Culturally Sensitive Parent Education: A Critical Review of Quantitative Research

Culturally Sensitive Parent Education: A Critical Review of Quantitative ResearchAuthor(s): Jean Cheng Gorman and Lawrence BalterSource: Review of Educational Research, Vol. 67, No. 3 (Autumn, 1997), pp. 339-369Published by: American Educational Research AssociationStable URL: http://www.jstor.org/stable/1170568 .

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Review of Educational Research Fall 1997, Vol. 67, No. 3, pp. 339-369

Culturally Sensitive Parent Education: A Critical Review of Quantitative Research

Jean Cheng Gorman and Lawrence Baiter New York University

The recent growth of culturally sensitive parent education programs neces- sitates an evaluative look at their effectiveness. This article critically reviews the quantitative literature on culturally sensitive parent education programs, discussing issues of research methodology and program efficacy in producing change among ethnic-minorityparents and their children. Culturally sensitive programsforAfrican American and Hispanicfamilies are described in detail. Quantitative studies of culturally sensitive programs are critiqued against existing literature on the effectiveness of traditional parent education programs. Main conclusions include the prevalence of flaws in research methodology, which may contribute to the finding of somewhat lower efficacy of these programs in comparison to standard programs. Although efficacy studies of programs for Native American and Asian American parents could not be found, efforts to serve these populations are also described. Recom- mendations for future research are proposed.

National statistics suggest that many of today's children are in jeopardy intel- lectually, emotionally, physically, and psychologically. For example, the number of reported cases of child maltreatment has more than tripled since 1976, with 328 cases reported per 10,000 children in 1986 (Haveman & Wolfe, 1994). Almost 16% of White children and 44.8% of African American children were living in poverty in 1990, and life in poverty has been shown to be associated with other negative conditions, such as poor nutrition and high probability of living in neighborhoods with high rates of crime and drug dependence (Zigler & Black, 1989). Numerous efforts have been made to improve child welfare through direct intervention with parents. Such interventions have included material supports, emotional encouragement, information presentation, therapeutic guidance, and skills development. Increased attention to intervention at the familial level can be found not only in psychological circles, but also in political and educational arenas as well (Zigler & Black, 1989). A central component of this movement has been the proliferation of parent education programs.

Systematic attempts to teach parenting skills have been documented since the early 1800s (Hess, 1980), though the majority of the literature on parent education programs has been published since 1970 (Medway, 1989). Early efforts focused on parent education through mass media and individual therapy (Pehrson &

This article was completed in partial fulfillment of the first author's scholarly requirements for the PsyD in Professional Child/School Psychology at New York University. Address correspondence concerning this article to the first author.

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Cheng Gorman and Baiter

Robinson, 1990). Since their conception, parent education programs have expanded tremendously to reflect various philosophical orientations, formats, and needs of parents. Parent education is an umbrella term, encompassing a wide variety of programs that differ in both content and format. Terms such as parent training, parenting programs, and parent support are often used interchangeably with parent education.

While the variation in terminology is somewhat arbitrary, it also reflects a continuing lack of consensus on the goals of parent education. Some, such as Zigler and Black (1989), argue that the overall goal of parent support programs should be to strengthen parents' informal support systems in order to empower them to raise their children successfully. Others, such as Wolfe and Edwards (1988), see parent education as existing primarily to prevent child maltreatment through skill building, as well as to promote child welfare through encouraging direct parent-child communication. This lack of consensus also reflects differing ideology concerning the role of parent education. For example, some, such as Becher (1984), see parent education as a component of a larger movement for "parent involvement." In contrast, others would argue that parent education perpetuates perceptions of ethnic-minority families as deficient, because it patron- izingly assumes a need for educating culturally diverse families in proper childrearing. That the debate is far from resolution and the movement for parent education increasingly complex is not necessarily unfavorable. Rather, the content and overall goals of these programs should differ according to the target populations, to accommodate the complex nature of working with families of diverse ethnicity.

