, 33 percent are ages 1-5, and 23 percent are ages 6-10 (Child Trends Databank, 2015c). Other information about the structure of American families is more difficult to come by. For example, there is a lack of data with which to assess trends in the number of children who are raised by extended family members through informal arrangements as opposed to through the foster care system.
As noted earlier, fathers, including biological fathers and other male caregivers, have historically been underrepresented in parenting research despite their essential role in the development of young children. Young children with involved and nurturing fathers develop better linguistic and cognitive skills and capacities, including academic readiness, and are more emotionally secure and have better social connections with peers as they get older (Cabrera and Tamis-LeMonda, 2013; Harris and Marmer, 1996; Lamb, 2004; Pruett, 2000; Rosenberg and Wilcox, 2006; Yeung et al., 2000). Conversely, children with disengaged fathers have been found to be more likely to develop behavioral problems (Amato and Rivera, 1999; Ramchandani et al., 2013). With both societal shifts in gender roles and increased attention to fathers’ involvement in childrearing in recent years, fathers have assumed greater roles in the daily activities associated with raising young children, such as preparing and eating meals with them, reading to and playing and talking with them, and helping them with homework (Bianchi et al., 2007; Cabrera et al., 2011; Jones and Mosher, 2013; Livingston and Parker, 2011). In two-parent families, 16 percent of fathers were stay-at-home parents in 2012, compared with 10 percent in 1989; 21 percent of these fathers stayed home specifically to care for their home or family, up from 5 percent in 1989 (Livingston, 2014). At the same time, however, fewer fathers now live with their biological children because of increases in nonmarital childbearing (U.S. Census Bureau, 2015).
In addition, as alluded to earlier, parents of young children face trans-formative changes in technology that can have a strong impact on parenting and family life (Collier, 2014). Research conducted by the Pew Internet and American Life Project shows that, relative to other household configurations, married parents with children under age 18 use the Internet and cell phones, own computers, and adopt broadband at higher rates (Duggan and Lenhart, 2015). Other types of households, however, such as single-parent and unmarried multiadult households, also show high usage of technology, particularly text messaging and social media (Smith, 2015). Research by the Pew Research Center (2014) shows that many parents—25 percent in
one survey (Duggan et al., 2015)—view social media as a useful source of parenting information.
At the same time, however, parents also are saturated with information and faced with the difficulty of distinguishing valid information from fallacies and myths about raising children (Aubrun and Grady, 2003; Center on Media and Human Development, 2014; Dworkin et al., 2013; Future of Children, 2008). Given the number and magnitude of innovations in media and communications technologies, parents may struggle with understanding the optimal use of technology in the lives of their children.
Despite engagement with Internet resources, parents still report turning to family, friends, and physicians more often than to online sources such as Websites, blogs, and social network sites for parenting advice (Center on Media and Human Development, 2014). Although many reports allude to the potentially harmful effects of media and technology, parents generally do not report having many concerns or family conflicts regarding their children’s media use. On the other hand, studies have confirmed parents’ fears about an association between children’s exposure to violence in media and increased anxiety (Funk, 2005), desensitization to violence (Engelhardt et al., 2011), and aggression (Willoughby et al., 2012). And although the relationship between media use and childhood obesity is challenging to disentangle, studies have found that children who spend more time with media are more likely to be overweight than children who do not (see Chapter 2) (Bickham et al., 2013; Institute of Medicine, 2011; Kaiser Family Foundation, 2004).
The benefits of the information age have included reduced barriers to knowledge for both socially advantaged and disadvantaged groups. Yet despite rapidly decreasing costs of many technologies (e.g., smartphones, tablets, and computers), parents of lower socioeconomic position and from racial and ethnic minority groups are less likely to have access to and take advantage of these resources (Center on Media and Human Development, 2014; File and Ryan, 2014; Institute of Medicine, 2006; Perrin and Duggan, 2015; Smith, 2015; Viswanath et al., 2012). A digital divide also exists between single-parent and two-parent households, as the cost of a computer and monthly Internet service can be more of a financial burden for the former families, which on average have lower household incomes (Allen and Rainie, 2002; Dworkin et al., 2013).
