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

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C 2002 Society for Prevention Research
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224
child’s social ecology are clearly the most effective
at reducing problem behavior and enhancing social
development.
PROJECT STAR (STEPS TO ACHIEVING
RESILIENCE)
Project STAR (Steps to Achieving Resilience:
Kaminski & Stormshak, in press) was developed as a
preventive intervention aimed at reducing the risk of
substance use and delinquency in an at-risk sample of
preschoolers (Head Start). The intervention targeted
each level of the social ecology, and included a school-
based universal intervention, a parenting group inter-
vention, and home visits to families during the tran-
sition to kindergarten. Home visits were designed to
enhance the content of the parenting group.
Project STAR was developed based on the eco-
logical model and was focused on reducing risk factors
that lead to substance use in middle childhood. The
targets of Project STAR included enhancing known
risk factors such as social competence, self-regulation,
and early literacy skills. These risk factors represented
distal outcomes expected to emerge after targeting
a more proximal outcome, which was parenting and
family–school involvement.
Parenting as a Risk Factor
There is probably no more important target in
early childhood prevention than parenting. Defined
broadly, “parenting” refers to skill-based practices as
well as the quality of the parent–child relationship.
In early childhood, relationship variables such as the
quality of attachment, positive family involvement,
and positive parent–child interactions predict both
internalizing and externalizing behavior (Campbell,
1991). Positive parent–child relationships established
in early childhood serve as a foundation for the uti-
lization of effective parenting skills into the preschool
years (Greenberg & Speltz, 1988).
In general, parenting skills associated with later
academic and behavioral problems include lack of
caregiver involvement and positive parenting prac-
tices, poor and inconsistent family management,
and punitive or negative parenting (e.g., Patter-
son & Stouthamer- Loeber, 1984; Petit et al., 1993;
Stormshak et al., 2000). Patterns of interaction learned
in the context of parent–child exchanges are typically
generalized to school settings and peer groups, lead-
Stormshak, Kaminski, and Goodman
ing to the development of later problems such as drug
use and delinquent behavior (Loeber et al., 1993). Be-
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-
tive and stable into adolescence (Campbell & Ewing,
1990; Keenan & Shaw, 1994; Loeber et al., 1993).
Research also indicates that parenting skills have
an impact on school readiness and success. For ex-
ample, in a longitudinal study of the cognitive per-
formance, Burchinal et al. (1997) found that whether
children’s cognitive performance increased or de-
creased during the preschool years was related to
the responsiveness and stimulating characteristics of
the child’s family environment. More recently, Lamb-
Parker et al. (1999) found that parents understand-
ing of play and facilitated learning predicted positive
outcomes for Head Start children, whereas overcon-
trol and negative parenting predicted distractibility
and hostility in the classroom and a subsequent de-
crease in early literacy skills. Similar findings were
reported by Brody et al. (1994) in a study investigat-
ing the contributions of protective and risk factors
to literacy and socioemotional competency in former
Head Start children attending kindergarten. Brody
and colleagues found that engaged, positive, and re-
sponsive caregiver–child interactions were strongly
related to child social and academic achievement in
kindergarten. Additionally, negativity in caregiver–
child interactions was associated with lower socio-
emotional, literacy, and cognitive outcomes (Brody
et al., 1994). Clearly, parenting interventions embed-
ded in Head Start centers are a critical component of
services for families to prevent mental health prob-
lems and promote school success.
Parenting in Context: Rural Oregon
Children considered to be at especially high
risk for behavior problems, deficits in social com-
petence, and academic difficulties are often from
economically disadvantaged homes (Hart & Risley,
1995; National Research Council, 1998). Project
STAR was implemented in five different rural
communities. These towns had been hard hit by
unemployment and job instability, leading to poverty
at a community level. Rural prevention research has
been infrequent in the prevention literature, and
often involves applying programs targeted at urban
populations to rural populations with limited success.
Recruitment and intervention can be particularly
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Enhancing Parenting Skills
difficult when populations are dispersed geographi-
cally and the interventionists are seen as “outsiders”
in the community (Spoth & Redmond, 1994).
