Pilot Evaluation of Parent and Child Enhancement Program for Disadvantaged Families

Abstract

Objective:

The present study was a pilot evaluation of the effectiveness of the Parent and Child Enhancement (PACE) program in enhancing child development for disadvantaged families with children aged 2 to 3.

Method:

Participants included 23 parent–child dyads who attended 2-hr sessions twice weekly for 20 weeks. Parents and children were assessed before and after program participation on child cognitive skills, learning motivation, behavior problems, parental stress, and social support. Where appropriate, teacher-reported measures were obtained.

Results:

The results indicated significant improvement in child cognitive scores, learning motivation, prosocial behavior, and a significant decrease in child behavior problems.

Conclusion:

The results provided limited initial but encouraging evidence for the effectiveness of the PACE program in promoting child outcomes. Implications for social work practice were discussed.

Keywords

early intervention learning children parent training

Children are the future of our society, and all children should be given the necessary support to enable them to develop their full potential. It is well known that poverty is associated with lower learning and educational achievement in children (Aikens & Barbarin, 2008; Marks & Coll, 2007; Reardon, 2011; Smith, Brooks-Gunn, Kohen, & McCarten, 2001). A meta-analysis of studies on the association between socioeconomic status and academic achievement indicated a medium to strong positive association between socioeconomic status and academic achievement, the higher the socioeconomic status, the higher the achievement (Sirin, 2010). Family income has become one of the major predictors of children’s academic achievement (Reardon, 2011).

Apart from academic achievement, children from low socioeconomic backgrounds were found to have a higher incidence of behavior problems than their counterparts (Qi & Kaiser, 2003). Patterson, Mockford, Barlow, Pyper, and Steward-Brown (2002) also found that the prevalence of child behavior problems was higher among manual social class families. If left untreated, these early behavior problems are likely to lead to conduct problems, social skills deficits, and academic difficulties during adolescence (Qi & Kaiser, 2003).

In arguing for a fair society, Marmot (2010) pointed out that the scale and level of intervention should be proportionate to the level of disadvantage. To improve their life chances, it is important that children from disadvantaged families be offered support and resources to enhance their learning and social skills, to enable them to fully develop their potential.

Background

Early intervention is important for four reasons. First, many adolescent and adult health problems such as conduct problems and drug abuse have their roots in the early years and this is one of the reasons for the importance of intervention during the early years (Webster-Stratton & Taylor, 2001). Second, early disadvantage can lead to a chain of disadvantages. Morgan, Farkas, and Hibel (2008) used the term “Matthew effect” to describe this phenomenon. The “Matthew effect” refers to “a pattern of increasing advantage or disadvantage following initial advantage or disadvantage” (p. 187). Matthew effect was found to be one sided, where children who were at risk of reading difficulties became poor readers over time but those at an initial advantage did not maintain the advantage over time (Morgan, Farkas, & Hibel, 2008). Third, early intervention means that help is given to children before a sense of failure sets in (Nelson, Westhues, & MacLeod, 2003), and this might help to prevent or overcome other problems, such as conduct problems, that might affect learning (Webster-Stratton & Taylor, 2001). Fourth, it is easier to reverse the effect of developmental delays at this early age, as this is the time of rapid growth and change, and many of these changes are associated with the early environment. An American longitudinal study found that learning stimulation (e.g., children being provided with educational toys) and parental responsiveness (e.g., parents making stimulating conversations with children) were positively associated with child language skills, and this association was stronger when children were younger (Bradley, Corwyn, Burchinal, McAdoo, & García Coll, 2001).

Effective early intervention programs such as Nurse Family Partnership, New Parents as Teachers, High/Scope Perry Preschool Program, Abecedarian Project, Early Headstart Program, and Home Instruction for Parents of Preschool Youngsters (HIPPY) focused on learning activities for children and parenting education. The results indicated improvement in child cognitive and language development, behavior and emotional adjustment, and the parents were more emotionally supportive (Burger, 2010; Manning, Homel, & Smith, 2010; Ramey et al., 2000). In a review of effective early intervention programs, Engle et al. (2007) concluded that the most effective interventions were comprehensive programs targeting younger and disadvantaged children and families. These programs should be of high quality and there was a positive association between program duration/intensity and effect size. The services should be provided directly to children, together with an active parenting education component involving skill building. Most of the programs had a child component and a family support component (Manning et al., 2010).

