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Prevention Science, Vol. 3, No. 3, September 2002 (°

C 2002)

Enhancing the Parenting Skills of Head Start

Families During the Transition to Kindergarten

Elizabeth A. Stormshak,1,3 Ruth A. Kaminski,2 Matthew R. Goodman1

Head Start centers provide an excellent context for the implementation and success of family-
based interventions, particularly home visiting. Based on a developmental–ecological model,
a universal family-centered intervention was implemented with Head Start families. Outcome
data from this parenting and home visiting program is presented (Project STAR: Steps to
Achieving Resilience). Results suggest that both parenting groups and home visiting inter-
ventions are effective at enhancing parenting skills: however, home visiting programs have
a higher participation rate. Additionally, home visiting by familiar staff was particularly suc-
cessful at improving parenting skills at follow-up. Results suggest that embedding targeted
interventions in universal strategies can be an effective means of engaging families in services.
The results have implications for service delivery methods in early childhood as a means of
enhancing parent participation.
KEY WORDS: parenting intervention; home visiting; Head Start; early childhood.

Preparing children for school is one of the great- Alexander, 1988; Hart & Risley, 1995; Landesman &
est challenges faced by educators today. As we enter Ramey, 1989).
the twenty-first century, the national educational goal The developmental course of conduct problems
that all children will enter school ready to learn is in early childhood is complex. Based on an ecological
particularly challenging in light of the fact that more model of development, children are embedded in a
young children than ever before—approximately series of nested structures, each uniquely impacting
one in four—are living in poverty. Among families their developmental course (Bronfenbrenner, 1979).
of young children there exists more homelessness, Within this model, the family, school, and community
single-parent families, exposure to street violence, all serve to either protect children from later prob-
illegal drugs, and life-threatening illnesses such as lems or these systems contribute to the development
AIDS. In addition, many families of young children of problem behavior by creating additional risk fac-
lack affordable health services and child care. It is a tors for children to overcome. Longitudinal, develop-
consistent finding in the literature that children from mental research has identified a set of problem be-
low-socioeconomic backgrounds are significantly less haviors that place children at-risk in early childhood
likely than their middle class peers to enter school for later problems such as delinquency and substance
ready to learn and to achieve success (Entwisle & abuse. These include aggressive behavior problems,
social skill deficits, and achievement difficulties such
as early reading problems. Early risk factors are ex-
1
Counseling Psychology Program, University of Oregon, Eugene,
acerbated by contextual risks such as poverty. More-
Oregon. over, these behaviors are associated with additional
2
School Psychology Program, University of Oregon, Eugene, risk at transitional points in development (e.g., as chil-
Oregon. dren enter school). Ameliorating risks during critical
3
Correspondence should be directed to Elizabeth A. Stormshak, junctures can alter the trajectories of children and pre-
PhD, Counseling Psychology and Human Services, 5251 Univer-
sity of Oregon, Eugene, Oregon 97403-5501; e-mail: bstorm@
vent the subsequent development of problems (Coie
darkwing.uore.ed. et al., 1993). Interventions aimed at each level of the

223
1389-4986/02/0900-0223/1 °
C 2002 Society for Prevention Research
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224 Stormshak, Kaminski, and Goodman

