Parent education for vulnerable rural families

Kay Bradford
Department of Family, Consumer, and Human Development
Utah State University

Carole A. Gnatuk
Kentucky Cooperative Extension Service
University of Kentucky

J. Douglas Burnham
College of Social Work
University of Kentucky

Amy Laura Arnold
Department of Child and Family Development
University of Georgia

Claire Kimberly
Department of Family Sciences
University of Kentucky

Abstract

Parent education has been shown to increase parents’ competence and build parent-child relationships. However, there are special challenges in teaching at-risk parents with acute needs, and research has not shown a conclusive positive impact of parent education with families with multiple long-term challenges. This mixed-methods exploratory study evaluated the implementation of the research-based Nurturing Parenting Program with three small groups of at-risk families in rural counties, taught by Cooperative Extension Family and Consumer Science (FCS) agents. Quantitative analyses showed that parents improved in terms of their expectations of their children, parental empathy, and attitudes regarding corporal punishment while maintaining strong instructor-participant relationship quality. There were no significant differences with parents who had in-home coaching. Instructor-participant working relationships were relatively strong, and instructor-participant relationship scores predicted outcomes for participants in the “treatment plus in-home coach” group but not for the “treatment only” group. Qualitative findings suggested participant improvements in terms of family time together, parent-child communication, and child behavior. Practice implications are discussed.

Keywords

parenting, parent education, at-risk families

Introduction

Effective parenting supports the development of children’s social and cognitive skills, encourages positive parent-child relationships, and helps prevent delinquency and mental health problems (Campbell and Palm 2004; Steinberg 2004). However, some families struggle to provide nurturing parenting because of problems such as poverty, substance abuse, intergenerational and community violence, and inadequate examples and training (Bowman, Pratt, Rennekamp, and Sektnan 2010). Research has not shown a conclusive impact of parent education with populations with such acute needs (Dore and Lee 1999). This exploratory study evaluates a small three-group intensive parent education program administered in rural areas of Kentucky and taught by county Cooperative Extension Family and Consumer Science (FCS) agents using a research-based parenting curriculum. The purpose of this mixed-methods study was to examine the quantitative and qualitative outcomes of a parent education program designed for parents at high risk for child abuse or neglect. Implications for practice are discussed, including the role of Cooperative Extension agents in delivering parent education to highly vulnerable families.

The context: Rural Kentucky

Poverty in Kentucky ranks in the top four in the United States (US Census Bureau 2011). The average poverty rate of the eight counties in this study exceeded state rates: 22.6 percent versus 17.3 percent statewide (Kentucky State Data Center 2009). Moreover, the average rate of poverty for children 18 and under in these eight counties is even higher: 33.7 percent. Thus, the families in this study may be considered rural poor. Challenges common to low-income families include financial and occupational stressors and risk for poor child outcomes (Bowman et al 2010). Additional problems in this geographical and social context include economic movements away from regional industries toward service industries, advancements in communication technology, shifts from county-based schools toward consolidated schools, infusion of illegal and prescription drugs, and long commutes to larger cities for work (Tickamyer and Duncan 1990). The term ‘vulnerable’ is used in this study to reflect the families’ risk levels.

Intensive intervention: FCS agents as providers

The parent educators were experienced Cooperative Extension FCS agents. Each formed a county team of two or three with the agriculture and 4-H/Youth Development agents. The FCS agents hold either bachelor’s or master’s degrees and teach in all areas of family and consumer sciences including child development, nutrition and health, family finance, clothing, environmental issues, and community development.

The educational services provided by Extension agents are typically considered to be universal (i.e., interventions applied to whole populations). However, the current program may be classified as selective (that is, applied to members of at-risk groups; Turner and Dadds 2001), or perhaps even as indicated (interventions applied to individuals or groups with mild symptomatology, or who are at very high risk of developing disorders), based on participants’ referral to the program by social services. Care was taken to distinguish this type of family life education from therapy. Doherty (1995) proposed a family involvement model with five levels of intensity that distinguishes family life education from family therapy. Doherty’s Level 1 consists of education focused on the individual and not the family; Level 5 is family therapy, and is thus outside the realm of education. The present intervention is classified as Level 3: education that involves the family, elicits feelings and experiences of the parents, and uses personal disclosure in the educational process. Due to the intensive nature of the intervention, classes were very small compared to typical Extension offerings.