The term parent education also encompasses a wide variety of program formats. While many are group meetings of parents that convene on a regular basis to discuss parenting problems and learn new skills, others are quite different. For example, Nelson (1986) describes a bimonthly newsletter for single parents containing information on issues central to single parenthood (e.g., rearing children in father-absent homes, and the impact of working mothers on child development) as being helpful to its readers. Samuels and Balter (1987) found that telephone consultations on common parenting concerns such as negative behaviors and separation anxiety have been overwhelmingly useful and effective for the callers. Popkin (1989) evaluated a video-based program that used video clips of parent-child interactions to instruct parents. In addition, numerous books, maga- zines, newspaper columns, and television programs dispense parenting advice.

Despite this diversity in service delivery, parent education programs have traditionally been categorized by their philosophical orientation. Specifically, Medway (1989) discusses three popular categories: reflective, behavioral, and Adlerian. Reflective parent education stems from Carl Rogers's client-centered therapy, particularly from the communicative techniques employed by that therapy, such as active listening. The major emphasis of a reflective program is to build parental awareness, understanding, and acceptance of the child's feelings (Tavormina, 1980). From this philosophical orientation arose Thomas Gordon's (1970) well-known and widely implemented Parent Effectiveness Training (PET) programs. A PET program typically consists of eight 3-hour training sessions that focus on building close, warm relationships between parents and children through parental acceptance of children and a democratic framework for decision making. 340



Culturally Sensitive Parent Education

Furthermore, rather than focus on employing punishments for negative behaviors, parents are encouraged to make environmental modifications that reduce the likelihood of child misbehavior (Gordon, 1970).

In contrast, behavioral parent education focuses on observable child behavior and the environmental circumstances that maintain behavior patterns. This type of program is geared toward training parents to use specific techniques to control undesirable behavior in their children and typically does not have a strong philosophical view of parenting to guide its curriculum. One such program is Aitchison's (as cited in Alvy, 1994) Confident Parenting program. Parents are informed that behavior is maintained by both positive and negative environmental reinforce- ments, such as attention. Leaders systematically teach parents to pinpoint specific negative and positive child behaviors that the parents desire to see decreased or increased, and encourage the implementation of techniques such as behavior- specific praise and time out to modify these behaviors. Other behavior modification principles, such as creating incentive systems, are also taught.

Adlerian parenting programs are derived largely from Rudolph Dreikurs's application of Alfred Adler's personality theories to childrearing (Nye, 1989). A prominent parent education program founded on these philosophies is the System- atic Training for Effective Parenting (STEP) program developed by Dinkmeyer and McKay (Carter, 1980). Parents are taught that all behavior is purposive. They are informed of goals of child misbehavior, such as gaining attention or obtaining revenge. Parents are encouraged to use natural and logical consequences to control behavior while maintaining a cooperative home environment. STEP programs are typically taught in eight to nine sessions of 1.5 to 2 hours each (Nye, 1989).

This classification system has been particularly useful in attempting to evaluate the effectiveness of parent education programs, as in the comprehensive review by Dembo, Sweitzer, and Lauritzen (1985) and in Medway's (1989) meta-analysis of parent education programs. Although this conceptualization has been helpful in comparing the general content of the programs, classification by the target group is also beneficial, as the actual content of the program units tends to vary according to the participants' needs (Medway, 1989).

A review of the literature indicates that programs have been aimed at four distinct types of target groups. There are programs designed to improve parenting generally, programs aimed at specific populations of parents, programs focused on specific populations of children, and programs built around specific parenting issues. General parenting programs are those that are geared toward generally well functioning parents who desire increased knowledge on how to handle everyday occurrences in rearing normally developing children. Parent population-specific programs are oriented toward parents whose conditions raise specific concerns- for instance, incarcerated parents or single parents. Child population-specific programs, which occupy much of the current literature, are those that address the needs of children with special demands, such as chronically ill children or children with learning disabilities. Issue-specific programs are those that address specific concerns of parents, such as raising drug-free teenagers.