child’s social ecology are clearly the most effective ing to the development of later problems such as drug
at reducing problem behavior and enhancing social use and delinquent behavior (Loeber et al., 1993). Be-
development. havior problems associated with this “early-starter”
model and parenting skills contributing to these prob-
lems can be identified as early as age 2 and are predic-
PROJECT STAR (STEPS TO ACHIEVING tive and stable into adolescence (Campbell & Ewing,
RESILIENCE) 1990; Keenan & Shaw, 1994; Loeber et al., 1993).
Research also indicates that parenting skills have
Project STAR (Steps to Achieving Resilience: an impact on school readiness and success. For ex-
Kaminski & Stormshak, in press) was developed as a ample, in a longitudinal study of the cognitive per-
preventive intervention aimed at reducing the risk of formance, Burchinal et al. (1997) found that whether
substance use and delinquency in an at-risk sample of children’s cognitive performance increased or de-
preschoolers (Head Start). The intervention targeted creased during the preschool years was related to
each level of the social ecology, and included a school- the responsiveness and stimulating characteristics of
based universal intervention, a parenting group inter- the child’s family environment. More recently, Lamb-
vention, and home visits to families during the tran- Parker et al. (1999) found that parents understand-
sition to kindergarten. Home visits were designed to ing of play and facilitated learning predicted positive
enhance the content of the parenting group. outcomes for Head Start children, whereas overcon-
Project STAR was developed based on the eco- trol and negative parenting predicted distractibility
logical model and was focused on reducing risk factors and hostility in the classroom and a subsequent de-
that lead to substance use in middle childhood. The crease in early literacy skills. Similar findings were
targets of Project STAR included enhancing known reported by Brody et al. (1994) in a study investigat-
risk factors such as social competence, self-regulation, ing the contributions of protective and risk factors
and early literacy skills. These risk factors represented to literacy and socioemotional competency in former
distal outcomes expected to emerge after targeting Head Start children attending kindergarten. Brody
a more proximal outcome, which was parenting and and colleagues found that engaged, positive, and re-
family–school involvement. sponsive caregiver–child interactions were strongly
related to child social and academic achievement in
kindergarten. Additionally, negativity in caregiver–
Parenting as a Risk Factor child interactions was associated with lower socio-
emotional, literacy, and cognitive outcomes (Brody
There is probably no more important target in et al., 1994). Clearly, parenting interventions embed-
early childhood prevention than parenting. Defined ded in Head Start centers are a critical component of
broadly, “parenting” refers to skill-based practices as services for families to prevent mental health prob-
well as the quality of the parent–child relationship. lems and promote school success.
In early childhood, relationship variables such as the
quality of attachment, positive family involvement,
and positive parent–child interactions predict both Parenting in Context: Rural Oregon
internalizing and externalizing behavior (Campbell,
1991). Positive parent–child relationships established Children considered to be at especially high
in early childhood serve as a foundation for the uti- risk for behavior problems, deficits in social com-
lization of effective parenting skills into the preschool petence, and academic difficulties are often from
years (Greenberg & Speltz, 1988). economically disadvantaged homes (Hart & Risley,
In general, parenting skills associated with later 1995; National Research Council, 1998). Project
academic and behavioral problems include lack of STAR was implemented in five different rural
caregiver involvement and positive parenting prac- communities. These towns had been hard hit by
tices, poor and inconsistent family management, unemployment and job instability, leading to poverty
and punitive or negative parenting (e.g., Patter- at a community level. Rural prevention research has
son & Stouthamer- Loeber, 1984; Petit et al., 1993; been infrequent in the prevention literature, and
Stormshak et al., 2000). Patterns of interaction learned often involves applying programs targeted at urban
in the context of parent–child exchanges are typically populations to rural populations with limited success.
generalized to school settings and peer groups, lead- Recruitment and intervention can be particularly
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Enhancing Parenting Skills 225