Hong Kong

Hong Kong is a special administrative region of China and an international city. From 2001 to 2011, the Gini coefficient (an income dispersion measure) grew from .470 to .475, indicating a widening income gap (Census and Statistics Department, 2012a), resulting in intensified relative poverty, social disadvantage, and social inequality. The Gini coefficient of Hong Kong is comparable to that of the United Kingdom, Canada, and some metropolitan cities such as New York City and Washington, DC, in the United States. The Gini coefficient of Hong Kong is lower than that in Singapore, a metropolitan city in southeast Asia (Census and Statistics Department, 2012a), but higher than Australia (Greenvile, Pobke, & Rogers, 2013). Based on the 2006 census, it was estimated that among Hong Kong children aged 10 or under, 12.1% were living in poverty (defined as half of median household income), compared with 20% in the United States (Chou, 2013).

According to the 2011 census, Hong Kong had 196,350 children aged 1 to 4, or approximately 50,000 children in each age (e.g., 2-year-old) group (Census and Statistics Department, 2012b). In Hong Kong, kindergartens (which are registered with the Education Bureau) provide services for children 3 to 6 years of age. Children attending nonprofit-making kindergartens can receive nonmeans-tested fee subsidies from the Education Bureau via the Preprimary Education Voucher Scheme, and the kindergarten attendance rate is about 91.3% for children aged 3 to 5 (Census and Statistics Department, 2012b). The Hong Kong preschool attendance rate is comparable with Australia where 85% of children aged 4 to 5 are attending a preschool program (Australian Bureau of Statistics, 2011) but higher than that of United States where about 75% of 4-year-old children and 50% of 3-year-old children are in some form of preschool program (Barnett, Carolan, Fitzgerald, & Squires, 2011).

For children below the age of 3, services are provided by child care centers, which are registered with the Social Welfare Department (2013). The Preprimary Education Voucher Scheme is not available to these children. Maternal and Child Health Centers (MCHCs) provide a range of free services for local children aged from birth to 5, and for their parents. However, with the completion of the immunization schedule, scheduled attendance to MCHCs becomes less frequent by 24 months. As kindergarten does not start until 36 months, the academic development of children from socially disadvantaged families such as low-income families is relatively unsupported from 24 months to 36 months.

Though there are effective programs such as Nurse Family Partnership, New Parents as Teachers, High/Scope Perry Preschool Program, Abecedarian Project, Early Headstart Program, and HIPPY for preschool children overseas, these programs are not available in Hong Kong. As these programs were developed in western countries, local adaptations would be needed to meet the needs of Hong Kong children.

The Parent and Child Enhancement (PACE) Program

To target the needs of young children from socially disadvantaged families (e.g., low-income families, new immigrant families), the PACE program was developed. The PACE was an expansion in at least three ways of the 30-session Hands-On Parent Empowerment (HOPE) program (Leung, Tsang, & Dean, 2011) referenced from the HIPPY, as well as the Positive Parenting Program (Sanders, 1999) and developed for new immigrant parents with children aged 3 to 5 in Hong Kong. First, the PACE program addressed younger children aged 2 to 3. Second, the PACE program included direct program input on the parent and the child, whereas the HOPE program trained parents and offered no direct training to the children. Third, the PACE program included 40 two-hour sessions, and ran along a two-session per week rhythm.

In the PACE program, the parents and children were to attend two sessions per week for 20 weeks. One hour of each session consisted of direct teaching to the children, and the parents were to observe and facilitate/assist their children’s participation. The other hour focused on training parents to enhance the development of their children. The Guide to the Pre-Primary Curriculum developed by the Curriculum Development Council (2006) was incorporated in the development of program materials for both children and parents. The learning activities for children focused on cognitive areas such as preschool concepts (e.g., color, size, numbers, categorization), with a particular emphasis on language (Ramey et al., 2000), but also included social and motor skills. For the parent training component, parents were taught to incorporate the learning activities and games into daily activities. Parents were taught skills to enhance their children’s learning and language, to strengthen the parent–child relationship, to increase their children’s positive behavior, and to manage their children’s inappropriate behavior. Between sessions, parents and children were to spend about 5 min each day working on homework activities. The details of the program are given in Table 1.

Table 1.

Program Content of the Parent and Child Enhancement (PACE) Program.