The Nurturing Parenting Program (NPP)

This project was a response to requests from numerous FCS agents for programming for parents at high risk of child maltreatment. The twenty-four-week program used the research-based Nurturing Parenting Program (NPP; Bavolek and Kaplan 2007) as its curriculum. The core values of the program include stimulating the parents’ positive self-worth, empathy, discipline skills, and play, and “experiential self-discovery replacing old, unwanted patterns with more functional nurturing patterns” (Bavolek and Kaplan 2007, 3). This program assumes that effective and nurturing parenting can be learned in place of ineffective or even abusive parenting by addressing cognitive and affective processes that underlie behavior. The program is recognized by the National Registry of Evidence-based Programs and Practices and by the Substance Abuse and Mental Health Services Administration. A number of studies – most with a pre-post design – have reported significant and positive change in conjunction with the NPP. For example, one study of 323 high-risk parents reported significant improvement in all five areas of parenting targeted: parental expectations, empathic awareness, use of corporal punishment, parent-child role reversal, and children’s power and independence (Devall 2004). Another study of 680 participants in rural Virginia reported significant and positive change in appropriate expectations of children, in empathy, in family roles, and decreased belief in corporal punishment (Matteo-Kerney and Benjamin 2004). However, most studies validating the NPP are research reports rather than published studies, and recent research reports have included no true control groups.

Study purposes

One purpose of this study was to test the effectiveness of the NPP as facilitated by Cooperative Extension FCS agents. Another purpose was to examine the strength and impact of the instructor-participant relationship. Studies of psychotherapy confirm the importance of the client-therapist relationship in therapy outcomes (Horvath 2001); thus, we were interested in examining the potential impact of the instructor-participant relationship. Finally, there is a need for broader examination of the subjective experiences of participants and facilitators in the NPP specifically, and more generally, of parenting programming with vulnerable families.

The purpose of this study was to test the outcomes of the Nurturing Parenting Program (NPP) as administered by FCS agents among rural, vulnerable families. Specifically, this study examined four major research questions: (1) Does NPP instruction by FCS agents among vulnerable parents of young children accomplish the specific objectives of the NPP; that is, does it lead to positive changes in (a) parental expectations of children, (b) parental empathy, (c) belief in corporal punishment, (d) parent-child roles, and (e) child power and independence? (2) How strong was the instructor-participant working relationship and did the working relationship have impact on outcomes? (3) What were participants’ subjective experiences in participating in this program? and (4) what were the FCS agents’ experiences in facilitating the NPP among a vulnerable rural population? Questions three and four are qualitative examinations (see Vaterlaus and Higginbotham 2011); question four focuses on FCS agents’ roles in conducting intensive programming with relatively high-need families.

Methods

Sites and facilitators

Nine geographically dispersed counties in the state were targeted for participation where parent education was typically unavailable. Counties were chosen where parent education is typically unavailable, and where a majority of families are among the working classes and/or live in poverty. One FCS agent served as facilitator in each county. Commitment of the FCS agents to the project was also considered. The quasi-experimental design consisted of two treatment conditions and one control condition: (a) a treatment plus in-home coach group of two counties (n=9), (b) a treatment group of three counties (n=15), and (c) a control group of three counties (n=8), composed of parents who received no treatment. There were thus five agents for the treatment groups and three for the control group. One of the “treatment plus in-home coach” counties dropped out because the Extension agent moved away, leaving two counties in this category. Appropriate Institutional Review Board (IRB) approval was obtained. Courses began in fall 2007, and ran through spring 2008.