However, a consideration of the populations targeted by general parenting programs reveals a cause for concern. Two prominent general parenting programs, PET and STEP, have been criticized for being irrelevant to non-White,

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non-middle-class parents and for being culturally insensitive. Specifically, the modal families described in the programs' units are two-parent families with adequate financial resources and parents who have completed at least a high school education (Alvy, 1994). This picture does not reflect many of the lower- income, minority families with whom the programs are often used. This is unfortunate, as the need for parent education support services in lower-income and minority populations is evident. In keeping with a general movement in psychology to make services more applicable to ethnic-minority populations, the development of culturally sensitive parent education programs has increased greatly in the last decade.

This article will critically review quantitative literature published between 1970 and the present on culturally sensitive parent education programs. For the pur- poses of this review, parent education refers to programs with curricula geared toward training parents in childrearing. This quantitative review focuses on the purported efficacy of such programs in producing change among ethnic-minority parents and their children. Although a sizable amount of research has been conducted on reflective and Adlerian programs, it is the case that, as in other areas of psychological research, behavioral programs seem to hold a greater degree of empirical robustness. In addition, of the four target classifications, the greatest number of programs appear to fall into the first category, general parenting improvement. Consequently, the majority of this article will focus on behavioral parent education programs geared toward general parenting improvement, in large part as a function of the constraints of the current available literature.

Culturally sensitive programs will be described in detail for two ethnic-minority target populations: African American families and Hispanic families. Efficacy studies of these programs will be critiqued. Although qualitative data provide valuable insight into the efficacy of these programs, only studies employing quantitative methodology are included in this review, to allow for meta-analytic comparison. Unfortunately, the paucity of quantitative studies of culturally sensitive programs prohibits a meta-analytic comparison of such studies with each other. Consequently, through effect sizes, these programs will be compared with the effectiveness of traditional parent education programs, as reflected in previous reviews of parent education literature by Medway (1989) and Dembo et al. (1985). Although no published efficacy research on programs for Native American or Asian American parents was found, parent education for these populations will also be described, so as not to overlook efforts to reach them. Finally, recommen- dations for future research will be proposed.

Culturally Sensitive Parent Education Racial and ethnic diversity used to be deemphasized in family intervention

efforts (Slaughter, 1988). However, recent research on the role of culture in individual behavior led to increased attention to cultural sensitivity in family programs. Slaughter (1988) noted, "Program goals may be frustrated or defeated simply because program designers know little of the cultural-ecological context of the families to be served" (pp. 464-465). The notion of cultural sensitivity implies not only an understanding of a group's unique values, beliefs, and customs, but an appreciation of these differences as well. Rather than judging a group by a particular standard, cultural sensitivity acknowledges different ways of being and

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acting. Differences are not automatically seen as deficits. In parenting programs, this may be reflected in an acceptance of nontraditional childrearing practices or unique family constellations. Cultural sensitivity falls along a continuum, demonstrated to a greater or lesser degree in a program's goals, content, and implementation, as well as in the facilitators' attitudes and beliefs.

Within the realm of parent education programs that can be described as culturally sensitive, three main types of programs have been identified: translated, culturally adapted, and culturally specific (Cheng Gorman, 1996). Typically, a translated program is a traditional parent education program that has been translated into a target population's native language-for instance, Spanish-usually to broaden availability. Despite the linguistic modification, the translated program remains essentially unchanged from the original program that was not culturally modified. A culturally adapted program is designed to incorporate, to a greater or lesser degree, the values and cultural traditions of the target population. Alvy (1994) refers to such programs as "transculturated." These two types of programs share philosophical similarities, in that both contain the essential content found in traditional parent education programs, such as PET and STEP. A third type is the culturally specific program. Like the culturally adapted program, the culturally specific program is designed to incorporate the values of the target population. However, the culturally specific program is distinct in the impetus for its creation: Culturally specific programs are intended to facilitate successful parenting within a specific group's culture. They are not merely derivations of traditional programs, but are formatted to be relevant to the target ethnic group. These programs appear to be sparse, and most of the literature on culturally sensitive programs discusses either translated or culturally adapted programs. Examples of these three types of culturally sensitive programs are discussed in this review; however, for a fuller discussion of the differences between these programs and the controver- sies regarding their use, see Cheng Gorman (1996).

