About this paper symposium

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Panel information
Panel 9. Family Context & Processes

Paper #1
Integrating an Early Childhood Parenting Program in the Primary-Care Health System in Jamaica
Author information	Role
Susan Walker, Caribbean Institute for Health Research, The University of the West Indies, Jamaica, Jamaica	Presenting author
Abstract
Introduction: The Reach Up early childhood parenting program is designed to strengthen abilities of mothers and other caregivers to support optimal development of their children, through responsive interactions and play. The program has extensive evidence of effectiveness and has been adapted and implemented in several low and middle income countries (Jervis et al, 2023). Millions of children globally do not attain their developmental potential and there is an urgent need for early child development interventions integrated into government services (Black et al, 2017; Richter et al, 2017). There is however limited evidence on how to achieve this. This evaluation examines the implementation and impact of the Reach Up program on child development and parenting skills when delivered by the Ministry of Health and Wellness, Jamaica through primary health-care centers. Hypothesis: The Reach Up program can be delivered with acceptable effectiveness through the primary health care system in Jamaica. Study Population: Parents and children who attended government well-child clinics and who were beneficiaries of the government conditional cash-transfer program. Methods: The intervention was implemented in one health district in each of 12 administrative parishes in Jamaica over an 8-month period. Trained community health workers (CHWs) conducted 2 sessions per month alternating between home visits and phone calls with play materials for the month provided at the home visit. Families received a parent manual with play activities and weekly text messages to encourage them to continue the activities with their child. Each CHW was assigned up to 8 families, randomly assigned to intervention or to a waitlist control group. Questionnaires were administered on enrolment to obtain information on family and child characteristics. Assessments of child development using the Griffiths Scales of mental development and parenting behaviors were conducted after the 8-month intervention period. Results: 237 of 311 children enrolled in the intervention group and 254 of 316 in the control group were assessed, a follow-up rate of 78.3%. Mean age at endline was 27 months. There were no significant differences between the groups in follow-up rate or in enrollment characteristics at endline. Intention to treat multivariate regression analyses, with inverse probability weights to adjust for any bias in loss, showed benefits in children’s developmental quotient with effect size, 0.17 SD, p=0.039 and for fine-motor ability 0.20 SD, p=0.021. There were also gains in the Home Observation for Measurement of the Environment (HOME) score (effect size 0.27 SD, p= 0.003) and parent attitudes concerning child development (effect size 0.18 SD, p=0.035). Parents in the intervention group were more likely make toys for their child and to use praise when the child behaved well. The results show that integration of the Reach Up program within the government primary-care health system achieved benefits for children’s development and parent behaviors. Staff training, intervention delivery and supervision were all conducted by staff in the health system and the benefits are encouraging. Several areas where improvement in implementation is needed were identified and need to be addressed for sustainability of effectiveness of the program as it expands.

Paper #2
Exploring the Role of Childcare in Parents’ Education and Employment Success
Author information	Role
Julia Honoroff, Northwestern University, United States	Presenting author
Terri J. Sabol, Northwestern University, United States	Non-presenting author
Abstract
American families with children face increasing economic challenges, making education a crucial pathway to financial stability (Federal Reserve Bank, 2024). Although about 1 in 10 low-income parents report being enrolled in education and training programs, they often struggle to balance education, work, and childcare responsibilities (Gardner et al., 2017; The Jed Foundation & Ascend at the Aspen Institute, 2021). In fact, around two-fifths of parents are likely to drop out of school to care for their dependents (Noll et al., 2017). One career pathways program, the Health Professions Opportunities Grant (HPOG) 2.0, offered support services like childcare to participants in an effort to address some of challenges parents face when seeking a postsecondary education. The majority of HPOG 2.0 participants (62%) were parents but it is not yet known whether childcare supportive services impacted their success in the program. Using experimental data from the HPOG 2.0 National Evaluation, we studied a subsample of participants with at least one dependent child who attended one of the programs awarded HPOG 2.0 grants across the country (n = 34,851). Research aims include: (1) exploring differences between the type of childcare offered to parent participants and childcare utilization; (2) examining whether certain demographic subgroups of parent participants are more likely to utilize childcare; and (3) assessing whether childcare utilization increases the effectiveness of career pathways programs for parent participants’ education and employment outcomes after 15 months. First, all program grantees offered childcare to their parent participants (i.e., those in the treatment group) yet only 6% of parents utilized the service. The largest proportion of parent participants who utilized childcare were part of programs that provided childcare directly, rather than through partnerships or referrals (see Table 1). The convenience and reliability of childcare directly provided by the program may be more beneficial for families compared to other strategies which have additional obstacles (Long, 2017). Second, we found that the odds of utilizing childcare were higher for partnered participants (B = 0.15, SE = 0.07, odds ratio = 1.16; p = 0.026) and participants with some college or higher (B = 0.17, SE = 0.06, odds ratio = 1.19, p = 0.002). The relationship between poverty level and childcare utilization was not significant (see Table 2). Educational attainment has a unique role in that it affords parents the capacity to seek out, identify, synthesize, and evaluate information for their child’s well-being such as childcare (Davis-Kean et al., 2019). Without the social and financial support of a partner, single parents are likely to face more stressors including sole responsibility for caring for their children and finding adequate childcare. Third, we plan on conducting causal, or near-causal, analyses to examine the third research question regarding the impact of childcare utilization on short-term educational and employment success. Results from this question will be included in the conference presentation. Understanding the mechanisms behind parents’ success in career pathways programs can help future policy initiatives more effectively serve families as well as promote educational success and intergenerational mobility.

