Person Center Planning

Description

The final portion of this Family Engagement Plan is to know how share power with parents and families in the creation of IFSPs/IEPs, as well as the ethical implications associated with it.DirectionsCourse Objective #6 – Sharing PowerComplete all components of Course Objective #6 (i.e., Monday-Wednesday, Thursday-Saturday)Compare the results you found with the results from the “Power of Partnerships Family Survey” (Step 1 – Survey), your School Observation (Step 2 – School Observation), and the Interview you conducted with a parent/family member (Step 3 – Parent Interview).Download and complete the Family-School Partnership Action PlanLinks to an external site. for this course objective. Be sure to include the following in your plan:At least one strategy from Student Learning Objective 6.1 (e.g., Person-Centered Planning, Student-Led IEPs). The article is the self advocacyAt least one strategy that you can apply from Student Learning Objective 6.2 (e.g., Codes, Ethical Dilemmas).The article is wfc-guide-final.pdfSubmit the following to Canvas:PTA National Standards for Family-School Partnerships Assessment Guide – Standards 5.Family-School Partnership Action PlanDownload Family-School Partnership Action Planfor Standards 5.

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6
Elements of Effective Parenting
Programs and Strategies for Increasing
Program Participation and Retention
Parenting programs in the United States are reaching millions of par­
ents and their children annually, but as discussed in Chapters 4 and 5, only
a limited number of evidence-based, high-quality trials of the effects of
these programs have been carried out. It is costly to conduct such evalua­
tions, and they often are difficult to implement. Very few programs have
undergone multiple evaluations using such designs. Other parenting inter­
ventions have been assessed through smaller studies, observational research,
and case-control studies. Those studies indicate that these interventions
may be effective, achieving improvements in outcomes similar to those
found for the manualized parent training programs that have been studied
experimentally (Chorpita et al., 2013).
This chapter identifies major elements of those programs that have
been found to be effective through randomized controlled trials and other
approaches. The identification of these elements is based on the committee’s
review of multiple studies, literature reviews (Axford et al., 2012), informa­
tion provided by a number of invited speakers at open sessions held for this
study, and committee members’ own expertise and experiences. It should be
noted that even those programs involving manualized interventions—with
their relatively strict ordering of treatment components, each with a pre­
scribed length—can be broken down into those components, which can be
used more flexibly with success (Nakamura et al., 2014). Thus, in assessing
current and developing new programs for strengthening and supporting
parenting, a state policy maker or community service provider could use
these components as benchmarks in determining the likelihood that a pro­
gram will be effective. The identified elements may be especially important
325
326
PARENTING MATTERS
in programs aimed at strengthening parenting in families that face multiple
adversities. Engaging and retaining these parents in parenting programs is
a challenge. They often live in areas without sufficient evidence-based ser­
vices, and they often lack the transportation needed to access such services.
For these families, providing programs that have not been shown to be
effective through experimental or quasi-experimental research but include
elements that are common to such programs may be necessary. Given that
parent participation and retention alone, however, cannot guarantee posi­
tive parent and child outcomes, these programs must have a sound theoreti­
cal approach to helping parents acquire the positive parenting knowledge,
attitudes, and practices discussed in Chapter 2.
Clearly, a parenting program cannot be successful unless parents par­
ticipate and remain in the program. As described earlier in this report and
by Breitenstein and colleagues (2014), studies of face-to-face parent train­
ing interventions indicate that 10 to 34 percent of parents of children in
the preschool to grade school age range enroll to participate (Baker et al.,
2010; Garvey et al., 2006; Heinrichs et al., 2005; Thornton and Calam,
2011). Among those who do enroll, average attendance ranges from 34 to
50 percent of sessions (Breitenstein et al., 2012; Coatsworth et al., 2006;
Scott et al., 2010). It has been estimated that between 20 and 80 percent of
families drop out of mental health prevention and intervention programs
prematurely with many of them receiving less than one-half of the interven­
tion (Armbruster and Kazdin, 1994; Ingoldsby, 2010; Masi et al., 2003).