Programs for African American Parents

Alvy (1994) describes the development of the Effective Black Parenting Pro- gram (EBPP) by the Center for the Improvement of Child Caring in the late 1970s. This program had its origin in culturally adapted units that were developed not to stand on their own but to be taught in conjunction with programs such as PET and STEP. However, Alvy notes that the original three units-"Pyramid of Success for Black Children," "Traditional Black Discipline versus Modem Black Self- Discipline," and "Pride in Blackness"-were "not fully integrated with the ideas and skills of the standard programs" and that the outcome was in effect more reflective of "teaching two programs at the same time" (p. 143). In the mid-1980s, the units were redesigned to constitute a self-standing program that consists of 15 three-hour sessions (Alvy & Marigna, as cited in Alvy, 1994). The format of each session roughly adheres to the following sequence: general sharing time, presentation of session lesson, practice, and discussion (Alvy, 1994).

The EBPP is conceptually divided into two sections: The first six sessions are aimed at establishing a foundation for the latter sessions, in which specific parenting skills are taught. For example, many of the early sessions are devoted to developing a framework in which childrearing can be viewed and to motivating parents to rear their children with positive life goals in mind. Specific behaviors

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are discouraged; for instance, corporal punishment is presented as carrying on the legacy of slavery. In latter sessions, parents are urged to use skills such as systematic ignoring and time out instead of corporal punishment. In addition, information on and discussion of substance abuse is presented in two sessions. Issues facing single parents are also addressed. More detailed information about the content of the program can be found in Table 1.

The EBPP can be viewed as an adaptation of traditional behavioral programs- specifically, the Confident Parenting program (Alvy, 1994)-because the overall content of the EBPP is focused on targeting behaviors and changing them through the use of specific corrective consequences. However, efforts have been made to increase the relevance of the program content to African American parents by focusing on the use of corporal punishment, drug abuse, and single parenting, all of which have been noted to occur with relatively high frequency in African American families. A critique of this culturally adapted approach may be that it is insufficiently sensitive to cultural values and tends to offer a limited (often negative) portrayal of the target culture. For further discussion on culturally adapted programs' limitations in cultural sensitivity, see Cheng Gorman (1996).

Programs for Hispanic Parents

Like the EBPP, the Los Nifios Bien Educados program was initially developed at the Center for the Improvement of Child Caring as a means of making the Confident Parenting program more applicable to "Latino-American parents" (Alvy, 1994, p. 155). Consequently, the skills portion of the program bears a strong resemblance to the EBPP, though Los Niiios Bien Educados focuses on other issues that are unique to the experience of Hispanics in the United States. The overall format is generally similar to that of the EBPP, with minor cultural modifications. Each session typically includes a time for sharing personal experiences, reviewing previous topics, learning and practicing skills, a "cafecito break" (Alvy, 1994, p. 171), homework assignments, and an informal discussion time at the end. The program consists of 12 three-hour sessions that can be taught in either Spanish or English, depending upon the needs of the group participants. Throughout the program, dichos, or Latino sayings, serve as orienting thoughts for the use of programs skills or methods. For example, the first dicho-Adonde el corazon se inclina el pie camina (Wherever our heart leans, there our feet will take us)-is intended to reinforce the notion that the parents' attendance at the first meeting resulted from and demonstrates their love and concern for their children.

As in the EBPP, the initial sessions of Los Nifios Bien Educados concentrate on building parental motivation and a foundation for implementing skills taught in latter sessions. Initially, Latino cultural views of parenting as encompassing four major functions (social-emotional, material, educational, and protective) are discussed. Issues relevant to immigrant families, such as acculturation and role expectations, are also included. Six sessions focus on skill building and teaching corrective consequences, such as the use of praise and mild social disapproval. The final three sessions are reserved for skill integration and individual consultations, in order for parents to obtain specific feedback on their use of the skills they have learned. The 12 sessions are described in greater detail in Table 2.

