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Maryland and Ohio Strategies
Parenting Programs: The Chicago Parent Program
The Chicago Parent Program (CPP) is an evidence-based program for parents of children 2-8 years old designed to promote positive parenting skills and address children’s behavior problems. CPP was developed at Rush University in Chicago with input from an advisory board of Black and Hispanic parents from low-income neighborhoods and it explicitly aims to be relevant to families from diverse racial, ethnic, and income backgrounds. CPP empowers parents by offering them a toolkit of skills to use in meeting parenting goals they have chosen that are consistent with their values. This profile provides an overview of CPP and then examines how CPP is implemented in Baltimore City Public Schools in Maryland and in Cincinnati, Ohio.
CPP is delivered to groups of 8-12 parents over 12 two-hour sessions that are facilitated by two trained group leaders. CPP sessions use more than 160 video vignettes of parent-child interactions at home and in public settings to illustrate both successful and unsuccessful parenting strategies, and to guide group discussion of ways to handle parenting challenges. Parents complete assignments between sessions in which they practice new skills with their children.
CPP has been used in more than 20 states and the District of Columbia, with large-scale implementation in Baltimore, Chicago, Cincinnati, and Rochester, New York. The current version is the third edition and is available in English and Spanish. Like earlier versions, it incorporates extensive consumer input, this time largely from experienced CPP group leaders covering their experiences as leaders and feedback they received from parents. The CPP group leaders helped program developers understand what felt outdated to parents, what they thought parents needed more content on, and what they struggled with and needed more guidance on.
CPP is delivered in a wide range of settings, including early care and education programs, schools, multiservice agencies, and mental health settings. CPP can be delivered to parents who are experiencing a wide range of psychosocial adversities (e.g., housing instability, trauma, involvement in the child welfare system) and who seek to strengthen their parenting skills and relationships with their child. Parents do not need to identify their child’s behavior as problematic in order to participate in CPP.
A web-based, digital version of CPP, called ezParent[i], is available, and developers are testing the addition of coaching calls and other hybrid components to increase parent engagement. ezParent is being used in a large project in Rochester, New York, paired with four virtual group sessions. CPP program developers are also testing adaptations for a) parents of infants and toddlers and b) use with individual families receiving treatment within a mental health clinic setting.
Workforce Development
Training for CPP facilitators is mainly virtual, consists of four live half-day sessions led by experienced CPP trainers, and requires participating in a mock CPP group to gain hands on experience implementing the program, as well as passing a post-test, before implementing the program for the first time. The minimum educational requirement to participate in training to become a CPP group leader is a high school diploma.
Trained CPP group leaders assess their implementation of the program after each session using the Group Leader Weekly Checklist. CPP offers optional fidelity assessments for group leaders, who submit audio recordings of each of the 12 sessions, which are then scored by trained members of the CPP team. Group leaders are scored on their adherence to the CPP manual and competence conducting the group session. The group leaders receive written feedback reports to promote any needed improvement. CPP group leaders can become certified after leading two 12-session classes and receiving fidelity assessments of three sessions that show adherence to the CPP quality standards. CPP has trained approximately 1,000 group leaders, with 30 achieving certification. CPP does not currently offer train-the-trainer trainings.
Financing
CPP training costs $899 per person (which includes the Group Leader Manual) and fidelity monitoring is $199 per session. Additional one-time costs for group leaders include the CPP videos ($875) and the implementation guide ($25; free to CPP group leaders). Additional manuals may be purchased by individuals who completed the training ($125). The cost of delivering a CPP group to parents includes covering the group leaders’ time, parent handouts ($20 per packet if purchased from CPP directly, but handouts can also be photocopied from the manual or downloaded from the website by group leaders only), and any costs for space rental, child care, food, and incentives used to promote parent participation. Agencies implementing CPP have used a range of funding sources, including federal Title I education funds, local school district funds, Head Start, and private foundations. In some states, CPP can be billed to both public (e.g., Medicaid) and private insurance by eligible providers if medical necessity or a diagnosis is determined for the child.