Most of the FCS agents grew up in or near the counties they serve. They hold bachelor’s and master’s degrees in vocational family and consumer sciences, child development, family studies, adult education, sociology, and adult education. Before this project, the agents were experienced in offering workshop-type programming in the short-term (one to four sessions of one to two hours in length), but were not experienced in offering a lengthy (twenty to twenty-four weeks) series of sessions of in-depth family relations and self-care to a population of multiple-problem, limited-resource families. The in-home educators and children’s group facilitators were carefully selected from within the community by the FCS agents in collaboration with the investigators, according to the stated position descriptions. Before beginning the program, all agents underwent intensive training for three days, conducted by the developer of the NPP, Dr. Stephen J. Bavolek. The in-home educators and the children’s group facilitators also attended the initial three-day training. The county agents, under the supervision of the investigators, gave additional training to the children’s group educators. For the duration of the project, the investigators made two or three visits to each of the five counties for supervision and mentoring purposes.

Participants

All families who participated in this study had been referred by local social service agencies. Thirty-six parents initially participated in the course, and twenty-four parents completed the twenty-four-week program, for a 67 percent completion rate. However, data were completed for only eighteen parents. This resulted in a final sample size of twenty-four, including the control group participants. The rate of 25 percent “missing data” among the treatment participants was due to portions of survey forms left blank, rather than non-participation in the research component. There were no significant differences in demographics regarding those who completed versus those who did not complete the data (e.g., age, sex, income). In their respective counties, parenting groups met weekly for 2.5 hours, and a family meal was provided. Parents and children first met separately, followed by a 30-minute family social time with snacks and games. Parents and children separated a second time, and later came together briefly to end the session. The paraprofessional in-home coaches (in only two counties) observed and supported the parents and children, visiting each home on a weekly basis. The project was funded by the University of Kentucky Health Education through Extension Leadership (HEEL) project.

Parents’ mean age was 31.4 (SD=9.6), and the parents had, on average, 2.5 children (mode of 3) with a mean age of 6 years; other demographic data for children were not gathered. The adult participants were 75 percent female and 25 percent male; 91 percent were Caucasian and the remaining 9 percent African American or Native American. Forty-one percent were married, 12 percent were cohabiting, 22 percent were single, and 25 percent were divorced. Almost all attended without partners. Forty-four percent were employed full-time, 31 percent were unemployed, 16 percent were disabled (and receiving varying government support), and 6 percent were employed part-time. Most families had very low incomes: 52 percent had annual incomes under $15,000, 34 percent had incomes below $25,000. The remaining 14 percent had incomes under $60,000.

Data collection procedures

FCS agents administered all surveys in treatment counties. Data were collected via paper-and-pencil surveys. Parents with limited literacy were assisted by the FCS agents. A research assistant collected data from participants in the control group. FCS agents were the program administrators and led adult educators in their counties. Each agent recruited at least one professional community partner as a co-facilitator. In addition, the FCS agent found volunteers or professionals who served as children’s group educators.

Measures

The Adult-Adolescent Parenting Inventory-Revised (AAPI-2) was used to measure child-rearing attitudes and to gain an index of risk for abusive and neglectful parenting attitudes and practices (Bavolek and Kaplan 2007). This instrument was given at the beginning and again at the end of the twenty-four weekly sessions. The AAPI-2 has been established as reliable and valid (Bavolek and Kaplan 2007). For these data, alpha levels were also reliable at .76 (Time I) and .68 (Time II). Parents rated themselves on a Likert scale using forty items that measure attitudes along five sub-scales, including appropriateness of parental expectations of children, parental empathy toward children’s needs, belief in the appropriateness of corporal punishment, appropriate parent-child family roles, and children’s developmentally appropriate power and independence. Sample items include “spanking teaches children right from wrong” (corporal punishment) and “children should be responsible for the well-being of their parents” (parent-child roles). Responses were scaled 1=strongly agree to 5=strongly disagree. Item-level reliability levels were calculated, and they ranged between .47 (belief in children’s power and independence, Time 1) and .86 (belief in corporal punishment, Time 1); the mean alpha level was .68. In practice, responses are converted to sten scores (i.e., scores standardized to range from 1 to 10) that compare the participant’s responses to a normal distribution. Sten scores ranging from 1 to 3 indicate high risk parenting attitudes, scores 4 to 7 indicate moderate to average risk, and scores ranging 8 to 10 indicate low risk.