Research on the FAST Track Project (Conduct
Problems Prevention Research Group [CPPRG],
1992) suggests that rural and urban differences in
the implementation of prevention programs do exist
and provides several guidelines for future prevention
research with rural families. For example, rural
parents are less likely to attend parenting groups
and to talk freely in the context of other parents
(Bierman & CPPRG, 1997).
Embedding Family Interventions in Existing
Head Start Agencies
Head Start is an agency that serves the many
needs of at-risk children and families in early child-
hood. As such, it is an ideal setting for the delivery
of family-centered interventions aimed at reducing
future risk. Two family intervention components that
have promise for implementation in Head Start agen-
cies are parenting groups and home visiting. Both par-
enting groups and home visits have empirical sup-
port in the literature as effective interventions in
early childhood (Olds et al., 1998; Webster-Stratton
& Hammond, 1990). Parenting interventions, in par-
ticular, are associated with both changes in parenting
skills as well as changes in child behavior (Serketich
& Dumas, 1996).
Both parenting groups and home visits are fam-
ily interventions that occur within Head Starts cur-
rently; however, engaging parents in these activities
is challenging. Webster-Stratton (1998) offered a par-
ent training intervention to Head Start families in an
urban setting. Attendance and participation were rel-
atively good for this sample (88% of parents attended
50% of the parenting groups), and results suggested
changes in parenting at posttest and follow-up. More
recently, Webster-Stratton et al. (2001) found lower
attendance rates for a briefer parenting group inter-
vention in Head Start centers (51% of parents at-
tended six or more sessions). A recent analysis of
parent involvement in Head Start parent activities
was conducted by Lamb-Parker et al. (2001). The re-
searchers set out to understand the barriers to par-
ent involvement in family-focused group activities in
Head Start. They found that some of the biggest bar-
riers to parental participation were maternal depres-
sion, having a baby or toddler at home, and having
a schedule that conflicted with Head Start activities.
Style file version Nov. 04, 2000
225
The results of this survey suggest that services other
than group activities, such as home visiting, may be
the best way to enhance family participation in Head
Start activities.
Preliminary Research
Over the course of our research on Project
STAR, we have been funded by several grants to
provide family services through Head Start. Family
services were part of a comprehensive intervention
that also included teacher training and classroom-
based intervention. The family-based services in-
cluded three components: a parent training curricu-
lum delivered in 12 and 6 sessions, home visits, and
“family nights.” Family nights were individual Project
STAR presentations addressing single topics that
closely match the parent training and classroom cur-
ricula (e.g., playing with your child, establishing home
routines). The Family Night presentations occurred
at regularly scheduled Head Start parent meetings
and, while not an intensive intervention, were an ad-
ditional mechanism for engaging parents in Project
STAR. Participation rates in Project STAR family-
based interventions with Head Start agencies in rural
Oregon across 6 years and three different grants have
varied based on the service offered. Interestingly, the
percentage of parents attending parenting groups was
similar regardless of the number of sessions offered,
with approximately one third of families selecting to
attend the parenting groups. Home visiting had the
highest percentage of participation (76%), followed
by Family Nights (43%).
In our initial research examining the efficacy of
our intervention program, we compared outcomes of
our intervention groups after the first and second year
of our project. Analyses conducted after kindergarten
compared parents who participated in our parenting
program (parenting group and home visiting) to those
who participated only in the universal intervention of-
fered in classrooms. The results suggested that parents
who participated in our parent group intervention
with home visiting showed improvements in parent-
ing skills (e.g., caregiver involvement) over the con-
trol group. Parents who participated only in our home
visiting program had scores on caregiver involvement
similar to those of our control group (Kaminski et al.,
in press). In other words, parent group attendance
plus home visiting during the kindergarten year ap-
peared to be the most effective treatment package
for increasing parenting skills.
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226
As is true of most intervention projects, difficul-
ties engaging families in treatment emerged in this
study. Parenting groups for rural Head Start families
were attended by only one third of the families even
when child care, food, and transportation were pro-
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-
tion, results of the home visiting intervention without
parent group attendance were limited.
