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Parents as First Teachers

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Evidence rating: 3+
Cost rating: 4

Parents as First Teachers (PAFT – also referred to as Parents as Teachers) is for parents with a child aged three or under, typically living in a disadvantaged community.

The aim is to develop family resilience and promote positive parenting behaviours that will persist after the family’s engagement in the programme has ended.

The frequency and duration of PAFT visits is determined by each family’s needs. During the visits, practitioners encourage parents to enhance their role as their child’s first teacher. Practitioners partner with families to share age-appropriate child development and neuroscience information, helping parents to observe their child’s developmental milestones.

Practitioners also facilitate parent-child interaction through age-appropriate talk, play and reading activities. They help parents reflect on their parenting, and jointly develop strategies for addressing developmental and behavioural concerns. Family wellbeing is also addressed during the visits.

EIF Programme Assessment

Evidence rating: 3+
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome. This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
Cost rating: 4
A rating of 4 indicates that a programme has a medium-high cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of €1200 – €2375. This figure is based on an analysis of UK costs and a conversion rate of 1.19.

What does the plus mean?

The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.

Child outcomes

This programme can affect outcomes for children in Active and healthy, physical and mental wellbeing.

According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:

Preventing obesity and promoting healthy physical development

Improved child self-help skills (e.g., sleeping, toileting, scissor use etc.)

based on study 1

  • Statement: 5.76-point improvement using an observational measure of Adaptive Behaviour (Self-Help Skills)
  • Score: 10
  • Timeframe: Immediately after the intervention

Improved developmental milestones (e.g., motor, language, communication skills etc.)

based on study 1

  • Statement: 3.86-point improvement using an observational measure of Adaptive Behaviour (Development Milestones)
  • Score: 11
  • Timeframe: Immediately after the intervention

Improved mastery motivation (task competence)

based on study 2

Preventing child maltreatment

Reduced child maltreatment and neglect

based on study 3

Enhancing school achievement & employment

Improved receptive language

based on study 1

  • Statement: 1.20-point improvement on the Bayley Scales of Infant and Toddler Development III
  • Score: 12
  • Timeframe: 2 years before the end of the intervention (interim measure)

Improved expressive language

based on study 1

  • Statement: 0.65-point improvement on the Bayley Scales of Infant and Toddler Development III
  • Score: 11
  • Timeframe: Immediately after the intervention

Improved vocabulary

based on study 1

  • Statement: 8.15-point improvement on the Language Assessment-Brief (SBE-2-KT and SBE-3-KT)
  • Score: 15
  • Timeframe: Immediately after the intervention

Preventing crime, violence and antisocial behaviour

Improved problem behaviour

based on study 1

  • Statement: 1.27-point improvement on the Child Behaviour Checklist
  • Score: 12
  • Timeframe: Immediately after the intervention

This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.

Who is it for?

The best available evidence for this programme relates to the following age-groups:

Infants Toddlers

How is it delivered?

The best available evidence for this programme relates to implementation through these delivery models:

  • Home visiting

Where is it delivered?

The best available evidence for this programme relates to its implementation in these settings:

  • Home
  • Children's centre or early-years setting

How is it targeted?

The best available evidence for this programme relates to its implementation as:

  • Targeted selective

Where has it been implemented?

  • Germany
  • Italy
  • Switzerland
  • United Kingdom
  • United States

Ireland provision

This programme has not been implemented in Ireland.

Ireland evaluation

This programme’s best evidence does not include evaluation conducted in Ireland.

About the programme

What happens during the delivery?

How is it delivered?

  • PAFT is delivered to parents in their home on a weekly, fortnightly, or monthly basis depending on the family’s level of need.
  • The visits begin at the time of enrolment and then continue until the child’s third birthday.
  • The typical length of a visit is one hour, although it can last up to an hour-and-a-half if the parent has more than one child.

What happens during the intervention?

  • During the home visits, practitioners guide parents in being their child’s ‘first teacher’ by demonstrating strategies that promote children’s development (including language development, social-emotional development, sensory-motor development and intellectual development).
  • These strategies include shared reading activities and play sessions that encourage children’s intellectual development. Practitioners share the activity with parents, modelling as appropriate, and then provide feedback to parents as they practise it with their child.
  • Parents also learn strategies for discouraging unwanted child behaviour and promoting their children’s self regulation.

What are the implementation requirements?

Who can deliver it?

  • Parents as First Teachers is delivered by one practitioner, qualified to NFQ-6 level.


What are the training requirements?

  • The practitioner receives 35 hours of programme training. Booster training of practitioners is recommended.

How are the practitioners supervised?

  • It is recommended that practitioners are supervised by one host-agency supervisor qualified to NFQ-7/8 level, also with 35 hours of programme training.


What are the systems for maintaining fidelity?

  • Newly trained practitioners and their supervisors are invited to a follow-up training day after they have implemented the programme for six months.
  • Agencies delivering PAFT are also required to complete an annual report demonstrating that practitioners are delivering the programme with fidelity.

Is there a licensing requirement?

There is a licence required to run this programme.


How does it work? (Theory of Change)

How does it work?

  • PAFT assumes that a warm and trusting relationship with a supportive practitioner will help parents feel less isolated and increase their sense of confidence.
  • Within this relationship, parents are more able to understand and accept relevant child development knowledge.
  • More confident parents will, in turn, be more likely to access community resources and take an active role in their children’s education.
  • Confident parents will also be more willing to attend parenting groups where they will make friends with other parents and share effective parenting strategies.
  • In the short term, parents will have increased access to community resources and feel less isolated.
  • In the longer term, parents will be better able to support their children’s development.
  • Ultimately, children will have improved physical, emotional and intellectual development.