Lower participation and retention rates limit program reach and dilute
program benefits for parents and families. Throughout the discussion in this
chapter of elements of effective parenting programs, therefore, approaches
that have shown success in increasing parents’ participation and retention
in such programs are noted. The following section of the chapter then de­
scribes some additional strategies for increasing participation and retention.
The final section presents a summary.
ELEMENTS OF EFFECTIVE PROGRAMS
The elements of effective parenting programs include parents being
treated as partners with providers, tailoring of interventions to the needs
of both parents and children, service integration and interagency collabora­
tive care, peer support, trauma-informed services, cultural relevance, and
inclusion of fathers.
Parents as Partners
A critical element of all parenting programs is viewing parents as equal
partners with the provider, experts in what both they and their children
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
327
need. The importance of this approach is evident in programs ranging from
patient-centered medical care to joint decision-making interventions for
parents’ engagement in children’s education (see Chapter 4).
Research has found that treating parents as partners enhances the qual­
ity of interactions between parents and providers and increases parents’
trust in providers (Jago et al., 2013). This idea was supported by parent
commentaries offered as part of the information gathering for this study.
Findings from longitudinal and semi-structured interview research suggest
that the level of therapeutic engagement with parents, empathic interaction
style, and parents’ feelings of being valued are related to participation in
and completion of program activities (Jago et al., 2013; Orrell-Valente et
al., 1999). In a review of 26 qualitative studies (Mytton et al., 2014), hav­
ing an intervention delivered by individuals trusted by or already known
to parents was important in parents’ decisions to participate. (See also the
discussion of participation and retention later in this chapter.)
Tailoring of Interventions to Parent and Child Needs
Because the needs of individual parents and children vary greatly
and often depend on family context, strong programs, including those
using manualized approaches, generally try to tailor the services to fit
individual needs. The importance of such tailored approaches is widely
recognized. For example, organizations providing Part C services under
the Individuals with Disabilities Education Act (IDEA) look to individual
family needs and child characteristics in designing interventions. The im­
portance of personalized approaches to parenting skills also is central in
working with parents with mental illness. Depressed parents, for example,
may benefit particularly from training in dealing with conflict and diffi­
cult child behaviors, whereas those with borderline personality disorder
may gain the most from education in providing a consistent routine and
nurturing (Beeber et al., 2014; Stepp et al., 2012). Certain mental health
disorders, such as schizophrenia, can lead to difficulty responding to emo­
tional cues from infants and children, so programs that promote coaching
to increase these skills may be particularly useful for individuals with
those disorders, especially given the importance of early infant attachment
(see Chapter 2) (Craig, 2004; Gearing et al., 2012; Nicholson and Miller,
2008; Stepp et al., 2012). This tailoring of treatment requires highly quali­
fied and trained staff.
In addition, tailoring programs requires understanding and responding
to gender differences in both the needs and the receptivity of parents. For
example, mothers and fathers are likely to respond differently to program
support based not only on their gender and role differences but also such
factors as their engagement with the child and family, the level of respon­
328
PARENTING MATTERS
siveness of program staff, the nature of familial and community expecta­
tions and supports, and their residential status.
As discussed in Chapter 1, many children are raised by a same-sex
couple or a sexual minority parent. Few studies have explored the par­
enting experience of sexual minority adults. Studies that have been done
suggest that lesbian and gay parents adjusting to parenthood generally
experience levels of stress comparable to those experienced by their het­
erosexual counterparts (Goldberg and Smith, 2014). Lesbian and gay
parents, particularly when new to parenthood, have many of the same
concerns as any other new parents and could benefit from the same sup­
port structures (e.g., those provided by parent support groups/classes,
medical professionals, teachers, or community groups). It is important
for these programs to recognize that some parents whom they are serving
might be sexual minorities and to adjust programming and terminology
to be inclusive of sexual minority parents and nontraditional families
more generally. Some studies have indicated that certain subsets of sexual
minority parents (e.g., female partners of biological lesbian mothers)
might have increased stress upon becoming parents, and it is important
for programs to offer support to these groups in particular (Tornello et al.,
2011; Wojnar and Katzenmeyer, 2014). In addition to experiencing the
routine stresses of parenting, sexual minority parents and their children
may face social stigma and discrimination.