	Parent		Child
Session	Domain	Parent Training	Domain	Child Learning
1	Introduction to parenting	Enhancing parent–child relationship	Introduction	Parent–child relationship
2	Encouraging curiosity	Communicating with child; encouraging curiosity	Preschool concepts	Names of body parts
3	Encouraging curiosity	Safe and stimulating environment; supportive attitude	Self-care	Dressing
4	Language skills	Importance of language and child language development	Preschool concepts	Functions of body parts
5	Language skills	Encouraging child expressive language	Preschool concepts	Functions of common daily objects
6	Language skills	Listening and responding to child	Language skills	Expressive language
7	Behavior management	Understanding child behavior	Social skills	Paying attention and lining up (queuing)
8	Behavior management	Praise	Self-care	Drinking with cup and taking off shoes
9	Preschool concepts	Shapes—circle, square, triangle	Preschool concepts	Shapes—circle, square, triangle
10	Preschool concepts	Primary colors	Preschool concepts	Primary colors
11	Behavior management	Behavior chart	Motor skills	Balance and gross motor skills
12	Behavior management	Ignoring	Motor skills	Fine motor skills
13	Behavior management	Effective commands	Social skills	Following instructions
14	Behavior management	Setting family rules	Revision	Revision
15	Preschool concepts	Number concept (1)	Preschool concepts	Counting
16	Preschool concepts	Number concept (2)	Preschool concepts	Numbers
17	Language skills	Paired reading (1)	Language skills	Stories
18	Language skills	Paired reading (2)	Language skills	Turning pages
19	Language skills	Choosing books	Language skills	Book corner
20	Preschool concepts	Size	Preschool concepts	Size
21	Preschool concepts	Number concept (3)	Preschool concepts	Number and counting
22	Preschool concepts	Quantity	Preschool concepts	Quantity
23	Preschool concepts	Matching	Preschool concepts	Matching
24	Preschool concepts	Positions—above and below	Preschool concepts	Positions—above and below
25	Motor skills	Gross motor skills	Motor skills	Gross motor skills
26	Motor skills	Fine motor skills	Motor skills	Fine motor skills
27	Learning through play	Learning through play	Learning through play	Games
28	Language skills	Paired reading (3)	Language skills	Listening, comprehension, and expression
29	Language skills	Paired reading (4)	Language skills	Listening, comprehension, and expression
30	Behavior management	Quiet area	Motor skills	Sensory motor skills
31	Behavior management	Time out	Motor skills	Eye–hand coordination
32	Behavior management	Prevention	Motor skills	Manipulative skills
33	Language skills	Library tour	Language skills	Library tour
34	Preschool concepts	Categorization (1)	Preschool concepts	Categorization (single attribute)
35	Preschool concepts	Comparison	Preschool concepts	Comparison (more–less)
36	Preschool concepts	Secondary colors and shapes	Preschool concepts	Secondary colors and shapes
37	Preschool concepts	Categorization (2)	Preschool concepts	Categorization (two attributes)
38	Preschool concepts	Sequence	Preschool concepts	Sequence
39	School readiness	Getting ready for school	Revision	Revision
40	Graduation	Conclusion and Graduation	Graduation	Graduation

A structured program manual was developed for each session, together with learning activities and materials for children, notes for parents, homework activities, and PowerPoint files to facilitate teaching. The program materials were developed by the project team, including the first and second authors (an educational psychologist and a clinical psychologist), one early childhood educator, and two social workers. The sessions were delivered by the two social workers involved in the development of the program materials. Role plays were used to enable parents to master the skills needed to complete the homework. The two social workers received regular supervision (daily consultation on program content and implementation through e-mail, phone contact, and face-to-face discussion) from the first and second authors, both psychologists. They also attended relevant professional development programs on parent training and child health issues. The first and second authors conducted visits to the programs for fidelity check and provided feedback to the social workers afterward.

The Present Study

The present study was a pilot evaluation of the PACE program, using pre- and postdesign. The aim was to evaluate the effectiveness of the PACE program in improving child and parent outcomes. The research question was to find out whether the PACE program was effective in producing positive changes in children’s learning and their behavior, as well as parental outcomes in terms of parental stress and social support. The hypotheses were:

Hypothesis 1: There would be positive changes in children’s learning, as measured by individual assessment of their cognitive skills, and parent (and teacher where appropriate)-reported measures of their learning behavior.

Hypothesis 2: There would be a decrease in child problem behavior after program participation.

Hypothesis 3: There would be a decrease in parental stress and increase in social support after program participation.

Method

Participants

The participants were recruited through two participating child care centers. The child care centers advertised the program to parents. Participation was voluntary. The participants included 23 parent–child dyads from these two child care centers. Of these children, 11 were attending one of the participating centers at the time of the study. The remaining 12 children were on the waiting list of the other child care center. There were no significant differences in demographic characteristics between parent–child dyads from these two child care centers. The inclusion criteria were (i) Children should be between 2 and 3 years old when starting the program; (ii) The families should be from disadvantaged backgrounds (e.g., income below the median household income, new immigrant parent, single parent, on social welfare benefits); and (iii) Children and parents should normally reside in Hong Kong. Children with diagnosed special education needs were excluded. In the present study, the income of 90% of the families was below the median household income, and close to half of the mothers were new immigrants. Over 50% of the mothers had less than 9 years’ education (junior secondary or below). The demographic characteristics of the participants are shown in Table 2.

Table 2.