Evaluation and Monitoring
Two randomized controlled trials of CPP delivered to African-American and Latino parents found that at one-year follow-up CPP reduced parent reports of corporal punishment and parent-reported, teacher-reported, and observed child behavior problems. In one of the studies, parents also gave fewer commands to children, and in the other, parents reported greater self-efficacy.[ii] Another study that randomly assigned predominantly low-income African-American mothers with 2-5 year-old children experiencing behavior problems to CPP or Parent-Child Interaction Therapy (a parent-child dyadic treatment model) found improvement in parent reports of child behavior problems for both treatments and no significant differences in the magnitude of decrease in child behavior problems.[iii] Parents randomized to CPP were more satisfied with their treatment and less likely to drop out than parents randomized to Parent-Child Interaction Therapy.[iv]
Baltimore City Public Schools
The Chicago Parent Program (called ChiPP in Baltimore) was brought to Baltimore City Public Schools (BCPS) in 2014 through a partnership with Johns Hopkins University School of Nursing (JHU), which provides professional development, evaluation, and fidelity monitoring, and The Fund for Educational Excellence (FFEE), which provides program coordination. Families in the original 11 schools that offered CPP were approximately three-quarters Black and 13 percent Latino; a large percentage were low-income families. FFEE, BCPS, and JHU are expanding CPP to additional schools with the goal of providing the program to 36 schools annually by 2023-2024.
Many of the schools that offer CPP are characterized by having strong connections to early care and education (ECE). All schools offer full-day prekindergarten. Some have Judy Centers, which offer birth to kindergarten services to families in Title I schools and have a dedicated Judy Center coordinator; some have principals who strongly support ECE programming; and others are Community Schools, which offer wraparound family supports and have a dedicated Community School coordinator. Nonteaching staff, such as the Judy Center coordinator, Community School coordinator, or a parent liaison, deliver CPP, which is considered part of their regular work responsibilities and does not require an additional source of funding. In schools where two CPP-trained staff are not available, FFEE and JHU maintain a directory of outside facilitators who are certified in CPP.
Schools typically offer CPP once a year in the fall, although the program is sometimes offered in the spring because of funding cycles. Some schools also offer a second, Spanish-language group. CPP is usually offered on-site in the morning after drop-off, though at some schools it is offered after pickup in response to parent preferences. During COVID, virtual CPP groups were offered.
Judy Center coordinators, Community School coordinators, and parent liaison staff recruit parents through one-page fliers and sharing information with parents at drop-off and pickup. Word of mouth is also a major source of referrals and most schools do not have difficulties recruiting full groups. The program is voluntary; it is not offered selectively to parents of children with behavioral challenges to avoid stigma and to leverage the different strengths parents bring to the program. However, most families who participate in CPP would say they have a child with behavior challenges and are looking for different ways to support their child. Schools aim to have 15 parents at the start of each group and most parents have a child in prekindergarten through 2nd grade. Families receive $15 to attend each session and $5 for each completed at home practice assignment. Child care and a meal are also provided, as appropriate.
CPP has high rates of parent retention. Some parents have taken CPP multiple times and at least one group has asked the CPP group leader if they could continue to meet after the program ended. The program often serves as a first point of connection for BCPS parents and helps them engage with the school and make friends with other parents in the program. Schools also report that CPP increases parent engagement with the school and teachers, and that this engagement is sustained over time.
Workforce Development
JHU offers CPP training at least three times a year. FFEE works with schools to identify staff to enroll in the training and covers the cost of participation. A foundation had provided scholarship funding for BCPS staff to participate in training, but now FFEE incorporates the training into the cost of running CPP.
FFEE encourages group leaders to submit recordings of their sessions for fidelity checks to the CPP office at Ohio State University in order to become certified, and is working to increase incentives for certification. Group leaders continue to conduct fidelity checks of their sessions even after certification.