While the specific skills being taught to parents are extracted directly from traditional behavioral programs, other aspects of the program are more culturally 344




specific. For example, the inclusion of sessions devoted entirely to skill building and consultation seems to be a particularly important factor in reaching Hispanic parents, who have been reported in the literature to respond well to active, concrete, problem-solving activities (Sue & Sue, 1990). This more personalized format seems to reflect a cultural emphasis on the importance of relationships (Sue & Sue, 1990). Although the initial intent was to modify a traditional program, Los Nifios Bien Educados appears to be a culturally adapted program whose format and content approach that of a culturally specific program.

Another parent education program designed for Hispanic parents is the Houston Parent-Child Development Center (Houston PCDC) program. The Houston PCDC program was developed as an "alternative to Head Start" for low-income Mexican American families (Johnson & Breckenridge, 1982). Johnson (1989) notes that the Houston PCDC program-unlike other parent education programs, which often have broad, undefined outcome goals for children-was developed with the primary aim of promoting children's competence in school through the education of their parents. Since its inception in the early 1970s, the program's goals have been expanded to include "the reduction of child behavior problems, [the] promo[tion of] higher self-esteem, and...foster[ing] social skills development" (Johnson, 1989, p. 93). Although the Houston PCDC program is identified as a parent education program, Johnson and Breckenridge (1982) recognize that it places equal significance on changes in parents and their children and that its overriding goal is primary prevention. Johnson (1989) states that as the overriding concern was to foster "the parent-child relationship, we chose to work with mother and child together much of the time" (p. 95).

The Houston PCDC program is 2 years (approximately 550 hours) long, and its format has been tailored to the needs of its Mexican American families. Not only does the program have a bilingual emphasis, but the program staff is overwhelmingly bilingual (Johnson & Breckenridge, 1982). Because of a cultural expectation that mothers of infants should stay home unless visiting relatives or shopping, a large part of the program is conducted in the parents' homes (Johnson, 1989). The program consists of two stages. Stage 1 involves biweekly home visits to the mother and child by a paraprofessional. Issues of infant development are discussed, and English language classes for the mothers and medical referral services for the children are provided. Stage 2 is composed of four weekly sessions at the center, in which activities including homemaking, child care, and child management techniques, such as the use of praise, are taught. Although Johnson and Breckenridge (1982) assert that "principles of child development are combined with practice in carrying out child-rearing skills" (p. 307), they do not state specifically what elements of childrearing are taught. However, Johnson (1989) states that topics such as communication, decision making in families, managing problem behaviors, and developing an authoritative childrearing style are included. Because detailed information on the specifics of the parent education component have not been described, it can only be speculated whether the Houston PCDC program is a culturally adapted or culturally specific program.

Finally, there are numerous Spanish translations of traditional programs. These include PECES (a translation of the STEP program), Crianza Con Carinio (a translation of the Nurturing program; Alvy, 1994), and the Hispanic Minnesota Early Learning Design (Junge & Ellwood, 1986). Because these are translations

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TABLE 1 Sessions of the Effective Black Parenting Program (EBPP)

Session Title Description

1 Building a Pyramid of Success for Black Children

2 Social Learning Theory Ideas for Understanding Child Behaviors

3 Street to Destruction

4 Traditional Black Discipline Versus Moder Black Self-Discipline

5 Drug Abuse Prevention

6 Development

Five specific life goals parents have for their children, such as getting a good job and resisting street pressures, are discussed. Necessary child characteristics and parental modeling and teaching of these qualities are stressed.

Trainers discuss the role of environmental consequences in maintaining behaviors and teach systematic recording of target behaviors.

Parents bring a friend or relative who is helping them raise their children. Efforts to increase awareness of the role parents have in preventing negative life outcomes for their children are made. Time is spent practicing the effective praise technique, with encouragement for parents and other caregivers to use positive expressions they are comfortable with, such as "Go girl!"

Instructors frame traditional methods of disciplining, such as the use of corporal punishment, as having their roots in slavery and contrast these with civil rights and Black Power movement methods of "self-discipline."

Information on drug abuse prevention is given to parents, and the use of family rules in disciplining is highlighted.

Information on children's developmental capacities, such as the ability to communicate and care for self, is presented.