Demographic Characteristics of Participants (N = 23).

	Number	%
Sex of target child—boy	10	43.5
Sex of target child—girl	13	56.5
Target child born in Hong Kong	22	95.7
Relationship of participant to target child—mother	22	95.7
Relationship of participant to target child—father	1	4.3
Mother as new immigrant (in Hong Kong for less than 7 years)	11	47.8
Father as new immigrant (in Hong Kong for less than 7 years)	5	21.7
Family status—nuclear family	15	65.2
Family status—extended family	7	30.4
Family status—reconstituted family	1	4.3
Marital status—married	22	95.7
Marital status—widowed	1	4.3
Mother’s education—junior secondary or below	13	56.5
Mother’s education—senior secondary or above	10	43.5
Father’s education—junior secondary or below	10	43.5
Father’s education—senior secondary or above	12	52.2
Mother employed	6	26.0
Father employed	21	91.3
Family income^a—HK$19,999 or below	21	91.3
Family income^a—HK$20,000 or above	2	8.7
On social welfare benefits	3	13.0
	M	SD
Age of target child (in years)	2.37	0.52
Age of mother (in years)	32.57	4.98
Age of father (in years)	38.73	7.53
Number of children	1.61	0.66

^aMedian household income based on 2011 census (Census and Statistics Department, 2012a) was HK$20,200.

Measures

To enhance the validity of findings, multiple method and multiple informants were used for data collection. Actual measures included direct assessment of children’s learning, parent reported measures on children’s learning and behavior, parent reported measures on parenting, and teacher reported measures on children’s learning (for children who were attending child care center at the time of the study). As the intended outcomes of the program included children’s learning and behavior, direct assessment of children’s cognitive skills and parent-reported measure of children’s behavior were included. Academic competence, motivation, and school readiness were found to be associated with children’s cognitive skills and academic achievement (Grant & Dweck, 2003; Maehr, 2001; Tudge, Odero, Hogan, & Etz, 2003) and so these measures were also included. To measure parent outcome, parental stress, and social support, two commonly used measures in the evaluation of parent training programs (Barlow, Coren, & Stewart-Brown, 2005) were included. The measures are as follows:

Direct assessment of children

Cognitive Subscale of Preschool Developmental Assessment Scale (PDAS; Leung, Mak, Lau, Cheung, & Lam, 2010, 2013)—This scale was designed for Chinese children aged 39 months to 75 months. It could differentiate between children of different age groups, as well as children with typical and atypical development (Leung et al., 2010, 2013), and it correlated with the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence–Revised (Leung et al., 2013). The current version included items suitable for 2-year-old children. This extension for younger children correlated positively with the Griffiths Mental Development Scales–Extended Revised (GMDS-ER; Luiz et al., 2004). It could differentiate 2-year-old children from 3-year-old children, as well as children with developmental disabilities from children with typical development. The reliability (KR-20) was .92 and test–retest reliability was .89 (Liu, 2013).

Measures completed by parents

Eyberg Child Behavior Inventory (ECBI; Eyberg & Ross, 1978)—This was a 36-item multidimensional measure of parental perception of disruptive behavior in children, and was completed by the parent. It consisted of two scales. The Intensity Scale was a measure of frequency of disruptive behavior and was rated on a 7-point scale. The Problem Scale measured the extent to which the parents were troubled by children’s behavior and was rated as yes (1) and no (0). The Chinese version of the inventory has been validated by Leung, Chan, Pang, and Cheng (2003). It correlated positively with the Child Behavior Checklist and Parenting Stress Index. The reliability (Cronbach’s α) was .94 for the Intensity Scale and .93 for the Problem Scale.

Strength and Difficulty Questionnaire (SDQ; Goodman & Scott, 1999)—The SDQ was a brief behavioral screening questionnaire for children and adolescents aged 4 to 16. In terms of its validity, the SDQ scores correlated with the Child Behavior Checklist and it could discriminate between psychiatric and dental cases (Goodman & Scott, 1999). The SDQ consisted of five subscales, Emotional Symptoms, Conduct Symptoms, Hyperactivity Symptoms, Peer Problems, and Prosocial Behavior. Parents rated each item on a 3-point rating scale from 1 (not true) to 3 (certainly true), with higher scores showing higher endorsement of the behavior domain. A Total Problem Behavior score could be computed by adding the raw scores from the subscales of Emotional Symptoms, Conduct Symptoms, Hyperactivity Symptoms, and Peer Problems. The Chinese version of the scale has been validated by Lai et al. (2010). It has been used with preschool children in Hong Kong (Leung, Sanders, Leung, Mak, & Lau, 2003). In the current study, only the Prosocial Behavior Subscale and Total Problem Behavior score were used. The former was used as a measure of appropriate behavior, while the latter was used as a summary of problem behavior.