Financing
Initial funding for CPP in BCPS came from a three-year commitment from a group of local foundations. Following this period, CPP schools have been applying to the central BCPS office for federal Title I Family and Community Engagement funds for the program. To determine the amount each school pays, FFEE estimates the total cost of delivering CPP to the 11 schools (FFEE staff time, training costs, quality checks, materials and meals, parent incentives, and external facilitator wages) and then calculates the per school share of the total. FFEE and the central office became concerned that CPP schools were drawing an inequitable amount of the Title I Family and Community Engagement funding for CPP and they are now exploring the use of state funds through the Blueprint for Maryland’s Future. This recently passed legislation increases funding for education and prioritizes school systems in historically underserved communities. Some schools also use their own general funds for CPP. As part of the plans to expand to 36 schools per year, a private funder will cover the cost of the first implementation at each new site, which will give FFEE and new schools time to identify sustainable funding sources beyond the first year.
Evaluation and Monitoring
During the initial three-year implementation period, JHU conducted a formal implementation evaluation of CPP in BCPS. While CPP was offered universally in the schools, approximately 40 percent of children whose parents participated experienced behavior problems in the clinical range. In addition to seeing a large reduction in child behavior problems following completion of the program, the study also found that parents reported feeling more valued by the school after the program and emphasized the benefit of the connections they made with other parents.[v] FFEE continues to conduct pre-post parent surveys and has found positive changes in parent reports of child behavior, bonding with their child, and their own parenting skills. FFEE also tracks parent attendance and has observed that parent attendance rates are higher when both facilitators are school staff compared to when two external facilitators are used.
Cincinnati Children’s Hospital Medical Center
Cincinnati Children’s Hospital Medical Center (CCHMC) began offering the Chicago Parent Program (called Parents on Point (PoP) in Cincinnati), as part an array of behavioral health prevention programs for children birth to five including maternal depression screening, behavioral health integration in pediatric primary care, and connecting families to in-home cognitive behavioral therapy through the Moving Beyond Depression program. CCHMC was looking for an evidence-based, culturally relevant parenting program to embed as a community support for IECMH and CPP was determined to be a good fit.
CCHMC has trained 11 community agencies to deliver CPP in five schools with preschool or prekindergarten programs, two social service agencies, four child development centers, and a pediatric primary care clinic. They have provided 36 CPP groups, including groups in Spanish, to approximately 350 caregivers of 1,000 children. The population served is primarily low-income families of color. A variety of agency staff have been trained to deliver CPP, including early childhood specialists, teachers, engagement coordinators, and social service providers.
It is at the agencies’ discretion to determine how often, when, and to whom they offer CPP. Most agencies offer CPP twice a year, once in the fall and once in the spring, with social service agencies occasionally delivering summer classes. Agencies work with parents to identify the best times of day for groups, at drop-off or pickup in the case of schools or after 5 pm in the cases of child development centers.
The different types of agencies vary in their particular recruitment practices, though most use flyers and e-newsletters. In social service agencies, home visitors encourage families to enroll, while in schools teachers recommend the program to parents. Schools market CPP broadly to encourage engagement of both parents who are new to the school system and parents whose children may be showing disruptive behavior. Social service agencies may target particular families for enrollment based on their own agency objectives (e.g., serving families who live in a particular area or also enrolled in a related, complementary social service program).
CPP in Cincinnati has high rates of caregiver retention, with a median of 9 sessions attended by enrollees. Families receive $20 to attend each session and $5 for each completed practice assignment, along with child care during the session and a meal. Agencies have noted that caregivers greatly benefit from CPP by connecting with other parents and the agencies’ facilitators.
Workforce Development
CCHMC has a site readiness checklist to use with agencies considering CPP and will help to facilitate training for those sites, including covering training costs. CCHMC also offers coaching after the initial CPP group leader training, which involves a supplemental roleplay session and weekly 15-minute coaching calls forthe first 11 weeks. These calls provide advice on delivering content with fidelity and successful facilitation. CCHMC has a CPP coordinator who can go onsite to address problems that arise (e.g., a facilitator is unable to attend).
CCHMC encourages CPP group leaders to become certified, and about one-third of group leaders have been certified to date. Certification helps in retention of group leaders, who view it as a resume-builder, and CCHMC offers financial support for the certification process.
Financing
The main source of funding for PoP is from the Convalescent Hospital for Children, a nonprofit associated with CCHMC. CCHMC will also partner with social service agencies to write grants for PoP. The schools are exploring federal Title IV education funds. For facilitators at social service agencies, CPP is embedded in their regular workload, whereas teachers who deliver CPP receive stipends from CCHMC through the Convalescent Hospital for Children.
