Cellular-Phone Enhanced Home Visitation Parenting Intervention: A Randomized Trial

Home visiting programs have demonstrated their potential to promote positive parenting outcomes and reduce child maltreatment, yet even the most powerful interventions have limited effects if parents are not engaged in the intervention or drop out of the program. Families with specific risk factors, such as low maternal education or family income, are often at highest risk for poor parenting, but are often the least likely to remain engaged in intervention programs. To meet this challenge, we designed an intervention enhancement using cellular phones to supplement a short-term home visiting parenting intervention.

In this randomized controlled trial, mothers (n=371) of pre-school children, and who were experiencing risk factors for child maltreatment were randomly assigned to one of the following groups:  SafeCare^® Planned Activities Training (PAT), cell phone enhanced PAT (CPAT), or a wait-list control. Parents assigned to the PAT and CPAT groups received a five-session parenting intervention aimed at teaching parents to promote positive interactions and prevent challenging child behavior. Parents assigned to the CPAT group also received twice daily text messages and a weekly phone call from their family coach promoting parent engagement, and supporting use of the parenting intervention. It was hypothesized that  while both intervention groups would demonstrate improvements in parenting skills, mothers in the cellular-phone enhanced group would be less likely to drop out of the intervention, would show greater growth in parenting skills, and with time, their children would show improvements in child behavior.

As hypothesized, mothers in the CPAT group were more likely to complete the intervention than mothers in the PAT group. At post-test and the 6-month follow-up assessments, significant improvements were found on parenting skills directly targeted in the intervention and on more general positive parent-child interaction skills. Both intervention groups showed improved child behavior at 6-months follow-up, but only children in the CPAT group had higher adaptive behavior skills. Relationships between parenting improvements and improved child outcomes were found:  parenting skills predicted child cooperative behavior; decreased parenting stress predicted improved child adaptive behavior; and maternal depression predicted children’s internalizing behaviors.

 

The most striking results from the study are minimized parent attrition, and the large treatment effects that were maintained over time in both conditions. Cellular phones offer a promising, cost-effective strategy for enhancing the benefits of home-visiting and other developmental interventions.