Parental Stress Scale (Cheung, 2000)—This 17-item scale measured the stress of parenting. The Chinese version has been validated by Leung and Tsang (2010). It correlated positively with the Parenting Stress Index and ECBI. It could also distinguish between parents of children with Attention Deficit Hyperactivity Disorder and children without special education needs. The reliability was .89.

Duke University of North Carolina Functional Social Support Questionnaire (Broadhead, Gehlbach, de Gruy, & Kaplan, 1988)—This was an 8-item questionnaire on perceived social support in various areas; it was used as a measure of parents’ social networks. The Chinese version of the questionnaire has been used with Chinese new immigrant parents of preschool children with satisfactory reliability (.84; Leung, Leung, & Chan, 2007).

Measures completed by parents and teachers

Behavior Academic Competence (BAC; Leung, Lo, & Leung, 2012)—This scale was developed based on the Behavior Rating Scale for Presented Academic Self-Esteem in Young Children (Fuchs-Beauchamp, 1996). It consisted of 16 questions on sense of competence, persistence, initiative, and coping, and it had a parent version and a teacher version. Teachers and parents were to rate their students/children on each statement on a 4-point scale (0 = never, 1 = seldom, 2 = sometimes, 3 = always). The scale correlated with child cognitive development and child behavior, and it could differentiate children with developmental disabilities from children with typical development. The validation study included children aged 4 and 5. After discussion with child care center teachers, it was decided that the current version could be used for 2-year-old children with 3 items deleted. Both parent and teacher versions of this extension version for younger children correlated positively with GMDS-ER (Luiz et al., 2004). Both parent and teacher versions could differentiate children with developmental disabilities from children with typical development. The reliability estimates (Cronbach’s α) of the teacher and parent version were .94 and .84. The test–retest reliability estimates of the teacher and parent version were .86 and .60, respectively (Lin, 2013).

Effort and Task Motivation (Leung & Lo, 2013)—This instrument was based on the Inventory of School Motivation (McInerney & Ali, 2006) and consisted of a parent version and a teacher version. The Effort Subscale measured effort attribution and effort-focused motivation. The Task Subscale measured task orientation and involvement. Teachers and parents were to rate their students/children on each statement on a 4-point scale (0 = never, 1 = seldom, 2 = sometimes, and 3 = always). They correlated with child cognitive development and child behavior, and they could differentiate children with developmental disabilities from children with typical development. The validation study included children aged 4 and 5. After discussion with child care center teachers, it was decided that the current version could be used for 2-year-old children, with 1 item deleted for effort motivation. Both teacher and parent versions of the Effort and Task Subscales for younger children correlated positively with GMDS-ER (Luiz et al., 2004). Both teacher and parent versions of the Effort and Task Subscales could differentiate children with developmental disabilities from those with typical development. For the Effort Subscale, the reliability estimates (Cronbach’s α) of the teacher and parent version were .93 and .88 whereas the test–retest reliability estimates were .74 and .43. For the Task Subscale, the reliability estimates (Cronbach’s α) of the teacher and parent version were .88 and .83 whereas the test–retest reliability estimates were .70 and .52 (Lai, 2013).

Gumpel Readiness Inventory (Gumpel, 1999)—This scale was developed in Israel to assess the school readiness of children entering first grade, and consisted of 6 items on a 4-point rating scale from 0 (never behaves in this way) to 3 (always behaves in this way), to be rated by preschool teachers, with higher scores indicating higher school readiness. The inventory was translated into Chinese using back translation. The Chinese version consisted of a parent version and a teacher version. It correlated with child cognitive development and child behavior, and it could differentiate children with developmental disabilities from children with typical development, as well as children from different age groups (Ho, Leung, & Lo, 2013). The validation study included children aged 3 to 5. The current version was a further extension of the scale for younger children, after confirming the content from teaching professionals. Both teacher and parent versions of the current version could differentiate between 2-year-old and 3-year-old children, as well as children with developmental disabilities and children with typical development. Both teacher and parent versions correlated positively with GMDS-ER (Luiz et al., 2004). The reliability estimates (Cronbach’s α) for the teacher and parent versions were .91 and .83, while test–retest reliability estimates were .88 and .62 (Li, 2013).