Paper #3
The Longer-Term Effects of a Two-Generation Education Program on Parents and Adolescents from Low-Income Families
Author information	Role
Dr. Teresa Eckrich Sommer, Ph.D., Northwestern University, United States	Presenting author
Lauren A. Tighe, Northwestern University, United States	Non-presenting author
Abstract
Parents’ level of education is one of the strongest predictors of children’s developmental outcomes and family well-being (Duncan et al., 2014; Magnuson, 2007). Yet, more than half of low-income parents of young children in the U.S. hold a high school degree or less (Jiang et al., 2017). One approach to supporting low-income families is two-generation programming, which offers coordinated education to both parents and children in the same family (Chase-Lansdale & Brooks-Gunn, 2014). One two-generation education program, CareerAdvance, offered tuition-free healthcare training to parents, as well as coaching support, peer meetings, and other supportive services paired with Head Start for young children. After one to three years, CareerAdvance demonstrated increases in parent education, employment in the healthcare field, self-efficacy, and optimism, but had no effects on income and stress (Chase-Lansdale et al., 2019; Chor et al., 2023). Subgroup analyses suggest differing benefits to parents based on initial education level. Parents’ CareerAdvance participation also led to increased child attendance and less chronic absence in Head Start (Sommer et al., 2020) but there were no effects on young children’s development (Sabol et al., 2024). It is not yet known whether participation in CareerAdvance when children were young translates to longer-term benefits in adolescence, particularly for important outcomes such as income which may take longer to change. Within the Head Start agency, 162 families enrolled in CareerAdvance and another 176 parents formed a comparison group similar to participant parents on a range of demographics. Of these families, 225 participated in a follow-up study examining the longer-term effects of CareerAdvance (treatment n=122, control n=105). Parents completed an online survey approximately 8 years after the program began. Four years later, both parents and adolescents completed individual surveys and parent-child dyad interviews. The follow-up sample was racially/ethnically diverse: 37% Black, 27% White, 12% Latino/a/x, and 24% identified as another race. Approximately a decade after study entry, CareerAdvance parents were more likely to hold a certificate and be employed in the healthcare field than matched comparison parents. Program parents also reported less material hardship. There were marginal effects on overall and full-time employment (see Table 1). Although there were no effects on income in the full sample, parents who began the program with postsecondary credentials reported higher wages per week (B=0.41, SE=0.17, p=.020). There were no significant differences between adolescents whose parents participated in CareerAdvance and adolescents of matched comparison parents on all survey outcomes (see Table 2). Through the dyad interviews, parents’ influence on adolescent education and career interests were largely positive and included a range of types of role modeling. There were also instances where either parents or youth reported neutral or negative influences of parents’ education, including limited time for the child. These negative influences tended to occur in conjunction with the positive influences. The current study is one of the first to examine the longer-term effects of a two-generation education and career program on parent and adolescent outcomes. Findings suggest a family-centered approach to education offers a promising avenue for future policy investment.

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