Intended outcomes

  • Achieving in all areas of learning and development
  • Active and healthy, physical and mental wellbeing
  • Active and healthy, physical and mental wellbeing
  • Safe and protected from harm
  • Safe and protected from harm

Contact details

Pam Holtom
Implementations contact
pamholtom@parentsasfirstteachers.org.uk

PAFT UK (General Enquiries)
info@parentsasfirstteachers.org.uk


About the evidence

Parents as First Teachers most rigorous evidence comes from an RCT which was conducted in Switzerland.  

This study identified statistically significant positive impact on a number of child outcomes.

This programme has evidence from at least one rigorously conducted RCT along with evidence from two additional comparison group studies.  Consequently, the programme receives a 3+ rating overall.

Study 1

Citation:Schaub et al. (2019)
Design:RCT
Country:Switzerland
Sample:252 families with an infant child living in disadvantaged communities in Switzerland
Timing:Interim measurement (2-year before end of intervention); Interim measurement (1-year before end of intervention); Post-test
Child outcomes:
  • Improved child self-help skills (e.g., sleeping, toileting, scissor use etc.)
  • Improved developmental milestones (e.g., motor, language, communication skills etc.)
  • Improved receptive language
  • Improved expressive language
  • Improved vocabulary
  • Improved problem behaviour
Other outcomes:
    Study rating:3

    Schaub, S., Ramseier, E., Neuhauser, A., Burkhardt, S. C., & Lanfranchi, A. (2019). "Effects of home-based early intervention on child outcomes: A randomized controlled trial of Parents as Teachers in Switzerland". Early Childhood Research Quarterly, 48, 173-185.

    Available at
    https://www.sciencedirect.com/science/article/abs/pii/S0885200619300432

    Study design and sample

    The first study is a rigorously conducted RCT. 

    This study involved random assignment of families to a PAFT home visiting group and a usual care group. 

    This study was conducted in Switzerland, with a sample of 252 families with children around 2 months old. The sample included families at an elevated level of psychosocial risk (i.e. mental illness, single parent family, lower socio economic status etc). 78.3% of children in the sample were non-native speakers. 

    Measures

    Expressive and receptive language was measured using the Bayley scales of Infant and Toddler Development III (expert observation of behaviour)

    Vocabulary was measured using the Language Assessment-Brief (SBE-2-KT and SBE-3-KT) (parent report)

    Behaviour was measured using the Child Behaviour Checklist (CBCL) (parent report)

    Findings

    This study identified statistically significant positive impact on a number of child outcomes.

    This includes:

    • Improved expressive language
    • Improved receptive language
    • Improved child behaviour
    • Improved vocabulary

    Study 2

    Citation:Drotar et al., 2008
    Design:RCT
    Country:United States
    Sample:464 families with a child under the age of 9 months living in the USA.
    Timing:Interim measurement (2-years before end of intervention); Interim measurement (18-months before end of intervention); Interim measurement (1-year before end of intervention); Post-test
    Child outcomes:
    • Improved mastery motivation (task competence)
    Other outcomes:
      Study rating:2+

      Drotar, D., Robinson, J., Jeavons, L., & Lester Kirchner, H. (2009). A randomized, controlled evaluation of early intervention: the Born to Learn curriculum. Child: care, health and development, 35(5), 643–649.
       
      Available at:
      https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2214.2008.00915.x
       

      Study design and sample

      The second study is an RCT. 

      This study involved random assignment of children to a PAFT treatment group and a usual care control group. 

      This study was conducted in the USA, with a sample of families with children under the age of 9 months.   

      Measures

      Mastery motivation (Task Competence) was measured using coded observation (expert observation of behaviour)

      Findings

      This study identified a statistically significant positive impact on one child outcome:

      • Improved mastery motivation (Task Competence)

      Study 3

      Citation:Chaiyachati et al., 2018
      Design:QED
      Country:United States
      Sample:4560 at-risk first-time mothers with a new born infant living in the USA.
      Timing:Post-test
      Child outcomes:
      • Reduced child maltreatment and neglect
      Other outcomes:
        Study rating:2

        Chaiyachati, B. H., Gaither, J. R., Hughes, M., Foley-Schain, K., & Leventhal, J. M. (2018). Preventing child maltreatment: Examination of an established statewide home-visiting program. Child abuse & neglect, 79, 476-484.

        Available at:
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894115/

        Study design and sample

        The third study is a QED using propensity score matching.   

        This study involved matching participants of a PAFT home visiting intervention to a no-treatment control group eligible for the programme but who did not participate.

        This study was conducted in the USA, with a sample of first-time mothers screened by the Child Protection Service and found to be at elevated risk of poor outcomes based on a series of risk factors including economic, social, and psychological risks.    

        Measures

        Child maltreatment was measured using Child Protection Service administrative records (expert observation of behaviour)

        Findings

        This study identified a statistically significant positive impact on one child outcome:

        • Reduction in substantiated child maltreatment and neglect

        The conclusions that can be drawn from this study are limited by methodological issues pertaining to the treatment and comparison groups not being generated by sufficiently robust methods, hence why a higher rating is not achieved.

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