difficult when populations are dispersed geographi- The results of this survey suggest that services other
cally and the interventionists are seen as “outsiders” than group activities, such as home visiting, may be
in the community (Spoth & Redmond, 1994). the best way to enhance family participation in Head
Research on the FAST Track Project (Conduct Start activities.
Problems Prevention Research Group [CPPRG],
1992) suggests that rural and urban differences in
the implementation of prevention programs do exist Preliminary Research
and provides several guidelines for future prevention
research with rural families. For example, rural Over the course of our research on Project
parents are less likely to attend parenting groups STAR, we have been funded by several grants to
and to talk freely in the context of other parents provide family services through Head Start. Family
(Bierman & CPPRG, 1997). services were part of a comprehensive intervention
that also included teacher training and classroom-
based intervention. The family-based services in-
Embedding Family Interventions in Existing cluded three components: a parent training curricu-
Head Start Agencies lum delivered in 12 and 6 sessions, home visits, and
“family nights.” Family nights were individual Project
Head Start is an agency that serves the many STAR presentations addressing single topics that
needs of at-risk children and families in early child- closely match the parent training and classroom cur-
hood. As such, it is an ideal setting for the delivery ricula (e.g., playing with your child, establishing home
of family-centered interventions aimed at reducing routines). The Family Night presentations occurred
future risk. Two family intervention components that at regularly scheduled Head Start parent meetings
have promise for implementation in Head Start agen- and, while not an intensive intervention, were an ad-
cies are parenting groups and home visiting. Both par- ditional mechanism for engaging parents in Project
enting groups and home visits have empirical sup- STAR. Participation rates in Project STAR family-
port in the literature as effective interventions in based interventions with Head Start agencies in rural
early childhood (Olds et al., 1998; Webster-Stratton Oregon across 6 years and three different grants have
& Hammond, 1990). Parenting interventions, in par- varied based on the service offered. Interestingly, the
ticular, are associated with both changes in parenting percentage of parents attending parenting groups was
skills as well as changes in child behavior (Serketich similar regardless of the number of sessions offered,
& Dumas, 1996). with approximately one third of families selecting to
Both parenting groups and home visits are fam- attend the parenting groups. Home visiting had the
ily interventions that occur within Head Starts cur- highest percentage of participation (76%), followed
rently; however, engaging parents in these activities by Family Nights (43%).
is challenging. Webster-Stratton (1998) offered a par- In our initial research examining the efficacy of
ent training intervention to Head Start families in an our intervention program, we compared outcomes of
urban setting. Attendance and participation were rel- our intervention groups after the first and second year
atively good for this sample (88% of parents attended of our project. Analyses conducted after kindergarten
50% of the parenting groups), and results suggested compared parents who participated in our parenting
changes in parenting at posttest and follow-up. More program (parenting group and home visiting) to those
recently, Webster-Stratton et al. (2001) found lower who participated only in the universal intervention of-
attendance rates for a briefer parenting group inter- fered in classrooms. The results suggested that parents
vention in Head Start centers (51% of parents at- who participated in our parent group intervention
tended six or more sessions). A recent analysis of with home visiting showed improvements in parent-
parent involvement in Head Start parent activities ing skills (e.g., caregiver involvement) over the con-
was conducted by Lamb-Parker et al. (2001). The re- trol group. Parents who participated only in our home
searchers set out to understand the barriers to par- visiting program had scores on caregiver involvement
ent involvement in family-focused group activities in similar to those of our control group (Kaminski et al.,
Head Start. They found that some of the biggest bar- in press). In other words, parent group attendance
riers to parental participation were maternal depres- plus home visiting during the kindergarten year ap-
sion, having a baby or toddler at home, and having peared to be the most effective treatment package
a schedule that conflicted with Head Start activities. for increasing parenting skills.
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226 Stormshak, Kaminski, and Goodman

As is true of most intervention projects, difficul- we were interested in potential moderators and me-
ties engaging families in treatment emerged in this diators of efficacy, including the relationship that par-
study. Parenting groups for rural Head Start families ents had with their home visitor, the number of home
were attended by only one third of the families even visiting sessions, and risk factors such as public assis-
when child care, food, and transportation were pro- tance, single parenting, and maternal depression.
vided and families were offered $5.00 for each par-
enting group attended. While almost three fourths of
the families participated in the home visiting interven- METHODS
tion, results of the home visiting intervention without
parent group attendance were limited. Recruitment

Recruitment of Schools
Transitioning children From Head Start to Elementary
School: Building Relationships Participating Head Start agencies in three rural
counties of Oregon included 16 sites and 23 class-
One major goal of Head Start is to show long- rooms. Schools were recruited at the agency level and
term benefits of this program into the high school then randomly assigned by site to either intervention
years. Even with a comprehensive high quality Head or control. Head Start sites with similar demographics
Start program, advantages derived from preschool were yoked and randomly assigned to different condi-
can be quickly lost without a smooth transition to a tions. In many cases, Head Start sites contained multi-
school environment and follow-up that builds upon ple classrooms. Because teachers worked together in
previous gains (Lee & Loeb, 1995). One way to po- these sites, all classrooms within a site were assigned to
tentially enhance the short-term gains made by Head the same condition. As a result, there were unequal
Start children would be to provide home visiting for numbers of classrooms assigned to the intervention
the first year of elementary school. Ideally, these and control group.
home visits would be conducted by someone who be- After obtaining agency approval for the project,
gan a relationship with the families during the Head teachers were recruited to participate in the study. Re-
Start year. cruitment was done at regularly scheduled Head Start
There is ample evidence within the community staff meetings. Teachers did the primary recruitment
prevention literature as well as the psychotherapy re- of families during home visits or regularly scheduled
search literature to suggest that clinical changes occur meetings with parents. Project STAR staff supported
within the context of positive relationships. In com- teacher recruitment by attending parent meetings at
munity prevention research, collaboration with regularly scheduled times and presenting the project.
community leaders increases positive outcomes. Two sites refused participation; hence, the final sam-
Community problems are solved when the focus is ple of schools included 14 Head Start sites with 11
on building programs that enhance existing strengths classrooms assigned to the intervention and 9 class-
(see Weissberg & Greenberg, 1998, for a discussion rooms assigned to the control condition.
of prevention and community research). In rural
communities, existing strengths may include the re-
lationship that families have with a known treatment Sample
provider such as Head Start staff. These relationships
are an important component of continued services Four-year-old children and families from par-
for families as children leave Head Start and enter ticipating Head Start sites were recruited for this
elementary school. study. Of the 261 four-year- olds in the Head Start
In Project STAR, parents were more likely to par- classrooms, 56% agreed to participate in Project
ticipate in our home visiting intervention than in our STAR in Year 1 (n = 146). The final sample was
parenting group intervention. However, results of our 52% female, with 45% of children living in fam-
home visiting intervention with no parent group at- ilies including both biological parents. Sixty per-
tendance were limited. Given the success of our home cent of the children and families received pub-
visiting program in terms of family participation, we lic assistance. Eighty-three percent were Caucasian
set out to more closely examine caregiver involve- and 13% were other ethnic groups, primarily His-
ment as an outcome of our intervention. In particular, panic. These demographics are representative of the
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Enhancing Parenting Skills 227