Parents report that several of the barriers to participation in parent­
ing programs are practical, such as not having transportation to reach
the site where the intervention is being provided, being unable to arrange
for child care, and having work and scheduling conflicts (Morawska et
al., 2011). Many evidence-based parenting interventions provide trans­
portation assistance and child care (Snell-Johns et al., 2004), and there is
evidence that matching program scheduling with parents’ own schedules
is associated with higher rates of participation (Gross et al., 2001). In a
recent systematic review of 26 qualitative studies in which parents were
asked about why they did or did not enroll in or complete a parenting
program, the time and place of the program delivery and the lack of col­
location of classes with child care emerged as major factors related to
participation (Mytton et al., 2014). Transportation is a primary barrier
across multiple types of programs, not just those focused on parenting,
particularly for those with limited income and access to personal and reli­
able public transportation.
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
329
Parent Voices
[One parent described transportation and child care-related challenges to
participation.]
“For us, we want our kids to go to school as soon as possible. Transporta­
tion is a problem. Head Start programs can start at noon or nine o’clock
in the morning. Time is a challenge for parents. Some women don’t know
how to drive. For our culture, we don’t want to put kids in daycare either.”
—Mother from Omaha, Nebraska
Service Integration and Inter-agency Collaborative Care
Service integration continues to be particularly important in the provi­
sion of services for families facing multiple challenges, including histories of
trauma, substance use, relationship instability, and lack of social supports
(Hernandez-Avila et al., 2004; Howell and Chasnoff, 1999). Integrated care
often includes using a centralized access point for treatment of the parents’
condition(s), combined with services to improve their parenting skills,
such as parent training or child-related interventions (Niccols et al., 2012).
Integration of services gives parents easier access to resources that address
multiple needs and improves collaboration and continuity of care (Krumm
et al., 2013; Schrank et al., 2015), and may help to reduce the stigma that
can be associated with targeted interventions (Cortis et al., 2009). Service
integration can also ease scheduling and transportation challenges for fami­
lies (Ingoldsby, 2010).
Families contending with an array of adversities often also need services
to address such needs as job training, housing, and income support, as well
as active support to help them access and utilize those services (Gearing
et al., 2012; Hinden et al., 2005, 2006). Helping parents deal with these
stressors may free up personal resources, enabling them to focus better on
improving their parenting skills (Ingoldsby, 2010). Indeed, lower economic
stress and interparental conflict have been found to be associated with
increased enrollment and participation in parenting interventions (Wong
et al., 2013). Likewise, mothers in a study that included “family coaches”
who helped link parents to other services in addition to direct parenting
support reported strong satisfaction with the program (Nicholson et al.,
2009). Conversely, interventions that fail to address coping mechanisms
for family issues and parental stressors can drive families out of programs
(Prinz and Miller, 1994).
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PARENTING MATTERS
Peer Support
Engagement in services and positive outcomes can be increased by
linking behavioral supports with peer support (Axford et al., 2012; Barrett
et al., 2008). Beyond increased engagement, strengthening social support
among parents can have multiple benefits, including reduced stigma, in­
creased sense of connection, and reduced isolation. For example, research
using various methodologies indicates that interventions have successfully
addressed both the stigma of mental illness and the social isolation of many
parents by providing peer support via groups, classes, or even the Internet
(Cook and Mueser, 2014; Craig, 2004; Kaplan et al., 2014; Schrank et al.,
2015; Wan et al., 2008).