The committee’s approach to its charge consisted of a review of the evidence in the scientific literature and several other information-gathering activities.
The committee conducted an extensive review of the scientific literature pertaining to the questions raised in its statement of task (Box 1-2). It did not undertake a full review of all parenting-related studies because it was tasked with providing a targeted report that would direct stakeholders to best practices and succinctly capture the state of the science. The committee’s literature review entailed English-language searches of databases including, but not limited to, the Cochrane Database of Systematic Reviews, Medline, the Education Resources Information Center (ERIC), PsycINFO, Scopus, and Web of Science. Additional literature and other resources were identified by committee members and project staff using traditional academic research methods and online searches. The committee focused its review on research published in peer-reviewed journals and books (including individual studies, review articles, and meta-analyses), as well as reports issued by government agencies and other organizations. The committee’s review was concentrated primarily, although not entirely, on research conducted in the United States, occasionally drawing on research from other Western countries (e.g., Germany and Australia), and rarely on research from other countries.
In reviewing the literature and formulating its conclusions and recommendations, the committee considered several, sometimes competing, dimensions of empirical work: internal validity, external validity, practical significance, and issues of implementation, such as scale-up with fidelity (Duncan et al., 2007; McCartney and Rosenthal, 2000; Rosenthal and Rosnow, 2007).
With regard to internal validity, the committee viewed random-assignment experiments as the primary model for establishing cause- and-effect relationships between variables with manipulable causes (e.g., Rosenthal and Rosnow, 2007; Shadish et al., 2001). Given the relatively limited body of evidence from experimental studies in the parenting literature, however, the committee also considered findings from quasi-experimental studies (including those using regression discontinuity, instrumental variables, and difference-in-difference techniques based on natural experiments) (Duncan et al., 2007; Foster, 2010; McCartney et al., 2006) and from observational studies, a method that can be used to test logical propositions inherent to causal inference, rule out potential sources of bias, and assess the sensitivity of results to assumptions regarding study design and measurement. These include longitudinal studies and limited cross-sectional studies. Although quasi- and nonexperimental studies may fail to meet the “gold standard” of randomized controlled trials for causal inference, studies with a variety of internal validity strengths and weaknesses can collectively provide useful evidence on causal influences (Duncan et al., 2014).
When there are different sources of evidence, often with some differences in estimates of the strength of the evidence, the committee used its collective experience to integrate the information and draw reasoned conclusions.
With regard to external validity, the committee attempted to take into account the extent to which findings can be generalized across population groups and situations. This entailed considering the demographic, socioeconomic, and other characteristics of study participants; whether variables were assessed in the real-world contexts in which parents and children live (e.g., in the home, school, community); whether study findings build the knowledge base with regard to both efficacy (i.e., internal validity in highly controlled settings) and effectiveness (i.e., positive net treatment effects in ecologically valid settings); and issues of cultural competence (Bracht and Glass, 1968; Bronfenbrenner, 2009; Cook and Campbell, 1979; Harrison and List, 2004; Lerner et al., 2000; Rosenthal and Rosnow, 2007; Whaley and Davis, 2007). However, the research literature is limited in the extent to which generalizations across population groups and situations are examined.
With regard to practical significance, the committee considered the magnitude of likely causal impacts within both an empirical context (i.e., measurement, design, and method) and an economic context (i.e., benefits relative to costs), and with attention to the salience of outcomes (e.g., how important an outcome is for promoting child well-being) (Duncan et al., 2007; McCartney and Rosenthal, 2000). As discussed elsewhere in this report, however, the committee found limited economic evidence with which to draw conclusions about investing in interventions at scale or to weigh the costs and benefits of interventions. (See the discussion of other information-gathering activities below.) Also with respect to practical significance, the committee considered the manipulability of the variables under consideration in real-world contexts, given that the practical significance of study results depend on whether the variables examined are represented or experienced commonly or uncommonly among particular families (Fabes et al., 2000).