rural population in Oregon. Although we were un- in the classroom. During the fall of Year 1, teachers
able to collect parent report data on the nonpartic- who agreed to participate attended a full-day work-
ipants, 250 families consented to teacher reports of shop designed to train the teachers on administering
child behavior. There were no differences between this intervention, which consisted of circle time activ-
children in the parenting portion of Project STAR ities to promote critical skills in each of the four areas
and nonparticipating children on externalizing be- listed above. Head Start teachers then administered
havior problems or social competence in the class- the intervention throughout the school year with con-
room as reported by teachers on the Social Compe- sultation provided on a bimonthly basis from Project
tence and Behavior Evaluation Scale (LaFreniere & STAR staff.
Dumas, 1996); F(1, 250) = 2.15, p < .14.

Attrition Selected Interventions

Data were collected over 2 years on our initial Parents of participating 4-year-olds were of-
sample of 146 families (48 control families and 98 in- fered a parenting group intervention in Year 1
tervention). Between Wave 1 (fall of preschool) and (preschool) and a home visiting intervention in Year 2
Wave 2 (spring of preschool), we experienced 24% (kindergarten). The parenting groups used the In-
attrition, which resulted in a Year 2 sample of 112. credible Years parenting curriculum developed by
These rates are similar to those reported by other re- Carolyn Webster-Stratton for children aged 4–8
searchers who have worked with Head Start popu- (Webster-Stratton, 1994). This video-based curricu-
lations (Webster-Stratton, 1998). When we examined lum provides training in positive parenting, limit set-
the differences between participants who attrited and ting, problem solving, and handling misbehavior. The
those retained at Wave 2, there were no differences in program has been implemented successfully in mul-
family make- up (maternal depression, marital prob- tiple research studies and leads to improved parent-
lems), or child behavior problems. At Wave 3 (spring ing as well as decreases in child behavior problems
of kindergarten), our sample included 97 children and (Webster-Stratton, 1990; Webster-Stratton & Ham-
families, and hence, our attrition from Year 2 to 3 was mond, 1990). Parenting groups were run by trained
only 13%. interventionists at each participating Head Start site.
Transportation and childcare were provided to fami-
lies in order to increase participation.
Self-Selection The home visiting intervention was developed as
an individualized approach to working with high-risk
Random assignment occurred at the Head Start families (Wasik et al., 1990). The home visiting cur-
site level for this study, and hence, parents were riculum combines the strategies from our classroom-
self-selected into the various parenting interventions. based intervention and the Incredible Years pro-
However, there were very few preintervention group gram into a home-based service delivery model
differences found on the variables of significance. Al- (Kaminski & Stormshak, in press). The curriculum
though parents who agreed to parenting groups had also includes other topics of relevance to children
higher levels of school involvement, groups did not transitioning from preschool to elementary school
differ on caregiver involvement, behavior problems, (e.g., talking with your child’s teacher, asking your
or social competence (see Kaminski et al., in press). child about school, involvement in your child’s aca-
demic achievement). These additional components
Intervention Procedures have been adapted from the FAST Track Parenting
Intervention (CPPRG, 1992).
Universal School Intervention At the initial meeting, families identified top-
ics they were interested in from a list of choices.
Children in participating classrooms received a These included items such as early literacy and read-
classroom intervention administered by Head Start ing, social competence, parenting more effectively,
teachers. This intervention included 20 sessions fo- and helping my child control anger. After this initial
cused on social competence, self-regulation, early lit- meeting, an individualized intervention package was
eracy, and language and was administered to children developed with the interventionist and family. The
by their Head Start teachers during regular activities overall goals of the home visiting were to provide
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228 Stormshak, Kaminski, and Goodman