Parenting programs using a multifamily or multiparent group format
allow participants to share their parenting experiences with others who
serve as a source of social support and peer learning (Coatsworth et al.,
2006; Levac et al., 2008; McKay et al., 1995). The opportunity to exchange
ideas and receive support from peers may be an important reason why
parents join and attend group parenting classes (Jago et al., 2012, 2013;
Mytton et al., 2014). In experimental research, parents with serious men­
tal illness, for example, report that peer groups help them feel understood
and safe, and this may motivate them to return to the groups (Dixon et
al., 2001, 2011). Peer support helps parents learn how others successfully
provide guidance and set limits for and engage in other positive interac­
tions with their children. Including spouses or partners in mental health
visits is another way of decreasing stigma and encouraging support, based
on findings from randomized controlled trials (Dennis, 2014). Notably,
peer support services may be reimbursable by Medicare, Medicaid, states,
and private health plans (Daniels et al., 2013). While peer support can be
valuable in engaging and sustaining parent participation, however, it is not
a substitute for professional staff with training in working with parents
facing specific adversities.
Finally, it is important to note that, despite the limitations of evidencebased approaches for fathers, fatherhood programs incorporating peer
support have shown success (Fagan and Iglesias, 1999). Evidence-based
approaches now being implemented in fatherhood programs are likely to
yield important data on the efficacy of peer support among fathers.
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
331
Parent Voices
[One parent described how she benefitted from peer support.]
“Sometimes you don’t realize stuff until you talk about it. You don’t realize
how angry you was [sic] or how much you are over stuff or this or that
until you talk about it. And then talking to people that don’t know you.
And not going to give you crazy feedback [from your family and friends].
And that advice never helps. Because as much as your family think [sic]
they know you, they have no idea.”
—Mother from Washington, DC
Trauma-Informed Services
Considerable research over the past 10 years has demonstrated the
significant impact of traumatic experiences on a variety of outcomes during
childhood and into adulthood. The Adverse Childhood Experiences (ACEs)
study, which surveyed more than 17,000 members of a health maintenance
organization in California, found that a large percentage had experienced
traumatic experiences and demonstrated the connection between such ex­
periences in early childhood and later adverse health outcomes (Anda et
al., 2009). Relevant to the present context, trauma can have a significant
impact on parenting ability. According to Banyard and colleagues (2003,
p. 334) “cumulative exposure to trauma is associated with less parenting
satisfaction, greater levels of neglect, child welfare involvement, and using
punishment.” Cumulative exposure to trauma is predictive of parents’
potential for child abuse, more punitive behavior, and psychological aggres­
sion in correlational research (Cohen et al., 2008).
Trauma has a particularly damaging effect on children’s development.
Children exposed to trauma often experience problems with regulation of
affect and impulses, constricted emotions, and an inability to express or
experience feelings (Armsworth and Holaday, 1993; van der Kolk, 2005).
Children who have experienced significant trauma without adequate paren­
tal support tend to have a heightened sense of vulnerability and sensitivity
to environmental threats; experience high levels of guilt and shame; and
have high rates of anxiety and depressive symptoms, including hypervigilance, hopelessness, anhedonia, suicidal ideation, and suicide attempts
(Armsworth and Holaday, 1993; van der Kolk, 2005).
Based on these findings, many parenting programs now adopt a traumainformed approach. Trauma-informed services are not about a specific in­
tervention or set of interventions. According to the Substance Abuse and
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PARENTING MATTERS
Mental Health Services Administration, a trauma-informed approach “real­
izes the widespread impact of trauma and understands potential paths for
recovery; recognizes the signs and symptoms of trauma in clients, families,
staff, and others involved with the system; responds by fully integrating
knowledge about trauma into policies, procedures, and practices; and seeks
to actively resist re-traumatization” (Substance Abuse and Mental Health
Services Administration, 2015b).