Procedures

Upon securing parent consent, trained research assistants who were not involved in the delivery of the program administered the Cognitive Subscale of the PDAS to the children in the child care centers about 2 weeks before the commencement of the program. The parents were requested to complete the preintervention measures in the child care centers while their children were being assessed. Teachers (where appropriate) were given the questionnaires 2 weeks before the commencement of the program. The teachers completed the relevant preintervention measures at their own time in a place of their convenience and returned them to the research team at the first session of the program. Upon completion of the program, the children were again assessed on the PDAS Cognitive Subscale by trained research assistants (who were not involved in the delivery of the program) in the child care centers within 1 week after the completion of the program. The parents were given the postintervention measures during the second last session and they returned the completed questionnaires in the last session of the program. The teachers (where appropriate) were given the postintervention measures at the same time as the parents, and they returned the completed questionnaires to the research team within 1 week of the completion of the program.

This study was approved by the ethics committee of The Hong Kong Polytechnic University.

Results

The Sample

There were three participants who withdrew from the program prior to completion, two because of employment and one because of health reasons. These three attended less than 30% of the program. All of them completed postintervention measures, and their data were included in the analysis to prevent selection bias. Among these 23 participant dyads, the attendance of 18 (78%) was 80% or above. The other two participants attended 70% and 55% of the sessions, respectively.

Quantitative Outcomes

Dependent t-test was used to examine the changes from preintervention to postintervention. The preintervention and postintervention measures of the participants, as well as the reliability estimates of the measures, are shown in Table 3. The reliability estimates (Cronbach’s α) of most measures were above .70.

Table 3.

Mean, Standard Deviation, Confidence Interval, and Reliability of Measures (N = 23).

	Preintervention				Postintervention
	M	SD	95% Confidence Interval	Cronbach’s α	M	SD	95% Confidence Interval	Cronbach’s α	Effect Size (Cohen’s d)
PDAS Cognitive	7.96	6.66	[5.07, 10.84]	.90	17.39	8.24	[13.83, 20.95]	.92	1.19*
Parent reported school readiness	14.61	4.47	[12.68, 16.54]	.72	19.65	2.60	[18.53, 20.78]	.49	1.26*
Parent reported behavior academic competence	26.13	4.68	[24.11, 28.16]	.77	29.39	4.38	[27.50, 31.28]	.79	0.72*
Parent reported effort motivation	11.17	4.40	[9.27, 13.08]	.93	14.09	3.12	[12.74, 15.44]	.91	0.73*
Parent reported task motivation	8.26	2.70	[7.09, 9.43]	.73	10.35	1.72	[9.60, 11.09]	.85	0.90*
Teacher reported school readiness^a	17.58	5.26	[14.24, 20.93]	.84	21.67	3.80	[19.25, 24.08]	.87	0.86*
Teacher reported behavior academic competence^a	25.25	6.80	[20.93, 29.57]	.91	27.25	3.36	[25.11, 29.40]	.70	0.36
Teacher reported effort motivation^a	11.83	2.86	[10.02, 13.65]	.83	14.83	2.41	[13.30, 16.36]	.82	1.14*
Teacher reported task motivation^a	7.92	1.78	[6.78, 9.05]	.64	9.42	1.24	[8.63, 10.20]	.28	0.81*
ECBI-Intensity	120.61	28.86	[108.99, 132.22]	.94	113.65	24.01	[103.27, 124.03]	.93	0.27
ECBI-Problem	14.35	8.39	[10.72, 17.98]	.92	8.52	6.93	[5.52, 11.52]	.90	0.75*
SDQ-Prosocial behavior	5.70	1.33	[5.12, 6.27]	.25	6.96	1.58	[6.27, 7.64]	.55	0.86*
SDQ-Total problem behavior	13.61	4.06	[11.85, 15.37]	.61	10.91	4.12	[9.13, 12.70]	.69	0.66*
Parental stress	48.43	8.89	[44.59, 52.28]	.81	46.52	11.93	[41.36, 51.68]	.91	0.18
Social support	25.61	6.54	[22.78, 28.44]	.89	26.96	5.96	[24.38, 29.53]	.92	0.21

Note. PDAS = Preschool Developmental Assessment Scale.

^a n = 12.

*p < .05.

For child learning outcomes, there was a significant improvement in children’s cognitive skills. Dependent t-test result was significant for PDAS Cognitive Subscale scores, t(22) = 10.24, p < .001, d = 1.19. There was a significant increase in PDAS Cognitive Subscale scores from preintervention to postintervention. There were also gains in children’s school readiness, BAC, and learning motivation as reported by their parents. Dependent t-test results were significant for parent-reported school readiness, t(22) = 6.79, p < .001, d = 1.26, BAC, t(22) = 2.36, p = .028, d = 0.72, effort motivation, t(22) = 4.03, p = .001, d = 0.73, and task motivation, t(22) = 3.65, p = .001, d = 0.90. Similarly, for children who were currently attending child care centers, their teachers also reported gains in their school readiness and learning motivation. Dependent t-test results were also significant for teacher report of school readiness, t(11) = 3.31, p = .007, d = 0.86; effort motivation, t(11) = 3.15, p = .009, d = 1.14; and task motivation, t(11) = 2.21, p = .050, d = 0.81, but not for BAC, t(11) = 1.03, p = .325, d = 0.36. The results suggested that there was an increase in children’s cognitive skills and an improvement in their school readiness, BAC, and motivation after program participation. Separate analyses for children in the two child care centers indicated positive changes for both centers in child cognitive scores, parent-reported school readiness, effort and task motivation.