support and education on significant predictors of be- of parent–child interactions were conducted at Waves
havior problems at this age. This included promot- 2 and 3 during the scheduled parent interview. Par-
ing social competence, self-regulation, parenting skills ents were paid $25.00 for each wave of assessment
and family management, and academic success. The and $5.00 for each parenting group or home visiting
average number of home visits received by families session in which they participated.
was 5, with a range from 1 to 14. For purposes of anal-
yses, families who received two or more home visits
were considered to have participated in this aspect of Assessment Measures
the intervention.
Parenting Practices Interview

Staffing This questionnaire was developed based on items

from the Discipline Questionnaire (Oregon Social
As a research project designed to be embedded in Learning Center, 1992; LIFT Project) and the Parent-
Head Start centers, Project STAR was focused on con- ing Practices Scale (Strayhorn & Weidman, 1988). The
necting with parents through Head Start. We took a measure includes items assessing parenting warmth
community approach to our prevention program with and praise, limit setting, problem solving, and puni-
a goal to train existing staff in our program content tive parenting strategies. In previous research with
so that when our project was over, the staff would items from this measure, scales of warmth, consis-
be able to use the materials and model in years to tency, punitiveness, and parental aggression (e.g., hit-
come. Limited resources in our rural communities ting) were formed in a confirmatory factor analysis
made this community collaboration model even more and were differentially predictive of a variety of child
critical. We hired and trained intervention staff along- behavior problems (Stormshak et al., 2000).
side family consultants from the Head Start centers.
Our staff worked collaboratively with these family
consultants, teachers, and parents to coordinate our Parent–Teacher Involvement Questionnaire
parenting groups, deliver our classroom-based inter- (INVOLVE-P; CPPRG, 1999)
vention, and provide home visits to families. In each
case, parenting groups were run with existing Head This is a 26-item measure developed initially for
Start staff. We feel this collaboration enhanced over- the FAST Track program (CPPRG, 1992) that as-
all participation in our parenting groups by creating a sessed the amount and type of contact that occurred
familiar environment for families and decreasing the between the parent and teacher in addition to the par-
likelihood that we would be seen as “outsiders” in ent’s interest in talking with the teacher, satisfaction
these rural communities. with the teacher, and involvement at school. This mea-
Home visits were staffed by trained profession- sure has good reliability and validity in addition to in-
als, each with extensive experience working with fam- ternal reliability of each subscale (school involvement
ilies and children. Of the six home visitors, all had and educational values, .89 and .91 respectively).
Master’s degrees in Counseling or Education. Each
visitor participated in a full-day training workshop
designed to improve the fidelity of the intervention. Depression Scale (Radloff, 1977)
Home visitors met biweekly for supervision through-
out the home visiting intervention. This measure is based on the CES-D, and in-
cludes 20 items that provided a reliable and valid mea-
sure of self-reported depressive symptoms. This mea-
Assessment Procedure sure was included in the assessment battery to be used
in analyses as a mediator.
Parent interviews were conducted in the home
during the three waves of data collection (fall
preschool, spring preschool, and spring kinder- Parent-Child Interaction
garten). In each case, parents were interviewed by
trained assessment staff and their responses were Parents and children participated in a 15-min
recorded on a laptop computer. Direct observations interaction task modeled after the Behavioral
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Enhancing Parenting Skills 229