Finally, the committee took into account issues of implementation, such as whether interventions can be brought to and sustained at scale (Durlak and DuPre, 2008; Halle et al., 2013). Experts in the field of implementation science emphasize not only the evidence behind programs but also the fundamental roles of scale-up, dissemination planning, and program monitoring and evaluation. Scale-up in turn requires attending to the ability to implement adaptive program practices in response to heterogeneous, real-world contexts, while also ensuring fidelity for the potent levers of change or prevention (Franks and Schroeder, 2013). Thus, the committee relied on both evidence on scale-up, dissemination, and sustainability from empirically based programs and practices that have been implemented and
evaluated, and more general principles of implementation science, including considerations of capacity and readiness for scale-up and sustainability at the macro (e.g., current national politics) and micro (e.g., community resources) levels.
The review of the evidence conducted for this study, especially pertaining to strategies that work at the universal, targeted, and intensive levels to strengthen parenting capacity (questions 2 and 3 from the committee’s statement of task [Box 1-2]), also entailed searches of several databases that, applying principles similar to those described above, assess the strength of the evidence for parenting-related programs and practices: the National Registry of Evidence-Based Programs and Practices (NREPP), supported by SAMHSA; the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which is funded by the state of California; and Blueprints for Healthy Youth Development, which has multiple funding sources. Although each of these databases is unique with respect to its history, sponsors, and objectives (NREPP covers mental health and substance abuse interventions, CEBC is focused on evidence relevant to child welfare, and Blueprints describes programs designed to promote the health and well-being of children), all are recognized nationally and internationally and undergo a rigorous review process.
The basic principles of evaluation and classification and the processes for classification of evidence-based practices are common across NREPP, CEBC, and Blueprints. Each has two top categories—optimal and promising—for programs and practices (see Appendix B; see also Burkhardt et al., 2015; Means et al., 2015; Mihalic and Elliot, 2015; Soydan et al., 2010). Given the relatively modest investment in research on programs for parents and young children, however, the array of programs that are highly rated remains modest. For this reason, the committee considered as programs with the most robust evidence not only those included in the top two categories of Blueprints and CEBC but also those with an average rating of 3 or higher in NREPP. The committee’s literature searches also captured well-supported programs that are excluded from these databases (e.g., because they are recent and/or have not been submitted for review) but have sound theoretical underpinnings and rely on well-recognized intervention and implementation mechanisms.
Other reputable information sources used in producing specific portions of this report were What Works for Health (within the County Health Rankings and Roadmaps Program, a joint effort of the Robert Wood Johnson Foundation and the University of Wisconsin); the What Works Clearinghouse of the U.S. Department of Education’s Institute of Education Services; and HHS’s Home Visiting Evidence of Effectiveness (HomVEE) review.
In addition, the committee chose to consider findings from research using methodological approaches that are emerging as a source of innovation and improvement. These approaches are gaining momentum in parent-
ing research and are being developed and funded by the federal government and private philanthropy. Examples are breakthrough series collaborative approaches, such as the Home Visiting Collaborative Innovation and Improvement Network to Reduce Infant Mortality, and designs such as factorial experiments that have been used to address topics relevant to this study.
Other Information-Gathering Activities
The committee held two open public information-gathering sessions to hear from researchers, practitioners, parents, and other stakeholders on topics germane to this study and to supplement the expertise of the committee members (see Appendix A for the agendas of these open sessions). Material from these open sessions is referenced in this report where relevant.