Transitioning children From Head Start to Elementary
School: Building Relationships
One major goal of Head Start is to show long-
term benefits of this program into the high school
years. Even with a comprehensive high quality Head
Start program, advantages derived from preschool
can be quickly lost without a smooth transition to a
school environment and follow-up that builds upon
previous gains (Lee & Loeb, 1995). One way to po-
tentially enhance the short-term gains made by Head
Start children would be to provide home visiting for
the first year of elementary school. Ideally, these
home visits would be conducted by someone who be-
gan a relationship with the families during the Head
Start year.
There is ample evidence within the community
prevention literature as well as the psychotherapy re-
search literature to suggest that clinical changes occur
within the context of positive relationships. In com-
munity prevention research, collaboration with
community leaders increases positive outcomes.
Community problems are solved when the focus is
on building programs that enhance existing strengths
(see Weissberg & Greenberg, 1998, for a discussion
of prevention and community research). In rural
communities, existing strengths may include the re-
lationship that families have with a known treatment
provider such as Head Start staff. These relationships
are an important component of continued services
for families as children leave Head Start and enter
elementary school.
In Project STAR, parents were more likely to par-
ticipate in our home visiting intervention than in our
parenting group intervention. However, results of our
home visiting intervention with no parent group at-
tendance were limited. Given the success of our home
visiting program in terms of family participation, we
set out to more closely examine caregiver involve-
ment as an outcome of our intervention. In particular,
Stormshak, Kaminski, and Goodman
we were interested in potential moderators and me-
diators of efficacy, including the relationship that par-
ents had with their home visitor, the number of home
visiting sessions, and risk factors such as public assis-
tance, single parenting, and maternal depression.
METHODS
Recruitment
Recruitment of Schools
Participating Head Start agencies in three rural
counties of Oregon included 16 sites and 23 class-
rooms. Schools were recruited at the agency level and
then randomly assigned by site to either intervention
or control. Head Start sites with similar demographics
were yoked and randomly assigned to different condi-
tions. In many cases, Head Start sites contained multi-
ple classrooms. Because teachers worked together in
these sites, all classrooms within a site were assigned to
the same condition. As a result, there were unequal
numbers of classrooms assigned to the intervention
and control group.
After obtaining agency approval for the project,
teachers were recruited to participate in the study. Re-
cruitment was done at regularly scheduled Head Start
staff meetings. Teachers did the primary recruitment
of families during home visits or regularly scheduled
meetings with parents. Project STAR staff supported
teacher recruitment by attending parent meetings at
regularly scheduled times and presenting the project.
Two sites refused participation; hence, the final sam-
ple of schools included 14 Head Start sites with 11
classrooms assigned to the intervention and 9 class-
rooms assigned to the control condition.
Sample
Four-year-old children and families from par-
ticipating Head Start sites were recruited for this
study. Of the 261 four-year- olds in the Head Start
classrooms, 56% agreed to participate in Project
STAR in Year 1 (n = 146). The final sample was
52% female, with 45% of children living in fam-
ilies including both biological parents. Sixty per-
cent of the children and families received pub-
lic assistance. Eighty-three percent were Caucasian
and 13% were other ethnic groups, primarily His-
panic. These demographics are representative of the
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Enhancing Parenting Skills
rural population in Oregon. Although we were un-
able to collect parent report data on the nonpartic-
ipants, 250 families consented to teacher reports of
child behavior. There were no differences between
children in the parenting portion of Project STAR
and nonparticipating children on externalizing be-
havior problems or social competence in the class-
room as reported by teachers on the Social Compe-
tence and Behavior Evaluation Scale (LaFreniere &
Dumas, 1996); F(1, 250) = 2.15, p < .14.
Attrition
Data were collected over 2 years on our initial
sample of 146 families (48 control families and 98 in-
tervention). Between Wave 1 (fall of preschool) and
Wave 2 (spring of preschool), we experienced 24%
attrition, which resulted in a Year 2 sample of 112.
These rates are similar to those reported by other re-
searchers who have worked with Head Start popu-
lations (Webster-Stratton, 1998). When we examined
the differences between participants who attrited and
those retained at Wave 2, there were no differences in
family make- up (maternal depression, marital prob-
lems), or child behavior problems. At Wave 3 (spring
of kindergarten), our sample included 97 children and
families, and hence, our attrition from Year 2 to 3 was
only 13%.