Trauma may affect provider relationships with parents and therefore
their children. In trauma-informed services, an understanding of trauma
permeates services, and all staff have the ability to view clients in the
context of their life histories. It is important that providers be able to rec­
ognize signs and symptoms of trauma, a history of trauma, and traumatic
stress, and have training in how to provide trauma-informed care (Institute
for Health and Recovery, 2016). Interventions for parents may include
present-focused trauma-specific therapies, such as Seeking Safety, Risking
Connection, and Sanctuary. All of these are considered present-focused
therapies, because they focus on developing skills to cope with trauma in
the present. These therapies teach such skills as self-soothing, grounding,
and engaging in healthy relationships, as well as other skills necessary for
coping with trauma (Substance Abuse and Mental Health Services Admin­
istration, 2015b).
It is important to note that trauma can occur within typical interac­
tions between parents and children or may be brought about as a result of
unusual circumstances. In both instances, parents must find safe places for
their children and navigate the turmoil that can have potentially deleterious
effects on their children and themselves. Considering the high prevalence
of trauma among at-risk parents and the impact of traumatic events on
parenting and child development, assessing for past traumatic experiences
and providing trauma-informed care for all at-risk parents can improve
outcomes and may be cost effective in the long run (Hornby Zeller Associ­
ates, 2011).
Cultural Relevance
Parenting programs have historically had low utilization, especially
among culturally diverse parents (Cunningham et al., 2000; Eisner and
Meidert, 2011; Katz et al., 2007; Sawrikar and Katz, 2008). If intervention
components and providers are not sensitive to cultural variations among
families with respect to their coping styles and expression of problems,
parents may be less likely to participate (Brondino et al., 1997; Moodie and
Ramos, 2014; Prinz and Miller, 1994). Baumann and colleagues (2015) ex­
amine the extent to which researchers and developers of several commonly
used evidence-based parent training programs (Parent-Child Interaction
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
333
Therapy [PCIT], Incredible Years, Parent Management Training-Oregon
[PMT-O], and Triple P) have used culturally adapted models. Of 610
articles on these programs, only 8 document a rigorous cultural adaptation
process, and just 2 of these programs used rigorous methods to test the
program implementation. Recent efforts to rigorously test cultural adap­
tations of PCIT (McCabe and Yeh, 2009), PMT-O (Parra Cardona et al.,
2012), and ParentCorps (Dawson-McClure et al., 2015) indicate growing
awareness of the importance of developing and testing innovative ways to
engage, retain, and educate Latino families.
At the same time, parenting programs delivered without significant
modification and not incorporating tested cultural adaptations are some­
times viewed as highly attractive by local communities. This was the case
with the implementation of SafeCare® in American Indian communities
in Oklahoma, where researchers found that their manualized, structured,
evidence-based model was a reasonable fit with American Indian parents
in child welfare. SafeCare had higher client ratings of cultural competency,
working alliance, service quality, and service benefit than services as usual
(Chaffin et al., 2012). The Huey and Polo (2008) review of evidence-based
psychosocial interventions for children found no pressing need for such ad­
aptations. The culturally adapted interventions that have been tested have
shown little added benefit, and outcomes for minority children and families
who receive unadapted services generally are good, although this is not to
minimize the need for cultural sensitivity and clinical expertise in order to
engage families in treatment (Huey et al., 2014).
Inclusion of Fathers
As noted previously, fathers are underrepresented in research on
parenting-related interventions. Moreover, relatively few fatherhood studies
have examined the relationships between specific fathering behaviors and
desired child outcomes. Although further research is needed, available
studies indicate that parenting interventions would benefit from the use of
approaches giving greater priority to fathers’ participation, such as starting
with an expectation that they will participate and using content and activi­
ties that they will find pertinent, in addition to using strategies that may
improve participation more generally (e.g., providing financial incentives
[discussed below] and scheduling sessions at times that are convenient)
(Administration for Children and Families, 2015; Zaveri et al., 2015).