As noted above, the committee’s task included making recommendations related to promoting the wide-scale adoption of effective strategies for supporting parents and the salient knowledge, attitudes, and practices. Cost is an important consideration for the implementation of parenting programs at scale. Therefore, the committee commissioned a paper reviewing the available economic evidence for investing in parenting programs at scale to inform its deliberations on this portion of its charge. Findings and excerpts from this paper are integrated throughout Chapters 3 through 6. The committee also commissioned a second paper summarizing evidence-based strategies used by health care systems and providers to help parents acquire and sustain knowledge, attitudes, and practices that promote healthy child development. The committee drew heavily on this paper in developing sections of the report on universal/preventive and targeted interventions for parents in health care settings. Lastly, a commissioned paper on evidence-based strategies to support parents of children with mental illness formed the basis for a report section on this population.4
In addition, the committee conducted two sets of group and individual semistructured interviews with parents participating in family support programs at community-based organizations in Omaha, Nebraska, and Washington, D.C. Parents provided feedback on the strengths they bring to parenting, challenges they face, how services for parents can be improved, and ways they prefer to receive parenting information, among other topics. Excerpts from these interviews are presented throughout this report as “Parent Voices” to provide real-world examples of parents’ experiences and to supplement the discussion of particular concepts and the committee’s findings.
4 The papers commissioned by the committee are in the public access file for the study and can be requested at https://www8.nationalacademies.org/cp/ManageRequest.aspx?key=49669 [October 2016].
As specified in the statement of task for this study (Box 1-2), the term “parents” refers in this report to those individuals who are the primary caregivers of young children in the home. Therefore, the committee reviewed studies that involved not only biolofical and adoptive parents but also relative/kinship providers (e.g., grandparents), stepparents, foster parents, and other types of caregivers, although research is sparse on unique issues related to nontraditional caregivers. The terms “knowledge,” “attitudes,” and “practices” and the relationships among them were discussed earlier in this chapter, and further detail can be found in Chapter 2).
The committee recognized that to a certain degree, ideas about what is considered effective parenting vary across cultures and ecological conditions, including economies, social structures, religious beliefs, and moral values (Cushman, 1995). To address this variation, and in accordance with its charge, the committee examined research on how core parenting knowledge, attitudes, and practices differ by specific characteristics of children, parents, and contexts. However, because the research on parenting has traditionally underrepresented several populations (e.g., caregivers other than mothers), the evidence on which the committee could draw to make these comparisons was limited.
The committee interpreted “evidence-based/informed strategies” very broadly as ranging from teaching a specific parenting skill, to manualized parenting programs, to policies that may affect parenting. The term “interventions” is generally used in this report to refer to all types of strategies, while more specific terms (e.g., “program,” “well-child care”) are used to refer to particular types or sets of interventions. Also, recognizing that nearly every facet of society has a role to play in supporting parents and ensuring that children realize their full potential, the committee reviewed not only strategies designed expressly for parents (e.g., parenting skills training) but also, though to a lesser degree, programs and policies not designed specifically for parents that may nevertheless affect an individual’s capacity to parent (e.g., food assistance and housing programs, health care policies).
As noted earlier in this chapter, this report was informed by a life-course perspective on parenting, given evidence from neuroscience and a range of related research that the early years are a critical period in shaping how individuals fare throughout their lives. The committee also aimed to take a strengths/assets-based approach (e.g., to identify strategies that build upon the existing assets of parents), although the extent to which this approach could be applied was limited by the paucity of research examining parenting from this perspective.
A number of principles guided this study. First, following the ideas of Dunst and Espe-Sherwindt (2016), the distinction between two types of family-centered practices—relational and participatory—informed the committee’s thinking. Relational practices are those focused primarily on intervening with families using compassion, active and reflective listening, empathy, and other techniques. Participatory practices are those that actively engage families in decision making and aim to improve families’ capabilities. In addition, family-centered practices focused on the context of successful parenting are a key third form of support for parenting. A premise of the committee is that many interventions with the most troubled families and children will require all these types of services—often delivered concurrently over a lengthy period of time.