Coding System developed by Forehand and RESULTS

McMahon (1981). The three 5-min tasks included
child-directed play, parent-directed play, and a toy Results from our initial work with this sample
clean-up task. Trained observers used a modified seemed to indicate that the mechanism for change was
version of the Coder Impressions Inventory (Capaldi the parenting group. That is, parents who attended the
& Patterson, 1989) and the Interaction Rating Scales parenting group showed gains in caregiver involve-
(IRS; Crnic & Greenberg, 1990) to rate the quality ment over those who attended the home visiting pro-
of the parent–child interaction. Ratings included gram only. However, despite positive results from the
positive and negative parenting as well as child parenting group we had difficulty reaching the major-
behavior. ity of our families with this service delivery model.
Instead, families in our study appeared to prefer a
home visiting approach to services as evidenced by
MULTIRATER CONSTRUCT OF CAREGIVER our high rates of participation in this component.
INVOLVEMENT Our home visiting program was extensive and de-
livery was individualized across families. Because of
On the basis of previous research, we created a random staff attrition, some families had home visits
theoretically derived construct of caregiver involve- conducted by an unfamiliar staff person. In an attempt
ment that consisted of two separate but related com- to understand potential moderators of efficacy associ-
ponents, positive involvement and negative parent- ated with the home visiting program, we further subdi-
ing. To test this theoretical model, a confirmatory vided our sample into those families who attended the
factory analysis (CFA) was performed at each wave parenting group and then received home visits from
of data collection. In each CFA, six parent-report a familiar staff person (i.e., their parent group facili-
measures loaded onto the positive involvement con- tator) versus those families who received home visits
struct, including the Involve-P Caregiver Involvement from a new intervention staff person (not the same
Scale, and five subscales of the Lift Parent Question- person who facilitated their parent training group).
naire (Positive Parent, Family Activities, Appropriate These results are presented in Fig. 1.
Limit Setting, Clear Expectations, and Monitoring). Although there were no differences between
Direct observations of positive involvement also groups on Time 1 caregiver involvement scores,
loaded onto the Positive Involvement construct. In F(4, 91) = 1.03, MSE = 0.33, p = .39, all analyses
each CFA there were two measures that loaded onto controlled for Time 1 caregiver involvement. The re-
a Negative Parent construct: the Lift Harsh Discipline sults suggest that families who received the home
Scale and the Lift Inconsistent Parent Scale. Negative visits from a familiar staff person had significantly
Parent was allowed to correlate with Positive Involve- higher caregiver involvement scores than every other
ment in order to estimate the relation between these group of families, F(1, 82) = 13.77, MSE = 2.88, p <
two constructs. The chi-square for this model was sig- 0.001. The results also suggest that families who
nificant; however, the CFA models fit relatively well received home visits from an unfamiliar staff per-
for all three waves as indicated by the Goodness of son did not have significantly higher caregiver in-
Fit Indices, (χ 2 (N = 146, d f = 16) = 25.79, p < .01, volvement scores than the other families, F(1, 82) =
GFI = .96, TLI = .89. Additionally, all of the mea- 0.39, MSE = 0.08, p = ns. Taken together, this anal-
surements significantly loaded onto the negative par- ysis suggests that familiarity with the home visitor may
enting or positive involvement constructs at all three be a critical ingredient in a successful home visiting
waves, indicating that all the measures are good in- program. The combined effect of a parenting group
dicators of their respective construct. Finally, there plus home visiting from a familiar staff person is the
was a moderate to strong negative correlation be- most effective set of interventions to increase care-
tween the negative parenting and the positive involve- giver involvement.
ment constructs (r = −.47, p < .01), suggesting that Next we examined whether or not level of par-
positive involvement and negative parenting are both ticipation accounted for these effects. We looked at
subcomponents of caregiver involvement. Our final the number of home visiting sessions attended by
measure of caregiver involvement was one measure each group of participants. Families who attended
that included both positive and negative aspects of the parenting group prior to being offered the home
parenting. visiting program participated in significantly more
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230 Stormshak, Kaminski, and Goodman

Fig. 1. Caregiver involvement by intervention group with familiar and unfamiliar project staff. Note. Class = Children who
received only the classroom intervention; Class and Home Visit = Children and families who received the classroom and
home visiting intervention with no parenting group. Unfamiliar versus familiar staff refers to the parents familiarity with
their home visitor (familiar = same staffing as parenting-group intervention).