Self-Selection
Random assignment occurred at the Head Start
site level for this study, and hence, parents were
self-selected into the various parenting interventions.
However, there were very few preintervention group
differences found on the variables of significance. Al-
though parents who agreed to parenting groups had
higher levels of school involvement, groups did not
differ on caregiver involvement, behavior problems,
or social competence (see Kaminski et al., in press).
Intervention Procedures
Universal School Intervention
Children in participating classrooms received a
classroom intervention administered by Head Start
teachers. This intervention included 20 sessions fo-
cused on social competence, self-regulation, early lit-
eracy, and language and was administered to children
by their Head Start teachers during regular activities
Style file version Nov. 04, 2000
227
in the classroom. During the fall of Year 1, teachers
who agreed to participate attended a full-day work-
shop designed to train the teachers on administering
this intervention, which consisted of circle time activ-
ities to promote critical skills in each of the four areas
listed above. Head Start teachers then administered
the intervention throughout the school year with con-
sultation provided on a bimonthly basis from Project
STAR staff.
Selected Interventions
Parents of participating 4-year-olds were of-
fered a parenting group intervention in Year 1
(preschool) and a home visiting intervention in Year 2
(kindergarten). The parenting groups used the In-
credible Years parenting curriculum developed by
Carolyn Webster-Stratton for children aged 4–8
(Webster-Stratton, 1994). This video-based curricu-
lum provides training in positive parenting, limit set-
ting, problem solving, and handling misbehavior. The
program has been implemented successfully in mul-
tiple research studies and leads to improved parent-
ing as well as decreases in child behavior problems
(Webster-Stratton, 1990; Webster-Stratton & Ham-
mond, 1990). Parenting groups were run by trained
interventionists at each participating Head Start site.
Transportation and childcare were provided to fami-
lies in order to increase participation.
The home visiting intervention was developed as
an individualized approach to working with high-risk
families (Wasik et al., 1990). The home visiting cur-
riculum combines the strategies from our classroom-
based intervention and the Incredible Years pro-
gram into a home-based service delivery model
(Kaminski & Stormshak, in press). The curriculum
also includes other topics of relevance to children
transitioning from preschool to elementary school
(e.g., talking with your child’s teacher, asking your
child about school, involvement in your child’s aca-
demic achievement). These additional components
have been adapted from the FAST Track Parenting
Intervention (CPPRG, 1992).
At the initial meeting, families identified top-
ics they were interested in from a list of choices.
These included items such as early literacy and read-
ing, social competence, parenting more effectively,
and helping my child control anger. After this initial
meeting, an individualized intervention package was
developed with the interventionist and family. The
overall goals of the home visiting were to provide
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support and education on significant predictors of be-
havior problems at this age. This included promot-
ing social competence, self-regulation, parenting skills
and family management, and academic success. The
average number of home visits received by families
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
the intervention.
Staffing
As a research project designed to be embedded in
Head Start centers, Project STAR was focused on con-
necting with parents through Head Start. We took a
community approach to our prevention program with
a goal to train existing staff in our program content
so that when our project was over, the staff would
be able to use the materials and model in years to
come. Limited resources in our rural communities
made this community collaboration model even more
critical. We hired and trained intervention staff along-
side family consultants from the Head Start centers.
Our staff worked collaboratively with these family
consultants, teachers, and parents to coordinate our
parenting groups, deliver our classroom-based inter-
vention, and provide home visits to families. In each
case, parenting groups were run with existing Head
Start staff. We feel this collaboration enhanced over-
all participation in our parenting groups by creating a
familiar environment for families and decreasing the
likelihood that we would be seen as “outsiders” in
these rural communities.
Home visits were staffed by trained profession-
als, each with extensive experience working with fam-
ilies and children. Of the six home visitors, all had
Master’s degrees in Counseling or Education. Each
visitor participated in a full-day training workshop
designed to improve the fidelity of the intervention.
Home visitors met biweekly for supervision through-
out the home visiting intervention.