7 Thinking Parent's Approach

8 Use of Corrective Consequences (Mild Social Disapproval)

9 Use of Corrective Consequences (Systematic Ignoring)

10 Use of Corrective Consequences (Time Out)

11 Use of Corrective Consequences (Point System Special Incentive Method)

12 Drug Abuse

13 Chit Chat Times

14 Pride in Blackness

15 Summary and Graduation

Parents are encouraged to think both before and after they act in response to rule-breaking behaviors.

Corporal punishment is again explained as descending from slavery. Child abuse laws are explained, and parents are encouraged to use "moder self-discipline" methods.

Parents are taught to use systematic ignoring as a means of reducing undesirable behavior. Issues for single parents, such as stress reduction, are also given attention.

Detailed attention is given to teaching the technique of time out, as improper administration of this technique reduces its effectiveness.

Parents are taught this version of a home token economy system and given homework to implement it.

Parents' roles in preventing or promoting childhood drug use are highlighted. This session also includes a parent self-test for the use of illicit and legal substances.

Parents are encouraged to have daily enjoyable sharing times with each of their children. Appropriate topics for discussion during these times are identified.

The group discusses topics such as culture and history and ways for parents to communicate positively about being Black. Role playing is used to help parents help their children to cope with racism.

Program content is summarized. Depending upon the wishes of the group, a formal or informal graduation party is given, and certificates of completion are presented.



TABLE 2 Sessions of the Los Ninos Bien Educados program

Session Title

1 Introduction

2 Role Expectations

3 Raising Children in the United States Context and the Effective Praise Method

4 Effective Praise Method and the Use of Corrective Consequences (Mild Social Disapproval)

5 Family Platica (Family Meeting) and Show and Tell

6 Use of Corrective Consequences (Ignoring and Time Out)

The group discusses four major parental and family functions: social-emotional, material, educational, and protective. Parents define the difference between children's being bien educado (respectful) and mal educado (disrespectful) to serve as a framework for the program.

Role expectations (family and gender roles) as well as age expectations parents have for their children are identified.

Issues pertinent to immigrant families, such as acculturation, are highlighted. In addition, the session includes a discussion of the causes of child misbehaviors. The first skill, the effective praise method, is taught.

Further practice in using the effective praise method is provided. With a backdrop of information about child abuse laws, the first technique in the use of corrective consequences, mild social disapproval, is taught.

Parents are encouraged to consider the causes of child behavior, such as differentiating between age- appropriate behavior and disrespectful behavior before taking action. Instructors teach the use of the family meeting. Parents are encouraged to demonstrate the task they would like their children to perform in requesting behaviors of children (show and tell).

Information on the use of systematic withholding of attention and time out in reducing undesirable behavior is presented.

Description



7 First/Then Method



10 Skill Integration and Individual Consultations

11 Individual Consultations

12 Skills Review and Graduation

Parents were asked to complete a questionnaire about their child's likes prior to the session, and their experiences in doing so are discussed. Previous program content is reviewed, and the first/then method of contingency contracting is taught.

Parents are taught this version of a home token economy system and given homework to implement it.

Parents are given additional help in implementing a home token economy system.

Skill integration exercises and individual parent consultations with the instructor are the focus of this session. Time allowing, substance abuse information is shared.

Additional consultations are given, and program material is reviewed. Particular emphasis is placed on parents' role and age expectations for their children.

Program content is summarized, and additional individual consultations are provided as needed. Depending upon the wishes of the group, a formal or informal graduation party is given, and certificates of completion are presented.




of standard programs rather than culturally adapted or culturally specific, they will not be described or evaluated in this article.

Programs for Native American Parents

In contrast to the programs described above, the unique Positive Indian Parenting: Honoring Our Children by Honoring Our Traditions closely approximates a culturally specific program. Positive Indian Parenting was developed in the mid- 1980s by the Northwest Indian Child Welfare Institute (as cited in Alvy, 1994) and bases its content on traditional American Indian childrearing principles. The program consists of eight sessions that are geared toward establishing a global positive orientation to parenting rather than imparting specific skills, such as those found in Los Nifios Bien Educados or the EBPP, though it does teach some skills found in traditional behavioral programs.