For child behavior, there was a significant decrease in children’s problem behavior and increase in prosocial behavior. Dependent t-test results were significant for ECBI-Problem, t(22) = 3.75, p = .001, d = 0.75, SDQ-Total Problem Behavior, t(22) = 3.01, p = .007, d = 0.66, and SDQ-Prosocial Behavior, t(22) = 4.16, p < .001, d = 0.86, but not significant for ECBI-Intensity, t(22) = 1.48, p = .152, d = 0.27. The results suggested a decrease in parent concern over children’s undesirable behavior and an increase in prosocial behavior after program participation. Separate analyses for children from the two child care centers indicated an increase in prosocial behavior for both centers.

In terms of parent measures, there were no significant differences in parental stress and social support. Dependent t-test results indicated no significant difference for parental stress, t(22) = 0.95, p = .352, d = 0.18, or social support, t(22) = 1.23, p = .232, d = 0.21. Separate analyses for parents of children in the two child care centers indicated that there was a significant decrease in parental stress in one of the centers.

Discussion and Application to Social Work

Hypothesis 1 on children’s learning outcome was supported. There were significant improvements in children’s cognitive scores, school readiness, and learning motivation. The results were based on direct assessment of children, parent, and teacher-reported measures. Hypothesis 2 was supported. There was a decrease in children’s behavior problems and an increase in prosocial behavior. Hypothesis 3 was not supported. There was no significant change in parent reported parental stress and social support.

The results of the pilot PACE program were encouraging. There were positive changes in child cognitive scores and learning (reported measures by parents and teachers), with large effect sizes in most cases. There was also a decrease in problem behavior and increase in prosocial behavior, with medium to large effect sizes. These child measures were based on direct assessment of children and reported measures from parents and teachers. The results provided some initial evidence on the effectiveness and importance of direct training with children in early intervention programs, which was consistent with overseas findings.

For parent outcomes, though improvements in parental stress and social support did not reach statistical significance, the group program provided opportunities for the parents to share their parenting experiences and problems with other parents, and to extend their social networks. Social support has been found to be important for parenting (Leung, Leung, Chan, Tso, & Ip, 2005) and this might be especially important for disadvantaged families who might be more isolated, such as new immigrant families. Facilitating such new immigrant young parents to acquire “classmates and teachers in parent education programs” as their social capital also helps to reduce the stigma placed on help seeking, which is still common in Chinese culture.

On the whole, the present results provided more evidence of improvements in child outcomes than did parent outcomes. One possible explanation was that the parents might have perceived the program as a learning program for their children and so they focused most of their attention on their children, who were also participating in the program. They were more sensitive to the changes in their children and were more enthusiastic in discussing their children’s progress with other parent participants. Future implementation of the program should include clear promotion of the program’s dual benefits for parents as well as children.

The attendance rate of the majority of participants was 80% or higher. This was very encouraging, as it was a 40-session program. This provided evidence that the “education approach” was the right choice to win acceptance of the program by parents and children. The fact that only two parents gave up the program for employment also indicated that the program was accorded a higher priority than increased family income, not just by the participating parent, but probably by the nonparticipating (bread-winning) parent as well.

Since this was a preventive program, cases with significant child behavior problems or parental stress were not specifically targeted. In the present sample, the child behavior problem and parental stress scores of the participants were not in the clinical range (Eyberg & Ross, 1978; Leung & Tsang, 2010). This might result in a smaller margin for improvement and might be one of the reasons for some of the insignificant results for parental stress and child behavior problems (e.g., ECBI-Intensity). On the other hand, positive changes such as improvements in prosocial behavior, learning and cognitive scores were observed in the children. These positive changes in adaptive behavior provided encouraging evidence for preventive programs for children from disadvantaged families for focusing on building positive strengths as preventive strategies.

This study provided an example of multidisciplinary collaboration. The program was produced by social workers and early childhood educators, under the supervision of two psychologists, with advice from senior child care teachers. The program was delivered by social workers in child care centers, under the supervision of psychologists. While the social workers are trained in group skills and working with parents, the early childhood educators have more experience and expertise in teaching children. The psychologists are trained in child development and learning as well as parenting techniques, with an emphasis on evidence-based theory and practice. This multidisciplinary team represents a productive synergy of research, theory, and practice on parents and children, which provides promising results for an evidence-based program acceptable to parents and children, and easily adopted by child care teachers and social workers. In fact, the trust in such a multidisciplinary team with practice and research track records was one of the reasons why some child care center principals agreed to provide space to house this very challenging 40-session project and refer families in their community to attend the program.