Assessment Procedure
Parent interviews were conducted in the home
during the three waves of data collection (fall
preschool, spring preschool, and spring kinder-
garten). In each case, parents were interviewed by
trained assessment staff and their responses were
recorded on a laptop computer. Direct observations
Style file version Nov. 04, 2000
Stormshak, Kaminski, and Goodman
of parent–child interactions were conducted at Waves
2 and 3 during the scheduled parent interview. Par-
ents were paid $25.00 for each wave of assessment
and $5.00 for each parenting group or home visiting
session in which they participated.
Assessment Measures
Parenting Practices Interview
This questionnaire was developed based on items
from the Discipline Questionnaire (Oregon Social
Learning Center, 1992; LIFT Project) and the Parent-
ing Practices Scale (Strayhorn & Weidman, 1988). The
measure includes items assessing parenting warmth
and praise, limit setting, problem solving, and puni-
tive parenting strategies. In previous research with
items from this measure, scales of warmth, consis-
tency, punitiveness, and parental aggression (e.g., hit-
ting) were formed in a confirmatory factor analysis
and were differentially predictive of a variety of child
behavior problems (Stormshak et al., 2000).
Parent–Teacher Involvement Questionnaire
(INVOLVE-P; CPPRG, 1999)
This is a 26-item measure developed initially for
the FAST Track program (CPPRG, 1992) that as-
sessed the amount and type of contact that occurred
between the parent and teacher in addition to the par-
ent’s interest in talking with the teacher, satisfaction
with the teacher, and involvement at school. This mea-
sure has good reliability and validity in addition to in-
ternal reliability of each subscale (school involvement
and educational values, .89 and .91 respectively).
Depression Scale (Radloff, 1977)
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-
sure was included in the assessment battery to be used
in analyses as a mediator.
Parent-Child Interaction
Parents and children participated in a 15-min
interaction task modeled after the Behavioral
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Enhancing Parenting Skills
Coding System developed by Forehand and
McMahon (1981). The three 5-min tasks included
child-directed play, parent-directed play, and a toy
clean-up task. Trained observers used a modified
version of the Coder Impressions Inventory (Capaldi
& Patterson, 1989) and the Interaction Rating Scales
(IRS; Crnic & Greenberg, 1990) to rate the quality
of the parent–child interaction. Ratings included
positive and negative parenting as well as child
behavior.
MULTIRATER CONSTRUCT OF CAREGIVER
INVOLVEMENT
On the basis of previous research, we created a
theoretically derived construct of caregiver involve-
ment that consisted of two separate but related com-
ponents, positive involvement and negative parent-
ing. To test this theoretical model, a confirmatory
factory analysis (CFA) was performed at each wave
of data collection. In each CFA, six parent-report
measures loaded onto the positive involvement con-
struct, including the Involve-P Caregiver Involvement
Scale, and five subscales of the Lift Parent Question-
naire (Positive Parent, Family Activities, Appropriate
Limit Setting, Clear Expectations, and Monitoring).
Direct observations of positive involvement also
loaded onto the Positive Involvement construct. In
each CFA there were two measures that loaded onto
a Negative Parent construct: the Lift Harsh Discipline
Scale and the Lift Inconsistent Parent Scale. Negative
Parent was allowed to correlate with Positive Involve-
ment in order to estimate the relation between these
two constructs. The chi-square for this model was sig-
nificant; however, the CFA models fit relatively well
for all three waves as indicated by the Goodness of
Fit Indices, (χ 2 (N = 146, d f = 16) = 25.79, p < .01,
GFI = .96, TLI = .89. Additionally, all of the mea-
surements significantly loaded onto the negative par-
enting or positive involvement constructs at all three
waves, indicating that all the measures are good in-
dicators of their respective construct. Finally, there
was a moderate to strong negative correlation be-
tween the negative parenting and the positive involve-
ment constructs (r = −.47, p < .01), suggesting that
positive involvement and negative parenting are both
subcomponents of caregiver involvement. Our final
measure of caregiver involvement was one measure
that included both positive and negative aspects of
parenting.
Style file version Nov. 04, 2000
229
RESULTS
Results from our initial work with this sample
seemed to indicate that the mechanism for change was
the parenting group. That is, parents who attended the
parenting group showed gains in caregiver involve-
ment over those who attended the home visiting pro-
gram only. However, despite positive results from the
parenting group we had difficulty reaching the major-
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
our high rates of participation in this component.