In spite of the tremendous diversity among American Indian tribes, three general principles of childrearing that are common to virtually all tribes form the backbone of Positive Indian Parenting. These are storytelling (the oral tradition), the spiritual nature of childrearing and the spiritual value of children, and the role of the extended family. Not only are these principles reflected in the content of the program, they are also found in the format. Each of the eight sessions is concluded with a half hour of social time for parents and children. Storytelling and a potluck meal are often incorporated. Of the eight sessions, only one is focused on teaching traditional behavior management skills, such as the use of consequences. The seven others focus on applying traditional teachings to contemporary childrearing. For instance, the program covers traditional models of nurturing, the use of nature to teach lessons, and the use of harmony as a guiding principle for family life. Each of the program's sessions is described in Table 3.

Although elements of Positive Indian Parenting might also be found in a reflective parenting program, it is clearly based on Native American philosophies rather than Rogerian personality theory. It promotes the uniqueness of the target group's culture by presenting parenting in that group's cultural frame of reference. Furthermore, its more general focus on traditional Native American childrearing provides some assurance that the "skills" taught are less likely to be impositions of the mainstream culture. In these respects, it is clearly different from culturally adapted programs. Unfortunately, no studies of the effectiveness of the program have been published, though a positive reception by the target community has been noted by Alvy (1994).

Programs for Asian American Parents

A PsycLIT search of literature published between 1974 and the present failed to yield any studies of parent education with Asian American parents, either in traditional or culturally sensitive programs. Specific cultural features may contribute to the absence of published reports of these efforts. Specifically, Lieh-Mak, Lee, and Luk (1984) describe the problems they encountered in attempting to train Chinese parents in Hong Kong in the use of behavioral techniques to treat their problem children. The authors cite cultural attitudes-such as a reluctance to see children's problems as psychological in nature, a fatalistic attitude, and dependence upon doctors for children's improvement-as contributing to their diffi- culty. In addition, traditional Chinese views of children as subservient to elders

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TABLE 3 Sessions of the Positive Indian Parenting program

Session Title Description

1 Traditional Parenting

2 Lessons of the Storyteller

3 Lessons of the Cradleboard

4 Harmony in Childrearing

5 Traditional Behavioral Management

6 Lessons of Mother Nature

7 Praise in Traditional Parenting

8 Choices in Parenting

Instructors use historical information to teach parents central tenets of American Indian traditional childrearing that may be unfamiliar to contemporary parents. These views are contrasted with the changes that have occurred as a result of influence by the "Western world."

This session focuses on the role of storytelling in rearing children. Stories that contain moral lessons, such as the Coyote Legends, are touted as producing quality time with children and teaching communication, values, and proper behavior. Parents are encouraged to use active listening with their children.

Models of nurturing based on the use of the traditional cradleboard are described. Information about child development, particularly about motor and social readiness skills, is presented.

In accordance with traditional ways, parents are encouraged to use harmony as a guiding principle in structuring family life. Parents are urged to encourage cooperation and sharing among their family members.

Instructors promote the use of traditional ways of discipline that emphasize children's learning self- control over imposition of adult discipline. This involves the child's experiencing shame, loss of adult attention, or natural consequences after misdeeds.

Parents are encouraged to use lessons from nature to promote the development of characteristics such as responsibility, self-awareness, and spirituality.

A global orientation of acceptance and warmth toward children is promoted, and specific praise, such as that from elders, is particularly emphasized as helping to build a child's position self-concept.

Using the guiding question, What makes it hard to be an Indian parent?, the group discusses issues such as poverty, alcoholism, and single parenting. Based on their responses, parents are helped to set goals for their parenting.




but representative of the family honor further contribute to the parents' reluctance to use such behavioral techniques as ignoring, praise, and negotiation. If Lieh- Mak et al.'s lack of success is reflective of other efforts in the field, it is understandable that published reports of programs with Asian American parents would not be plentiful, because much of the research on parent education focuses on efficacy. However, programs teaching parenting skills to Asian American parents do exist. The first author of the present article conducted an informal telephone survey of social service agencies that serve the Asian American community of the greater metropolitan New York area.' Those that offered parent education provided parenting skills classes and discussion groups rather than standardized programs. Additional inquiry is needed to clarify the absence of Asian American parents in the parent education literature. Indeed, the results of Lieh-Mak et al. suggest that certain cultural values may make traditional behavioral parent education inappropriate for Asian Americans. The notion that cultural values may make some groups more amenable to certain types of parent training is particularly deserving of additional attention.