Despite the encouraging results, there were some limitations to the present study. First, being a pilot trial, this study only adopted a pre- and postdesign. The positive changes could also be explained in terms of maturation or measurement effects. A more rigorous design is needed to demonstrate the efficacy of the program. Nonetheless, the current results provided support for the commencement of a randomized controlled trial, the final results of which would shed more light on the effectiveness of the program. Second, some children were attending child care centers and some children were not. Some of the positive changes might be due to the input of child care center teaching, though separate analyses of the two groups indicated that there were significant changes in both groups of children in most cases. Third, some of the families were (relatively) less disadvantaged. There were two families with income above the median household income, and about 40% of the mothers had completed senior secondary education or above. Fourth, due to logistical difficulties, in one of the child care centers, the children were in the same room as their mothers who attended the parent training sessions. They might have caused some distractions and interruptions, which might have affected the mothers’ learning. Fifth, there was only one father participant in the program, so the results might not be generalizable to fathers. Further program revision and implementation should also focus on gender-sensitive fine tuning. Sixth, though the program was restricted to children aged between 2 and 3, there were still variations in children’s development, and some activities might have been too hard or too easy for some children. Seventh, the SDQ was validated for children aged 4 to 16 years (Goodman & Scott, 1999) and the SDQ results in the present study should be interpreted with caution.

The study has several implications for social work practice.

First, the fact that such a challenging 40-session program can be accepted by some child care center staff and parents shows that the program has correctly identified gaps in the structure and substance of early childhood educational and social support in specific communities, and has taken the right initiative to develop an evidence-based project to address such gaps. The research team’s success in engaging community stakeholders to agree to launch this demanding project in their centers, and the encouraging results generated from this pilot study paved stronger commitments from these community partners for the subsequent efficacy study of the PACE project. The PACE project should function as a timely evidence-based address of some assertions from preschool education concern groups (e.g., the proposal on the blueprint of quality preprimary education development in Hong Kong by the Council for Non-profit-making Organizations for Pre-primary Education, 2012) and echoed in the Hong Kong Government’s (2013) Policy Address to inject more resources to help young families and children (especially those in disadvantaged conditions) to obtain equal, if not optimal, opportunities for early development. In fact, the established usefulness of school social work services in primary and secondary schools, and the demonstrated importance of early support to families with young children have prompted some nongovernment organizations (like Hong Kong Caritas) in recent years to seek donations to start social work services in their kindergartens and child care centers. In 2008, the Council of Non-profit Making Organizations for Pre-primary Education and the Hong Kong Council of Social Service jointly completed a survey on “Potential Crisis in Family with Young Children” and asserted the need to formalize social work services in kindergartens (Council of Non-profit Making Organizations for Pre-primary Education and the Hong Kong Council of Social Service, 2008). The review of family services in Hong Kong since 2001, and the review of the Integrated Family Service Centre (IFSC) service mode, also persistently advocated for closer collaboration between the IFSCs and MCHCs for timely support of families with young children (Tsang & Consultancy Team, 2010). As part of the Comprehensive Child Development Service in Hong Kong, a mechanism for collaboration between MCHCs and social services (IFSCs) has been established whereby MCHCs can refer young families in need to IFSCs for services (Leung, Leung, Chan, Lee, & Ip, 2007). The PACE project is another example for such collaboration and contribution.

Second, the project provides an opportunity for social workers to contribute to early childhood education through cross-professional work, including working with psychologists to design and implement programs, and to collect data on program efficacy. As the program is run by research team social workers in child care centers, the research team social workers have to master skills in engaging the teaching and administrative staff in the secondary settings (not in the research university) to understand and support the smooth delivery of such a long-term project serving young children and parents in groups. They also have to ensure the professional completion of all the logistics in research, which is often perceived in service-focused centers to be very meticulous. The fact that the pilot study was smoothly completed with very satisfactory attendance rate helped to convince the agencies that when the program quality is sound, the participants will still support the programs that initially appear to be demanding in duration and format. This experience from PACE is a strong encouragement to the program team to uphold essential principles in quality program design and delivery.

Finally, the project further reinforces the direction of social work education—to prepare future members of the profession to work even more competently with young children and their families alongside frontline workers and administrators in the community, preschool educators, in secondary settings like kindergartens and child care centers, in service development, implementation, and evaluation.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by the Public Policy Research Fund, Hong Kong.

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