The Working Alliance Inventory (WAI), collected monthly, was used to measure the working relationships between the educators and parents (Horvath and Greenberg 1989). The wording was modified slightly to be appropriate for family life education. This twelve-item survey asks the respondent the extent to which the educator is able to relate to and understand the parent. The items were reliable (alpha = .92). Sample items include “I believe the group leader likes me” and “We agree on what is important for me to work on” (1=not at all; 7=exactly).

Qualitative data eliciting broad responses regarding participants’ and facilitators’ experiences were collected using the parents’ written comments on the Program Evaluation Forms and Family Logs, which were completed by parents at evening’s end on a monthly basis during the program, then later transcribed. This log asked respondents open-ended questions about changes they noticed “in me,” “in my children,” and “in my family.” Qualitative data were also collected from the FCS agents themselves through a group de-briefing interview with the FCS agents conducted after the sessions were completed. This all-day group interview was guided by a protocol of a series of questions covering all aspects and time periods of the project. The agents’ interview data were recorded and transcribed. Content analysis was used to analyze all qualitative data. Data were separated into themes using main categories, and then divided into subcategories to which codes were assigned.

Results

The results are presented according to the four principal research questions: (1) program impact, (2) instructor-participant working relationships, (3) participants’ experiences in the program, and (4) FCS agents’ experiences in serving a vulnerable rural population.

Program impact

Participant risk levels. Sten scores were first examined to determine risk levels. Mean Time I scores for all participants ranged from 3.91 (parental empathy) to 5.51 (child power and independence), indicating that, according to this measure, parents began the program having levels of risk that bordered on high, but were moderate in risk. Regarding risk, it should be noted that all families in the study had come to the attention of the Department of Community Based Services as FINSA (Families in Need of Service Assessment).

Between-group comparisons. We first ran a one-way ANOVA to test between-group differences in Time I AAPI scores and, as expected, found no significant differences (F(2,25) = 1.40, p = .263). A second one-way ANOVA was computed to examine the between-group differences in Time II AAPI scores. Contrary to expectations, there were no significant differences (F(2,25) = .99, p = .385), suggesting that in this initial analysis the scores of the parents from the three groups did not differ significantly in terms of their progress over the program.

Within-group analyses. Given the lack of group differences as well as the small sample size, we combined the treatment groups into a single treatment group before conducting within-group comparisons. To examine within-group differences, paired-samples t–tests were calculated to compare mean Time I and Time II scores. These results are reported in Table 1. For the treatment group, there were significant improvements in three areas: expectations of children, parental empathy, and corporal punishment. There was no improvement in parent-child roles and child power/independence. The overall Time II subscale mean was significantly higher than Time I (t(17) = -3.96, p < .001), suggesting that the parenting program facilitated improved parenting attitudes and less risk of abuse. However, for the control group, parental empathy was significantly higher at Time II, and the overall Time II subscale mean was also significantly higher than Time I (t(7) = -2.50, p < .05).

Table 1. Paired-samples t-tests of parent attitudes scores.

AAPI-2 Subscales	AAPI-2 Mean Treatment Groups: n=18			AAPI-2 Mean Control Group: n=8
	Pre	Post	t	Pre	Post	t
1. Expectations of children	2.67 (.53)	2.92 (.60)	-2.05† (17)	2.84 (1.05)	2.84 (1.22)	.00 (7)
2. Parental empathy	3.61 (.52)	4.20 (.47)	-5.97*** (17)	3.71 (.77)	4.40 (.337)	-3.06* (7)
3. Corporal punishment	3.30 (.73)	3.73 (.68)	-2.68* (17)	3.67 (.60)	3.84 (.83)	-.62 (7)
4. Parent-child roles	3.76 (.76)	3.64 (.73)	.79 (17)	3.36 (.79)	3.48 (.89)	-.57 (7)
5. Child power/ independence	4.09 (.60)	3.93 (.71)	.70 (17)	3.95 (.59)	3.90 (.59)	.18 (7)
Overall mean	3.45 (.50)	3.72 (.46)	-3.96*** (17)	3.51 (.59)	3.75 (.52)	-2.50* (7)

Note: Standard deviations are in parentheses.