Our home visiting program was extensive and de-
livery was individualized across families. Because of
random staff attrition, some families had home visits
conducted by an unfamiliar staff person. In an attempt
to understand potential moderators of efficacy associ-
ated with the home visiting program, we further subdi-
vided our sample into those families who attended the
parenting group and then received home visits from
a familiar staff person (i.e., their parent group facili-
tator) versus those families who received home visits
from a new intervention staff person (not the same
person who facilitated their parent training group).
These results are presented in Fig. 1.
Although there were no differences between
groups on Time 1 caregiver involvement scores,
F(4, 91) = 1.03, MSE = 0.33, p = .39, all analyses
controlled for Time 1 caregiver involvement. The re-
sults suggest that families who received the home
visits from a familiar staff person had significantly
higher caregiver involvement scores than every other
group of families, F(1, 82) = 13.77, MSE = 2.88, p <
0.001. The results also suggest that families who
received home visits from an unfamiliar staff per-
son did not have significantly higher caregiver in-
volvement scores than the other families, F(1, 82) =
0.39, MSE = 0.08, p = ns. Taken together, this anal-
ysis suggests that familiarity with the home visitor may
be a critical ingredient in a successful home visiting
program. The combined effect of a parenting group
plus home visiting from a familiar staff person is the
most effective set of interventions to increase care-
giver involvement.
Next we examined whether or not level of par-
ticipation accounted for these effects. We looked at
the number of home visiting sessions attended by
each group of participants. Families who attended
the parenting group prior to being offered the home
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-
tend the parenting group, F(1, 48) = 16.52, MSE =
88.13, p < .001. However, parents in the familiar ver-
sus unfamiliar group did not differ in their participa-
tion in home visiting. This finding suggests that level
of participation in home visiting does not account for
the influence of familiarity on caregiver involvement.
However, a parenting group delivered prior to the
home visiting intervention did increase family partic-
ipation in the home visiting program.
Next, we were interested in examining change
in caregiver involvement as a function of number of
home visiting sessions participated in across the three
intervention groups (home visits only, parent group
plus home visit from familiar staff person, and par-
ent group plus home visit from unfamiliar staff per-
son). We found a moderately significant interaction
between intervention group and number of sessions
attended on our caregiver involvement construct. This
is shown in Fig. 2, F(3, 49) = 2.49, p = .083. Our lim-
ited sample size at this point decreased the power of
our findings; however the trend depicted in Fig. 2 sug-
gests that with a familiar home visitor, level of partici-
pation in home visiting, or dosage, predicted increases
in caregiver involvement scores. It appears that for
families with a familiar home visitor, more home vis-
its led to increased improvements in caregiver in-
volvement. However, with an unfamiliar visitor or no
parenting group, dosage did not predict caregiver in-
volvement. For these families, dosage had no impact
of levels of caregiver involvement.
In an attempt to further understand potential
moderators of efficacy associated with this program,
we subdivided our sample into several final groups.
We examined differences in caregiver involvement for
families who received the home visiting intervention
and were (a) on public assistance, (b) single parents,
or (c) depressed.
In separate analyses, we found no effects for pub-
lic assistance or single parenting on our home visiting
intervention. Parents who were on public assistance
or who were single parents did not differ in their
Wave 3 caregiver involvement scores from parents
without these risk factors. When we subdivided our
families by scores on the CES-D (using a mean split),
we found that mother’s with more depression scored
lower on Wave 3 caregiver involvement than moth-
ers who were not depressed, F(1, 82) = 8.00, MSE =
2.53, p < .001. Both depressed and nondepressed
parents received the same number of home visits
(mean = 7).
DISCUSSION
This research presented findings from Project
STAR, an early intervention program designed to
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Enhancing Parenting Skills
Fig. 2. Dosage of the home visiting program predicting caregiver involvement for familiar staffing.
embed family-centered services in an existing service
delivery system for low income, rural families. It is
clear from this research that home visiting interven-
tions are an effective means of maintaining a connec-
tion with Head Start families as they transition from
Head Start to kindergarten. Home visiting had the
highest participation rate of all the interventions of-
fered to Head Start families. Additionally, it appears
that the staffing of this intervention is critical. Head
Start families who were visited by a familiar staff per-
son made significant gains above families who were
visited by an unfamiliar staff person. These gains were
not based on attendance. For families who were vis-
ited by a familiar staff person, there was a significant
correlation between dosage (number of home visits)
and caregiver involvement scores. This was not true
of any other group.