Evaluation and Monitoring
CCHMC has been collecting data from sites as part of a research component and plans to publish its findings. Data were collected pre-, post-, and three-months post, with measures used in the original clinical trial, described above. Results have reproduced the original findings, with increased parent confidence, decreased use of corporal punishment, decreased reports of children’s behavior problems, and decreased parent stress at three months. Sites have been able to use these data to help apply for grants and maintain support among agency leaders.
CCHMC submits audio recordings of sessions to the CPP office at Ohio State University for fidelity monitoring. Certified group leaders are asked to submit one session per group for fidelity checks. Sites also collect parent surveys after each group session, which CCHMC analyzes in order to provide results to sites for planning purposes.
Last updated December 2022
Special thanks to the following individuals for providing information for and/or reviewing this profile: Susie Breitenstein, Professor and Assistant Dean for Research and Innovation, Ohio State University College of Nursing; at Johns Hopkins University, Amie Bettencourt, Assistant Professor of Psychiatry and Behavioral Sciences, and Debbie Gross, Leonard & Helen Stulman Professor of Mental Health & Psychiatric Nursing; at the Fund for Educational Excellence, Roger Schulman, President and CEO, and, Kwane Wyatt, Program Director; and Cindy Zion, Program Manager, Cincinnati Children’s Hospital Medical Center.
References
[i] Breitenstein, S. M., Brager, J., Ocampo, E. V., & Fogg, L. (2017). Engagement and adherence with ezPARENT, an mHealth parent-training Program Promoting Child Well-Being. Child Maltreatment, 22(4), 295-304. https://doi.org/10.1177/1077559517725402
Breitenstein, S. M., Fogg, L., Ocampo, E. V., Acosta, D. I., & Gross, D. (2016). Parent use and efficacy of a self-administered, tablet-based parent training intervention: A randomized controlled trial. JMIR mHealth and uHealth, 4(2), e36. https://doi.org/10.2196/mhealth.5202
Breitenstein, S. M., Fehrenbacher, C., Holod, A. F., & Schoeny, M. E. (2021). A randomized trial of digitally delivered, self-administered parent training in primary care: Effects on parenting and child behavior. The Journal of Pediatrics, 231, 207-214.e4. https://doi.org/10.1016/j.jpeds.2020.12.016
Greene, M. M., Patra, K., Czyzewski, P., Gonring, K., & Breitenstein, S. (2020). Adaptation and acceptability of a digitally delivered intervention for parents of very low birth weight infants. Nursing Research, 69(5S Suppl 1), S47-S56. https://doi.org/10.1097/NNR.0000000000000445
[ii] Breitenstein, S. M., Gross, D., Fogg, L., Ridge, A., Garvey, C., Julion, W., & Tucker, S. (2012). The Chicago Parent Program: Comparing 1-year outcomes for African American and Latino parents of young children. Research in Nursing & Health, 35(5), 475-489. https://doi.org/10.1002/nur.21489
[iii] Gross D., Belcher, H. M.E., Budhathoki C., Ofonedu, M. E., Dutrow, D., Uveges, M. K., & Slade, E. (2019). Reducing preschool behavior problems in an urban mental health clinic: A pragmatic, non-inferiority trial. Journal of the American Academy of Child & Adolescent Psychiatry, 58(6), 572-581.e1. https://doi.org/10.1016/j.jaac.2018.08.013
[iv] Gross D., Belcher, H. M. E., Budhathoki, C., Ofonedu, M. E., Uveges, M. K. (2018). Does parent training format affect treatment engagement?: A randomized study of families at social risk. Journal of Child and Family Studies, 27(5), 1579-1593. https://doi.org/10.1007/s10826-017-0984-1
[v] Bettencourt, A. F., Gross, D., & Breitenstein, S. (2019). Evaluating implementation fidelity of a school-based parenting program for low-income families. Journal of School Nursing, 35(5), 325-336. https://doi.org/10.1177/1059840518786995