† p > .10; * p > .05, *** p > .001

Instructor-participant working relationships

Data were collected in all five treatment counties on parents’ ratings of relationships with the Extension agents. Out of a possible high score of 7, mean county scores ranged from 5.08-6.41, with means of 5.81 (Time I) and 5.97 (mid-way through the program). This translates to 83 percent and 85 percent rates of approval, respectively. Parents thus had reasonably strong working alliances with the agents. A one-way ANOVA yielded no significant differences in WAI Time I scores county to county (F(4,18) = 2.09, p = .125), suggesting that working relationships were not significantly weaker or stronger in any given county site.

Correlations were examined to determine whether the instructor-participant relationship was predictive of program outcomes (i.e., on AAPI-2 means). For the “treatment plus in-home coach” group, there was a significant relationship between the mean instructor-participant relationship score (WAI) and the outcome (AAPI-2 mean): r = .75 (p = .02). For the “treatment only” group, the relationship was not predictive of program outcomes (r = .21; p = .46).

Participant experiences

Space limitations in this article prevent in-depth coverage of qualitative themes. There were three themes that emerged as most prominent in the content analyses: increased time together, positive communication, and improved child behavior. The following quotes illustrate these themes.

Time together. Common quotes in this theme included statements such as “We do more things together” and “We’re growing closer and spending more time together.” One parent wrote, “We are finding ways to do more as a family and all work together.” Another wrote, “I’m trying to include [my husband] in [the children’s] bedtime routine.”

Positive communication. Partnered parents noted improvements in their own adult interactions: “We talk more instead of yelling at each other,” “We all react better during a difficult situation,” and “We seem to understand each other better . . . we work together better.” Improvements were also noted in parent-child communication. Participant comments included statements such as “We are happier as a family. We’ve learned to deal with issues in a different way,” “I have found better ways to use my words to talk to the kids,” and “I’ve been a lot calmer talking to him [child].”

Improved child behavior. Parents noted that children were improving their personal behavior. One parent stated, “More of the time they are doing what they were asked the first time and being more responsible.” Another stated, “[My child] is happier and listens a little more.” Parents said they learned how to teach and better understand their children, to handle personal frustration, to improve their self-image, and to have more patience with their children. One participant stated, “We are closer due to changes I’ve made and things I’ve learned to understand.”

Program evaluation. When parents were asked about the sessions, the lessons and videos were mentioned numerous times. One parent commented, “I think every parent should have these classes.” Other responses centered on being able to communicate about parenting (discussing the lesson and just talking with the group), and the environment (having a safe place to talk or vent with the leader and the other participants). Finally, participants indicated that the food (pre-program evening meal and snacks) was pleasant. Some parents told facilitators that their families had not ever sat together to eat a meal before this experience. When asked about what changes the parents would make in the session, statements mostly involved requests for more information on certain topics (e.g., more content on behavior problems, stepchildren). Responses about what participants did not like included not having enough time in the sessions, not enjoying some of the videos, and not agreeing with some of the lessons. Participants also remarked that there was a large amount of paperwork related to the evaluation, and they requested less paperwork.

FCS agent experiences

Three major themes emerged among the agent data: in-depth work beyond one’s typical role, flexibility with the curriculum, and the view that the project was difficult, but worth it.

In-depth work beyond typical role. Agents stated that this work was more in-depth than their typical work as educators, and that their relationships with participants were crucial in conveying the content to these vulnerable parents. They were able to forge deeper relationships than usual, and they found them meaningful in terms of helping to create change. One agent said “We were closer than facilitators. We really wanted them to learn as an equal, and that was something that…is a little bit different.”

Use of curriculum. Agents appreciated the research-based programming, but also stressed the need to keep the sessions interactive and fun. One agent stated, “I felt like I needed that structure, because I would not have had time to prepare for that as the author had it prepared in the book. For an agent to take on a project like this and have to plan everything is too much. He had it planned and we went right by his plans.” Another agent said she liked the NPP better than any other packaged program. However, agents also noted that the curriculum was missing some basic topics such as anger and stress management, cleanliness and hygiene, as well as getting and preparing food.

