Changing the Criteria Used for
Nurturing Parenting Programs and Over 30 Years of Evidence
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Changing Criteria for Evidence-Based Status: Randomized Control Trial (RCT) Research Design
The field of parenting education, particularly as it pertains to providing parenting education to families charged with child abuse and neglect, is witnessing a dramatic change in what is being recognized as an evidence-based program.In conducting research to support the effectiveness of a program, there are essentially two categories of research design that are acceptable in the field: Experimental and Quasi-Experimental Designs for Research. The design most used in experimental studies is called Randomized Control Trial (RCT).
A book written in the 1960s by Donald T. Campbell and Julian C. Stanley called Experimental and Quasi-Experimental Designs for Research remains a classic in the field. According to Stanley and Campbell, RCTs are best used to test the efficacy or effectiveness of various types of medical interventions within a patient population. The key feature of the RCT is subjects for the study are assessed for eligibly and recruitment. Assessment of study subjects is an attempt to control for differences. After each subject is assessed, those who are accepted for suitability are randomly assigned to two groups:
One group is assigned to receive the treatment while;
The other group does not get any treatment.
Quasi-experimental research designs have a history of extensive use in social services. The most common quasi-experimental research designs are simple pre-posttest, posttest only, pre-posttest comparison groups, and pre-posttest comparison groups with longitudinal follow up. All four of these models are very acceptable research designs, especially when measuring the effectiveness of a treatment, or parenting program.
The California Evidence Based Clearinghouse (CEBC) along with the Office of Juvenile Justice and Delinquency Prevention (OJJDP) are two organizations that have changed their criteria for what constitutes “strong evidence supporting the efficacy of a program.” Both have adopted the RCT as their primary research model and their criteria for receiving the highest possible rating. CEBC has also included that the study’s results be published in a peer review journal with a time contingent of two years which helps determine if the study is acceptable for evidence based recognition.
Prior to this change, the Nurturing Parenting Programs® were highly rated, evidence-based programs for families receiving services in Child Welfare. After the adoption of the RCT model as evidence of programs effectiveness the Nurturing Program for Parents and their Infants, Toddlers and Preschoolers® is no longer afforded that designation.
RCT is reserved for trials that contain control groups in which groups receiving the experimental treatment are compared with control groups receiving no treatment. Withholding services from families who are mandated by the courts to complete parent education is ethically inappropriate, in addition to jeopardizing the health and lives of children.
The Nurturing Program® Research and the RCT Design
In 1980-83 when the first Nurturing Parenting Program® was developed and validated, there were no proven and published programs for families charged with child maltreatment. In essence, there was nothing to compare the results of families attending the Nurturing Program®. Families involved with Social Services for child maltreatment were not receiving parenting education from a validated, evidence-based parenting program. There were not any validated parenting programs on the market. A decision was made to run a quasi-experimental pre-posttest, longitudinal research design instead to test the effectiveness of the Nurturing Program®. The results were phenomenal.
Since the validation for the first Nurturing Parenting Program for Parents and their School age Children®, twenty additional Nurturing Programs have been developed and validated using the pre-posttest longitudinal follow-up quasi-experimental design. See the NPP validation report.
In the pre-posttest, longitudinal design research model, the criteria for effectiveness are the proven cessation of child maltreatment and the elimination of recidivism. It did not matter if the NPP was any better than no program if the child abuse continued. In essence, the effectiveness of the NPP was measured against the practices of maltreatment. Were the practices of maltreatment replaced with the practices of Nurturing Parenting? And what was the recidivism rate among parent(s) completing the NPP? The stated goal was a recidivism rate of 0. The outcome was a recidivism rate of 9%. At the time, the recidivism rate among families completing treatment for child abuse was between 25% to 47%.
History and Development of the Adult-Adolescent Parenting Inventory (AAPI) and the Nurturing Parenting Programs®.