Second, many programs are designed to serve families at particular risk for problems related to cognitive and social-emotional development, health, and well-being. Early Head Start and Head Start, for example, are means tested and designed for low-income families most of whom are known to face not just one risk factor (low income) but also others that often cluster together (e.g., living in dangerous neighborhoods, exposure to trauma, social isolation, unfamiliarity with the dominant culture or language). Special populations addressed in this report typically are at very high risk because of this exposure to multiple risk factors. Research has shown that children in such families have the poorest outcomes, in some instances reaching a level of toxic stress that seriously impairs their developmental functioning (Shonkoff and Garner, 2012). Of course, in addition to characterizing developmental risk, it is essential to understand the corresponding adaptive processes and protective factors, as it is the balance of risk and protective factors that determines outcomes. In many ways, supporting parents is one way to attempt to change that balance.
From an intervention point of view, several principles are central. First, intervention strategies need to be designed to have measurable effects over time and to be sustainable. Second, it is necessary to focus on the needs of individual families and to tailor interventions to achieve desired outcomes. The importance of personalized approaches is widely acknowledged in medicine, education, and other areas. An observation perhaps best illustrated in the section on parents of children with developmental disabilities in Chapter 5, although the committee believes this approach applies to many of the programs described in this report. A corresponding core principle of intervention is viewing parents as equal partners, experts in what both they and their children need. It is important as well that multiple kinds of services for families be integrated and coordinated. As illustrated earlier
in Box 1-1, families may be receiving interventions from multiple sources delivered in different places, making coordination all the more important.
A useful framework for thinking about interventions is described in the National Research Council and Institute of Medicine (2009) report Preventing Mental, Emotional, and Behavioral Disorders among Young People. Prevention interventions encompass mental health promotion: universal prevention, defined as interventions that are valuable for all children; selected prevention, aimed at populations at high risk (such as children whose parents have mental illness); and indicated prevention, focused on children already manifesting symptoms. Treatment interventions include case identification, standard treatment for known disorders, accordance of long-term treatment with the goal of reduction in relapse or occurrence, and aftercare and rehabilitation (National Research Council and Institute of Medicine, 2009).
The committee recognizes that engaging and retaining children and families in parenting interventions are critical challenges. A key to promoting such engagement may be cultural relevance. Families representing America’s diverse array of cultures, languages, and experiences are likely to derive the greatest benefit from interventions designed and implemented to allow for flexibility.
Finally, the question of widespread implementation and dissemination of parenting interventions is critically important. Given the cost of testing evidence-based parenting programs, the development of additional programs needs to be built on the work that has been done before. Collectively, interventions also are more likely to achieve a significant level of impact if they incorporate some of the elements of prior interventions. In any case, a focus on the principles of implementation and dissemination clearly is needed. As is discussed in this report, the committee calls for more study and experience with respect to taking programs to scale.
This report is divided into eight chapters. Chapter 2 examines desired outcomes for children and reviews the existing research on parenting knowledge, attitudes, and practices that support positive parent-child interactions and child outcomes. Based on the available research, this chapter identifies a set of core knowledge, attitudes, and practices. Chapter 3 provides a brief overview of some of the major federally funded programs and policies that support parents in the United States. Chapters 4 and 5 describe evidence-based and evidence-informed strategies for supporting parents and enabling the identified knowledge, attitudes, and practices, including universal and widely used interventions (Chapter 4) and interventions targeted to parents of children with special needs and parents who themselves face adversities
(Chapter 5). Chapter 6 reviews elements of effective programs for strengthening parenting capacity and parents’ participation and retention in effective programs and systems. Chapter 7 describes a national framework for supporting parents of young children. Finally, Chapter 8 presents the committee’s conclusions and recommendations for promoting the wide-scale adoption of effective intervention strategies and parenting practices linked to healthy child outcomes, as well as areas for future research.
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