Although the literature suggests potential pos-
itive benefits to home visits in early childhood, the
mechanism for change is still unclear. It may be, for ex-
ample, that parents form a working relationship with
the home visitor that allows for discussion and pro-
cess around parenting issues as well as other family
problems (Heinicke et al., 1999). In this case, the rela-
tionship with the home visitor plays a significant role
in the change process. Support for this theory is also
12:51 Style file version Nov. 04, 2000
231
found in research suggesting that parents who per-
ceive the home visitor to be empathic will in turn
show positive, empathic parenting with their infant
(Korfmacher et al., 1998). It also may be that home
visits allow the interventionist to understand cultural
and contextual factors that may be impacting the child
and family and provide a more sensitive intervention
for that family (Slaughter-Defoe, 1993).
Our findings are consistent with those of Olds
et al. (1998, 1999) who suggested that home visits need
to be of sufficient frequency and duration of visit need
to be sufficiently long to effect change. In addition, as
evidenced by our results, continuity of staff appears
to be an important factor. This relationship-based en-
hancement of effects does not necessarily mean, how-
ever, that the relationship qualities of the home visitor
were responsible for the changes in families. It may
be that Head Start families take some time to build
trust with staff and with their community. The con-
tinuity of a familiar staff person from Head Start to
kindergarten provided a community connection for
these families that was supportive and constant. In
turn, families were able to form a working relation-
ship more quickly with a familiar interventionist and
perhaps work more intensely on parenting problems
and family–school relationships.
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232
An added benefit of the home visiting model is
that therapists have the opportunity to understand the
family in their own context. Child development and
behavioral concerns of parents can all be understood
more fully in the situational contexts of the home
visit (e.g., chaotic households, cramped living quar-
ters, unsafe neighborhoods, and stressful interactions
with neighbors and community). Although the ma-
jority of our sample was Caucasian, these nonspecific
benefits of home visiting allowed staff to understand
each family’s culture. Certainly, rural families do ex-
ist in their own culture. It is often times one of isola-
tion, community problems, and lack of resources. In
particular, limited recreational, education, and men-
tal health services maintain problems for rural fami-
lies (Sherman, 1992). Stressful economic conditions in
rural areas lead to family problems, which in turn pre-
dict child behavior problems (Conger & Elder, 1994).
These problems can be understood more fully when
interventions occur in the home.
Our research effort involved embedding our in-
tervention into existing services that were already be-
ing offered at Head Start centers. Parenting groups
and support are provided as a regular part of Head
Start. Home visits are also provided, but vary widely
in implementation. In order to increase participation
in our parenting groups, we offered $5.00 in gift cer-
tificates for each group attended, childcare, and trans-
portation. We coordinated these incentives with the
Head Start centers involved in our intervention to in-
crease the likelihood of success (for example, Head
Start staff provided the childcare). We also reduced
the number of parent group sessions from 12 to 6 over
the course of our work with Head Start centers in
order to increase parent participation. We hypothe-
sized that offering less sessions would increase atten-
dance by reducing the overall time commitment from
families.
Despite our efforts directed toward parent group
attendance, participation in our parenting groups was
still low. In our research, almost three fourths of the
rural families participated in home visits compared
to only one third who attended the parenting groups.
Although rural communities may seem like the per-
fect environment for a parenting group, it has been
our experience that the opposite is true. The fact that
most of our families knew each other well (due to
living in a small community) may have at times pre-
vented them from attending a parenting group be-
cause they feared that their problems were not going
to be confidential. Families are not anonymous in ru-
ral communities and parents have relationships with
Stormshak, Kaminski, and Goodman
other families that extend back to their own childhood
years and sometimes even further. A home visiting
intervention, therefore, may meet the needs of rural
families much better than of urban families who may
be less connected to their communities.