The data are clear and poignant regarding the lack of evidence-based
strategies in fatherhood programs. In a study by Bronte-Tinkew and col­
leagues (2008), only 4 of 18 programs reviewed had rigorous enough
designs to be considered model and promising. Much of the research on
fathers and programs that include them has examined low-income, non­
334
PARENTING MATTERS
BOX 6-1
A Father’s Story
A proud husband and father of three children shared his story with the
committee during one of its open sessions. His experience of becoming a father
altered the direction of his life, influencing him to find the right path so as to be
a role model for his children. During his journey as a father, he became part
of a community in the Fatherhood Is Sacred Program in Sacramento. There he
realized the importance of community support in helping him achieve his goal of
becoming a good father.
He grew up in a tough neighborhood in North Sacramento, California. During
his childhood and adolescence, he was forced to stick up for himself and his
brothers. He came from a home in which the outward expression of love was rare.
He pinpointed this, along with the fact that he did not have a role model at home,
as the reason why he began hanging around with the wrong crowd. “I would say
it was the wrong crowd of people to support me.” He experienced a troubled
adolescence: “I have been beat up, just been beat down by every obstacle that
I can imagine.”
The birth of his first child, a daughter who is now 10 years old, helped him
start viewing his life from a different perspective—the perspective of a father. He
worked toward becoming a better parent, but he struggled, as it was easy to fall
back into the habits he had developed in the first 32 years of his life. “You learn
so much of this terrible way of living. . . . Yes, I did fall back.”
After the birth of his two sons, he recognized the need for support in keeping his family together and being a role model to his children, but this need was
something he tried to ignore. It was then that other fathers in his neighborhood
led him to Fatherhood Is Sacred, where he was immediately welcomed into a safe
environment. “As a grown man, I felt safe and invited and welcomed, like I was
at home.” Once he became engaged in the program, he began doing the work to
strengthen his parenting skills—work he had not been doing for 32 years. He has
been actively involved with Fatherhood Is Sacred for nearly 3 years.
He views Fatherhood Is Sacred as more than a program; for him, it is a family. He works to engage families in the program throughout Sacramento, where
he grew up. “For years, I took from our community. I was a big contributor to that
[and] it is all positive now.” Doing this work has helped him strengthen his ties, not
only to his community, but also to his three children. In contrast with the household in which he was raised, he expresses to his children that he loves them. He
educates them, and he believes that education starts in the home. “It is true, the
saying, a father is a son’s first hero . . . and a daughter’s first love, because that’s
where it starts. . . . I am very proud to be here and to be where I am at today, for
our next generation and generations to come for my family, for my friends, for the
people that look up to me, [and] for my community.”
SOURCE: “Perspectives from Parents,” Open session presentation to the Committee on Supporting the Parents of Young Children, June 29, 2015, Irvine, California.
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
335
residential fathers but has not monitored effectively how fathers negotiate
the core problems they face (e.g., unemployment, alienation of children
and families, low schooling) or examined the effects of fathers’ program
participation on children over a sustained period of early development.
Recent attention to programs for fathers and the need for systematic and
grounded research should ultimately yield greater understanding of how
fathers are affected by their involvement in such programs (see Box 6-1),
but still may not illuminate with evidence-based data complex issues related
to father-child interactions.
ADDITIONAL STRATEGIES FOR INCREASING
PROGRAM PARTICIPATION AND RETENTION
As noted above, evidence indicates that parenting programs often ex­
perience substantial difficulty in engaging and retaining parents, especially
those facing multiple adversities. Some of the reasons for this difficulty are
discussed in Chapter 5 and above. In recent years, two strategies—monetary
incentives and motivational interviewing—have been used to address this
problem. Although these are promising practices, more research is needed
to determine how they might best be utilized. Also important to engaging
and retaining parents in parenting programs is appropriate preparation of
the workforce, discussed in this section as well.