Development of the Adult-Adolescent Parenting Inventory (AAPI)
In 1978, Dr. Bavolek developed the Adolescent Parenting Inventory (API) as a doctoral student at Utah State University. The Adolescent Parenting Inventory (API) was designed to assess the parenting beliefs and practices of abused and non-abused adolescents. Responses to the API would indicate the risk level of pre-parent teens in replicating the abusive and neglecting parenting practices they experienced during the process of growing up.
Critical to the study was identifying the parenting practices that represent child maltreatment. In essence, what are the practices of child abuse and neglect? Five specific behaviors were identified and validated from the on-going research with abused and non-abused teens. The constructs of child maltreatment are:
Inappropriate developmental expectations of children;
Parental lack of empathy for their own needs and for the needs of their children;
A strong belief in the use of corporal punishment as a means of punishing children for their disobedience;
Reversing parent-child roles leading to robbing the child of their childhood;
Oppressing children’s power and independence.
The research findings of the study indicated that teens with verified histories of abuse and neglect did indeed express significantly (P <.001) more abusive parenting beliefs in all five constructs than teens without verified histories of maltreatment. Gender also indicated significant (P < .001) differences. Males as a population expressed more abusive parenting practices than females.
Research studies continued in assessing risk levels of adult and teen parent populations. Teen parents and adult parents charged with child abuse and/or neglect did indeed express significantly (P<.001) more abusive parenting beliefs and practices than adult and teen parents without verified charges of maltreatment.
Today, the Adult-Adolescent Parenting Inventory (AAPI-2) is widely utilized both nationally and internationally, having assessed nearly 3 million adults and teens since its initial development in 1978.
Development of the Nurturing Parenting Programs® (NPP)
In 1980, the National Institute of Mental Health (NIMH) funded a half-million dollar, six state research project to Dr. Stephen Bavolek while he was at the University of Wisconsin-Eau Claire. The purpose of the research was to develop and validate a proven program to treat and prevent child abuse and neglect. The grant was awarded to Dr. Bavolek for his years of research in developing and validating the Adult-Adolescent Parenting Inventory (AAPI-2).
The Nurturing Parenting Program® (NPP) was developed and validated in 1983 utilizing the five parenting constructs of the AAPI to form the foundation of the lessons of the Nurturing Parenting Program®. In this manner, the AAPI provided the level of risk assessment and the Nurturing Parenting Program® provided the treatment. The NIMH study showed remarkable and significant changes in positive family interactions. Findings of the three year project included:
A retention rate of 83% of DSS/DCF families completing the 15 session group-based program.
Significant posttest gains in positive personality characteristics, family functioning, parenting beliefs and knowledge of proper (non-abusive) parenting strategies.
Most importantly, longitudinal follow-up on recidivism rates was 7% of the 95 families completing the program.
Important to recognize that in the mid-1980s, no valid or published parenting programs were available for families charged with child maltreatment. The Nurturing Parenting Program® was the first family-based program designed specifically for parents who were identified as abusive and/or neglecting of their children (treatment) or who were high risk for child maltreatment (prevention/intervention).
The Recognition of Evidence-Based Programs: Nurturing Parenting Ratings
Based on the findings of the initial NIMH study, the Nurturing Parenting Program® for School Age Children was recognized by the Office of Juvenile Justice and Delinquency Prevention (OJJDP), the Center for Substance Abuse Prevention (CSAP), and Substance Abuse, Mental Health Services Administration (SAMHSA), and other government and state agencies as an evidence-based program; the only parenting program for the treatment of child abuse and neglect.
In November 2000, OJJDPdevoted an entire issue of their Newsletter to the quality of the Nurturing Parenting Program as a proven treatment program. Years later, the California Evidence Based Clearinghouse (CEBC) also recognized the research and findings of the Nurturing Parenting Programs® as evidence-based programs.