home visiting sessions than parents who did not at- parenting group, dosage did not predict caregiver in-
tend the parenting group, F(1, 48) = 16.52, MSE = volvement. For these families, dosage had no impact
88.13, p < .001. However, parents in the familiar ver- of levels of caregiver involvement.
sus unfamiliar group did not differ in their participa- In an attempt to further understand potential
tion in home visiting. This finding suggests that level moderators of efficacy associated with this program,
of participation in home visiting does not account for we subdivided our sample into several final groups.
the influence of familiarity on caregiver involvement. We examined differences in caregiver involvement for
However, a parenting group delivered prior to the families who received the home visiting intervention
home visiting intervention did increase family partic- and were (a) on public assistance, (b) single parents,
ipation in the home visiting program. or (c) depressed.
Next, we were interested in examining change In separate analyses, we found no effects for pub-
in caregiver involvement as a function of number of lic assistance or single parenting on our home visiting
home visiting sessions participated in across the three intervention. Parents who were on public assistance
intervention groups (home visits only, parent group or who were single parents did not differ in their
plus home visit from familiar staff person, and par- Wave 3 caregiver involvement scores from parents
ent group plus home visit from unfamiliar staff per- without these risk factors. When we subdivided our
son). We found a moderately significant interaction families by scores on the CES-D (using a mean split),
between intervention group and number of sessions we found that mother’s with more depression scored
attended on our caregiver involvement construct. This lower on Wave 3 caregiver involvement than moth-
is shown in Fig. 2, F(3, 49) = 2.49, p = .083. Our lim- ers who were not depressed, F(1, 82) = 8.00, MSE =
ited sample size at this point decreased the power of 2.53, p < .001. Both depressed and nondepressed
our findings; however the trend depicted in Fig. 2 sug- parents received the same number of home visits
gests that with a familiar home visitor, level of partici- (mean = 7).
pation in home visiting, or dosage, predicted increases
in caregiver involvement scores. It appears that for DISCUSSION
families with a familiar home visitor, more home vis-
its led to increased improvements in caregiver in- This research presented findings from Project
volvement. However, with an unfamiliar visitor or no STAR, an early intervention program designed to
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Enhancing Parenting Skills 231

Fig. 2. Dosage of the home visiting program predicting caregiver involvement for familiar staffing.

embed family-centered services in an existing service found in research suggesting that parents who per-
delivery system for low income, rural families. It is ceive the home visitor to be empathic will in turn
clear from this research that home visiting interven- show positive, empathic parenting with their infant
tions are an effective means of maintaining a connec- (Korfmacher et al., 1998). It also may be that home
tion with Head Start families as they transition from visits allow the interventionist to understand cultural
Head Start to kindergarten. Home visiting had the and contextual factors that may be impacting the child
highest participation rate of all the interventions of- and family and provide a more sensitive intervention
fered to Head Start families. Additionally, it appears for that family (Slaughter-Defoe, 1993).
that the staffing of this intervention is critical. Head Our findings are consistent with those of Olds
Start families who were visited by a familiar staff per- et al. (1998, 1999) who suggested that home visits need
son made significant gains above families who were to be of sufficient frequency and duration of visit need
visited by an unfamiliar staff person. These gains were to be sufficiently long to effect change. In addition, as
not based on attendance. For families who were vis- evidenced by our results, continuity of staff appears
ited by a familiar staff person, there was a significant to be an important factor. This relationship-based en-
correlation between dosage (number of home visits) hancement of effects does not necessarily mean, how-
and caregiver involvement scores. This was not true ever, that the relationship qualities of the home visitor
of any other group. were responsible for the changes in families. It may
Although the literature suggests potential pos- be that Head Start families take some time to build
itive benefits to home visits in early childhood, the trust with staff and with their community. The con-
mechanism for change is still unclear. It may be, for ex- tinuity of a familiar staff person from Head Start to
ample, that parents form a working relationship with kindergarten provided a community connection for
the home visitor that allows for discussion and pro- these families that was supportive and constant. In
cess around parenting issues as well as other family turn, families were able to form a working relation-
problems (Heinicke et al., 1999). In this case, the rela- ship more quickly with a familiar interventionist and
tionship with the home visitor plays a significant role perhaps work more intensely on parenting problems
in the change process. Support for this theory is also and family–school relationships.
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232 Stormshak, Kaminski, and Goodman