Monetary Incentives
Some parenting programs offer families modest monetary incentives in
an effort to improve enrollment and retention, but few randomized studies
have assessed the effectiveness of such incentives in increasing participa­
tion. In one randomized study, Dumas and colleagues (2010) evaluated the
effect of a small monetary incentive on low-income parents’ engagement
in sessions of the Parent and Child Enrichment (PACE) Program over an
8-week period. (PACE is a manualized intervention designed to address
parents’ challenges related to childrearing.) The monetary incentive encour­
aged some parents to enroll but not to attend sessions. Among parents who
both enrolled in the study and attended sessions (N = 483), attendance over
eight sessions was comparable between groups who did and did not receive
the incentive. There also was no major difference between the two groups
in the percentage of parents who dropped out of the program at any point
after the first session. Similarly, in a European randomized study (Heinrichs,
2006), low-income families who were offered a small payment to attend a
series of Triple P parent trainings did not attend at a significantly higher rate
than families who were not offered payment. Payment did appear to result
in a large increase in recruitment compared with the unpaid condition,
336
PARENTING MATTERS
leading the authors to conclude that payment may be an effective strategy
for increasing recruitment and initial attendance for some populations (see
also Guyll et al., 2003). Older research on financial incentives and attrition
in parent education has yielded mixed findings, with some studies showing
a positive effect (Mischley et al., 1985; Rinn et al., 1975) and others not
(Lochman and Brown, 1980; Sadler et al., 1976; Snow et al., 2002).
Some evidence indicates that the use of an incentive that exceeds an
individual’s perception of the value of an intervention may result in distrust
and be counterproductive (Snow et al., 2002). Consistent with cognitive
dissonance theory (Festinger and Carlsmith, 1959), if a potential partici­
pant thinks the incentive is too large, the value of the intervention may be
compromised by the person’s discomfort stemming from the feeling that his
or her beliefs/values and behavior are incongruent. Moreover, while some
experimental research suggests that modest monetary incentives help attract
families that otherwise would not participate (Dumas et al., 2010; Guyll et
al., 2003; Heinrichs, 2006; Heinrichs and Jensen-Doss, 2010), these pay­
ments do little to mitigate practical (e.g., child care, transportation) and
other obstacles to parents’ attendance and retention over time.
Another approach to incentives is the use of conditional cash transfers
(CCTs). This approach entails providing cash payments to families living in
poverty based on the parents’ or children’s engagement in specific activities.
CCT programs traditionally have focused on improving children’s health
and well-being and conditioned families’ receipt of cash transfers on receipt
of recommended preventive health services or nutrition education and/or
children’s school attendance. CCTs are increasingly being used to promote
other behaviors as well (Fernald, 2013).
Building on some successes in developing countries (Engle et al., 2011;
Fernald, 2013; Rasella et al., 2013), the first demonstration of CCTs in the
United States was launched in New York City in 2007. Called Opportunity
NYC-Family Rewards, it provided cash assistance to families in the city’s
highest-poverty communities with the goal of reducing intergenerational
economic hardship. Payments were conditioned on families’ efforts to im­
prove their health, increase parents’ employment and income, and support
children’s education. Children also were paid in response to their educa­
tional activities and performance.
An experimental analysis of this program involving 4,800 families who
participated for 3 years found that the families were transferred more than
$8,700 during the 3-year period and that poverty, hunger, and housingrelated hardships were reduced, but these effects weakened as the cash
transfers ended. Parents’ self-reported full-time employment also increased,
but not in jobs covered by unemployment insurance (Riccio et al., 2013).
Results for children varied by their age. Neither school attendance nor over­
all achievement improved among elementary and middle school students
ELEMENTS OF EFFECTIVE PARENTING PROGRAMS
337
whose families received the payments. But children in these families who
entered high school as proficient readers attended school more frequently,
earned more course credits, were less likely to repeat a grade, scored higher
on standardized tests, and had higher graduation rates. Families’ receipt of
preventive d