The National Registry of Evidence-based Programs and Practices (NREPP) developed as a branch of SAMHSA also recognized the research findings and the effectiveness of the Nurturing Programs® as evidence-based programs. Over the years, thirty-five additional programs and studies have been conducted. The results of these studies are available on line attesting to the effectiveness of the Nurturing Parenting Programs®. Links are provided to NREPP web site and to the Summary Research Report of the Nurturing Programs, and to the CEBC web site.
Agencies that Support the Effectiveness of the Nurturing Programs® without RCTs
National Registry for Evidence Based Programs and Practices (NREPP) rate all the Nurturing Programs at or near their highest standard.
The United States Department of Defense (DoD) has adopted the Nurturing Parenting Program for Parents and their Infants, Toddlers and Preschoolers® as their program of choice for their New Parent Support Program (NPSP). The Nurturing Programs® have been used by the military for over 20 years. Currently, all brands of the military are using the Nurturing Programs® worldwide. The data indicate families are making significant pre-post gains.
Prevent Child Abuse-Hawaii has implemented the Nurturing Parenting Program for the past 25 years.
Birth and Beyond Home Visitation program of Sacramento completed 4,600 home visitations with parents serving 9,752 children. They implemented the NPP for Parents and their Infants, Toddlers and Preschoolers betweenthe years of 2010 and 2013. The recidivism rate of families dropped 85%; the percentage of families with substantiated CS reports dropped 88%; recidivism rates dropped 64%; and the data indicated that the more lessons the parents completed, the lower the levels of referrals to CPS post-program.
The Nurturing Programs® are implemented throughout the State of Louisiana through the Department of Social Services. Analysis of the data conducted by Casey Foundation indicated dosage of sessions completed made a difference. The more sessions completed the less likely they were reported for child maltreatment six months after the completion of the program. Analysis of the data also found that program costs and cost savings were calculated with a benefit to cost ratio of 0.87 demonstrating that the Nurturing Program approaches cost-neutrality. The data also indicated a retention rate of 70% of program participants, a significantly higher rate than research on other programs implemented in child welfare systems.
As of 2014, the State of Arkansas has received government funding to implement the Nurturing Programs for Parents and their School Age Children statewide through their Department of SocialServices.
The Children's Trust Funds of Kentucky and Tennessee are launching the Nurturing Programs statewide in the Spring/Summer/Fall of 2015. Colorado CTF for years has funded agencies within Colorado who implement the Nurturing Programs®.
Cook County in Chicago is implementing a RCT study with the Nurturing Program® in their research to reduce the amount of out-of-home placements.
The State of Oregon has also implemented an RCT study in implementing the Nurturing Program® testing whether Supervised Supervision with some families receiving the Nurturing lessons during supervision is more effective in preventing recidivism rates after reunification then families receiving traditional supervision.
In a six year study from 1999 to 2005, the Florida State Department of Children and Families (DCF) conducted a statewide study designed to assess the effectiveness of parenting programs offered throughout the state to high risk families as well as families charged with child abuse and neglect.
A total of 33,001 families and 22 programs participated in the study. Parents who completed the NPP for Parents and their Infants, Toddlers and Preschoolers had significantly higher posttest mean scores in each of the five parenting constructs of the AAPI than parents in the non-Nurturing Parenting Programs®.
The Center for the Study Social Policy who embraces the trauma informed philosophy published an article on how the Nurturing Programs® link to the Strengthening Families Protective Factors Framework.
Family Development Resources has been providing cost-effective, validated approaches to help treat and prevent child abuse and neglect for over 30 years. Families learn new attitudes and skills that reduce dysfunction in families, with follow-up studies indicating low rates of recidivism. The Nurturing Programs® have and will continue to make a significant contribution to the overall health and functioning of families.
The ratings remain very high for the Infant, Toddler and Preschooler Program as well as all the Nurturing Programs® as published in the National Registry of Evidence Based Programs and Practices (NREPP), the US Department for Defense and the hundreds of service providing agencies across the country.