The project was worth it. Agents strongly felt they made a difference even though change was hard. One stated, “We probably kept at least one child from being abused and an adult from being abused. I really think … that it helped at least three or four of them … from being abused.” Success was not universal. Another agent stated, “Was the program successful here? Yes, for two families; for two others, no.” Some agents noted that this was because some family problems were long-term, and even intergenerational, and thus difficult to change. All agents noted that such intensive work with high-needs families clashes with Extension’s expectation of serving large numbers of people; however, work on this project was viewed with approval from regional directors.

Discussion

Given the complexities in the lives of parents such as those in this study (e.g., poverty, underprivileged statuses), scholars have questioned whether it is even realistic to expect that parent education might result in improvements (Dore and Lee 1999). Overall, these results suggest that there were at least modest benefits for the participants. However, the positive effects may be real or there may have been a Hawthorne effect (improvement due to observation) or both; participants in the control group described the research assistant as very warm and supportive. Still, a strength of this quasi-experimental design is its use of a control group, which here raised the question of improvement by observation. The finding that the facilitator-participant relationship predicted outcomes for the “treatment plus in-home coach” group confirms the finding from the agents: that the relationship was an important vehicle for program gains in this treatment condition. Whether the relationship would be a significant predictor in other circumstances and among larger sample sizes remains to be examined empirically. Taken together, the results of this study add to the base of knowledge regarding the NPP, and the results confirm findings from previous studies (see Devall 2004 and Matteo-Kerney and Benjamin 2004) in terms of gains in child expectations, parental empathy, and in diminished belief in the use of corporal punishment. Methodologically, the results underscore the need for experimental studies to strengthen the empirical basis of the NPP’s efficacy.

Several limitations innate to this exploratory study have impact on the study’s implications. As stated previously, the sample size was very small; further testing of the NPP should be conducted with larger samples. Due to the small sample size and also the initial lack of between-group differences, treatment groups were combined. Further tests are needed to determine whether there might be significant differences in treatment outcomes with the use of in-home coaches or with other formats. Moreover, participants were not randomly assigned in this quasi-experimental design; randomized experimental studies are needed to strengthen conclusions regarding efficacy of the NPP. Qualitative examinations of participants’ and agents’ experiences contextualized program outcomes, but were necessarily abbreviated due to space limitations in this report.

Implications

The qualitative results from parents allowed us to understand their experiences more broadly and subjectively. These data suggest that educational programs may (1) help parents spend more time with their children, (2) improve positive communication, and (3) support improvements in child behavior. The parents’ feedback shows that educational programs should (4) allow parents a safe environment in which to come together and talk and reduce isolation. Agent feedback suggested that for these families, (5) a good working relationship was crucial, and (6) the programming including both adults and children meant in-vivo opportunities to learn and play together.

Despite the considerable time spent with relatively few families as well as the intensity of the work, it appears to have paid off in terms of lowered risk of abuse and neglect and more healthy family functioning, which in turn implies better outcomes for children’s educational and life success. However, working intensely with these families may go against the traditional Extension model of serving large numbers of clientele. Although agents ultimately expressed their deep satisfaction of having worked intensely to serve families that were really in need and having achieved positive results, they also noted the sacrifice of their usual breadth of work to achieve that depth. The relevance demonstrated by this exploratory study for carefully selected FCS agents of supporting highly vulnerable families in such in-depth family education may suggest further examination of the mission of Cooperative Extension in today’s world.

Taken together, the findings suggest that highly vulnerable rural parents can benefit from a program facilitated by FCS agents. This is especially remarkable given the significant needs of these families, all of whom were referred by agencies, and thus who presented with identified levels of risk in their parenting. Although the quantitative results were somewhat mixed, both the quantitative and qualitative results provide positive support for FCS agents as parent educators. It is likely that without the services provided by these agents, the families would have had either inadequate services, no services at all, or would have had to commute long distances to attend programs in other counties. Due to the nature of the families’ situations, the program was high-intensity and reached relatively few; however, such intensity was needed given the acute needs of these families.

Acknowledgement: Funding for this project was made possible by the University of Kentucky Health Education through Extension Leadership (HEEL) grant. The authors thank the Cooperative Extension agents for their work on this project and the families for their participation.

 

 

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