Clearly, familiar staff enhanced the results of our
intervention. In hiring staff to work on our project,
we first looked for skilled therapists from the rural
community. In only one case were we able to hire
someone in the community to serve as a parent group
facilitator and home visitor. The reasons for this were
varied, and primarily were related to a lack of avail-
able and qualified individuals in these communities. In
smaller communities, qualified staff are already em-
ployed full-time and Head Start teachers and fam-
ily consultants were not available to do additional
home visits even when offered extra compensation.
This was in part due to their teacher-union guidelines
as well as a lack of outside time and staff commit-
ment to Project STAR. Thus, our home visiting staff
were typically not from the community; however, they
were familiar because we tried to use the same staff
to run parenting groups and conduct the home visits
1 year later. By the time the staff were conducting the
home visits, they had been working in the commu-
nity for a full year. Staff attrition was not atypical and
included factors such as moving and career changes.
These normative reasons for staff attrition, however,
can clearly change the results of a prevention pro-
gram. This is a critical consideration for staffing pre-
vention research and administering prevention pro-
grams in rural communities.
When we examined dosage as a predictor of out-
comes, we found that dosage was only related to care-
giver involvement for families who were visited by a
familiar home visitor. Although the results should be
interpreted with caution, this preliminary finding has
implications for future service delivery. In traditional
psychotherapy outcome research based on a medical
model of service delivery, dosage is conceptualized as
having a direct relation to outcomes. That is, the more
therapy that is delivered the greater the outcomes for
children and families. However, recent research sug-
gests that within child and family treatment models,
clinically significant change may be based on multi-
ple factors including group dynamics and adherence
to the program rather than quantity of sessions de-
livered (Dishion & Kavanagh, in press). For exam-
ple, in a careful analysis of clinical cases treated at
Oregon Social Learning Center, Weber (1998) did
not find evidence for a dose–response relation be-
tween the number of sessions and changes in child
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Enhancing Parenting Skills
behavior or parenting. Changes appeared to be a func-
tion of the interchange between the therapist and the
client rather than a simple dose–response relationship
(Stoolmiller et al., 1993). In a home visiting service
delivery model, the relationship with the home visi-
tor appears to be a critical component in the relation
between dosage and positive outcomes for families.
We also examined several risk factors as predic-
tors of outcomes of our home visiting program. These
included public assistance, single parenting, and de-
pression. We did not find any differences in fami-
lies on public assistance or single parents; however,
we did find that parents who were more depressed
scored lower on caregiver involvement after the inter-
vention than those parents who were not depressed.
This finding is consistent with other research in this
area that suggests depression can mediate the im-
pact of parenting interventions (Webster-Stratton &
Hammond, 1990). It is likely that parents who are de-
pressed require a much more extensive intervention
program, aimed at their child as well as contextual
factors in their lives that may be predicting depres-
sion (e.g., marital problems, substance use, etc). Our
program did not target these problems specifically but
focused more broadly on parenting and family–school
linkages.
In summary, understanding factors that moder-
ate the efficacy of family interventions is critical to
understanding how to improve implementation and
engage families in treatment. It is important in pre-
vention to establish relationships with existing agen-
cies that serve at-risk populations. Head Start oper-
ates in some regards as a community agency, serving
the multiple needs of many families. Retaining this
family connection into the kindergarten year and sup-
porting families as they transition to school may have
positive benefits for both children and families. Al-
though this research did not examine child outcomes,
improvements in parenting are an important first step
to making overall changes in child behavior. Contin-
ued research with this population will be important in
order to solidify our understanding of effective family
interventions at this age.
ACKNOWLEDGMENTS
This research was funded by a grant from
The Center for Substance Abuse Prevention (UR6-
SP07957) to the second author, a grant from the
U.S. Department of Education, Office of Educational
Research and Improvement (R305T990474), to the
Style file version Nov. 04, 2000
233
second and first authors, and a grant from the U.S.
Department of Education, Office of Special Educa-
tion Programs (H324C990074), to the second and first
authors. Thanks to all the staff at Lane County, Linn-
Benton, and Douglas County Head Start who assisted
with this research. Special thanks to Berry Broadbent
and Stacy Mendez for their dedication to this work
and strong community connections with teachers and
families.
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