An added benefit of the home visiting model is other families that extend back to their own childhood
that therapists have the opportunity to understand the years and sometimes even further. A home visiting
family in their own context. Child development and intervention, therefore, may meet the needs of rural
behavioral concerns of parents can all be understood families much better than of urban families who may
more fully in the situational contexts of the home be less connected to their communities.
visit (e.g., chaotic households, cramped living quar- Clearly, familiar staff enhanced the results of our
ters, unsafe neighborhoods, and stressful interactions intervention. In hiring staff to work on our project,
with neighbors and community). Although the ma- we first looked for skilled therapists from the rural
jority of our sample was Caucasian, these nonspecific community. In only one case were we able to hire
benefits of home visiting allowed staff to understand someone in the community to serve as a parent group
each family’s culture. Certainly, rural families do ex- facilitator and home visitor. The reasons for this were
ist in their own culture. It is often times one of isola- varied, and primarily were related to a lack of avail-
tion, community problems, and lack of resources. In able and qualified individuals in these communities. In
particular, limited recreational, education, and men- smaller communities, qualified staff are already em-
tal health services maintain problems for rural fami- ployed full-time and Head Start teachers and fam-
lies (Sherman, 1992). Stressful economic conditions in ily consultants were not available to do additional
rural areas lead to family problems, which in turn pre- home visits even when offered extra compensation.
dict child behavior problems (Conger & Elder, 1994). This was in part due to their teacher-union guidelines
These problems can be understood more fully when as well as a lack of outside time and staff commit-
interventions occur in the home. ment to Project STAR. Thus, our home visiting staff
Our research effort involved embedding our in- were typically not from the community; however, they
tervention into existing services that were already be- were familiar because we tried to use the same staff
ing offered at Head Start centers. Parenting groups to run parenting groups and conduct the home visits
and support are provided as a regular part of Head 1 year later. By the time the staff were conducting the
Start. Home visits are also provided, but vary widely home visits, they had been working in the commu-
in implementation. In order to increase participation nity for a full year. Staff attrition was not atypical and
in our parenting groups, we offered $5.00 in gift cer- included factors such as moving and career changes.
tificates for each group attended, childcare, and trans- These normative reasons for staff attrition, however,
portation. We coordinated these incentives with the can clearly change the results of a prevention pro-
Head Start centers involved in our intervention to in- gram. This is a critical consideration for staffing pre-
crease the likelihood of success (for example, Head vention research and administering prevention pro-
Start staff provided the childcare). We also reduced grams in rural communities.
the number of parent group sessions from 12 to 6 over When we examined dosage as a predictor of out-
the course of our work with Head Start centers in comes, we found that dosage was only related to care-
order to increase parent participation. We hypothe- giver involvement for families who were visited by a
sized that offering less sessions would increase atten- familiar home visitor. Although the results should be
dance by reducing the overall time commitment from interpreted with caution, this preliminary finding has
families. implications for future service delivery. In traditional
Despite our efforts directed toward parent group psychotherapy outcome research based on a medical
attendance, participation in our parenting groups was model of service delivery, dosage is conceptualized as
still low. In our research, almost three fourths of the having a direct relation to outcomes. That is, the more
rural families participated in home visits compared therapy that is delivered the greater the outcomes for
to only one third who attended the parenting groups. children and families. However, recent research sug-
Although rural communities may seem like the per- gests that within child and family treatment models,
fect environment for a parenting group, it has been clinically significant change may be based on multi-
our experience that the opposite is true. The fact that ple factors including group dynamics and adherence
most of our families knew each other well (due to to the program rather than quantity of sessions de-
living in a small community) may have at times pre- livered (Dishion & Kavanagh, in press). For exam-
vented them from attending a parenting group be- ple, in a careful analysis of clinical cases treated at
cause they feared that their problems were not going Oregon Social Learning Center, Weber (1998) did
to be confidential. Families are not anonymous in ru- not find evidence for a dose–response relation be-
ral communities and parents have relationships with tween the number of sessions and changes in child
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Enhancing Parenting Skills 233

behavior or parenting. Changes appeared to be a func- second and first authors, and a grant from the U.S.
tion of the interchange between the therapist and the Department of Education, Office of Special Educa-
client rather than a simple dose–response relationship tion Programs (H324C990074), to the second and first
(Stoolmiller et al., 1993). In a home visiting service authors. Thanks to all the staff at Lane County, Linn-
delivery model, the relationship with the home visi- Benton, and Douglas County Head Start who assisted
tor appears to be a critical component in the relation with this research. Special thanks to Berry Broadbent
between dosage and positive outcomes for families. and Stacy Mendez for their dedication to this work
We also examined several risk factors as predic- and strong community connections with teachers and
tors of outcomes of our home visiting program. These families.
included public assistance, single parenting, and de-
pression. We did not find any differences in fami-
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