Research on Programs for African Americans

Studies of Parent Outcomes

Few quantitative studies have been published on the efficacy of culturally adapted programs, and only two published studies on programs for African Americans were found. Alvy (1988) reported on the pilot studies of the culturally adapted STEP, PET, and Confident Parenting programs (traditional programs that incorporated cultural units) that preceded the EBPP. A total of 48 program parents were pre- and posttested using attitudinal measures. Of the 48, 19 were low attendance, having attended only three to six training sessions, while the other 29 were high attendance, having attended seven or more sessions (Alvy, 1988). Scores on the Parental Acceptance-Rejection Questionnaire (Rohner, as cited in Alvy, 1988) were analyzed for the low- and high-attendance groups. High- attendance parents were found to have significantly improved acceptance scores, while low-attendance parents did not. When the scores of high attendees in each of the three programs were analyzed, high-attendance parents in the Confident Parenting and PET programs showed significant attitudinal change, whereas those in the STEP program did not.

Parents were also questioned at posttest on the quality of their relationships with their children using a 5-point Likert scale. The mean change reported by low- attendance parents was somewhat smaller than that of high-attendance parents (3.715 versus 4.35, where 3 = "same," 4 = "better," and 5 = "much better"). Alvy (1988) also cited qualitative data regarding the program's success: The "vast majority" (p. 156) of the parents stated that they had had positive reactions to the instructional units. All but one had attempted to teach the skills to friends.

In a somewhat more rigorous fashion, Myers et al. (1992) conducted a 2-year quasi-experimental study of the EBPP using a two-group pre- and posttest design. Participants in the programs (10 programs in the first year, 7 in the second) were African American parents with elementary-school-age children residing in South Central Los Angeles, predominantly a low-income, inner-city community. These families were recruited from elementary schools through letters, meetings with

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teachers and principals, phone calls, and home visits. Because inconsistent attendance proved to be a problem in earlier pilot testing of the program, participants in the study were given monetary incentives for attending each session. Follow- up information was obtained from a portion of the experimental group 1 year after the intervention.

The 1 st-year families that comprised Cohort 1 were selected from an initial pool of 107 parents who had attended at least one EBPP class. However, the treatment group consisted only of high-attendance participants: 64 parents who had attended 7 or more sessions (28 had attended all 15 sessions). A no-treatment control group was formed with 28 parents who resembled the treatment group demographically. Cohort 2 (2nd-year families) was slightly smaller, with 45 high-attendance parents, 34 of whom had attended all 15 sessions. The control group for Cohort 2 consisted of 36 demographically similar parents. Alvy (1994) reports that a small portion of the overall participant group consisted of parents who had been reported for child abuse and neglect and thereby participated in the EBPP as part of a family preservation project. However, this information is absent in Myers et al. (1992), and the published demographic information consisted of parental age, number of children, parental educational level, marital status, family income, and government aid status.

Four variables were investigated using self-report measures to test the efficacy of the EBPP. These variables were parental acceptance/rejection of their children, use of specific parenting practices, quality of parent-child and other family relationships, and child behavior problems and competencies. Controlling for demographic variables through the use of multivariate analysis of covariance, Myers et al. (1992) describe their overall findings as "mixed" (p. 144). For parental acceptance/rejection, a significant pre-post decrease in mean "undifferentiated rejection" by treatment parents was found for Cohort 1, in contrast to control group increases. Similarly, Cohort 2 treatment parents reported statistically significant reduction of hostile rejection and undifferentiated rejection, whereas control parents reported increases. Unexpectedly, Cohort 1 control parents showed significant pre-post increases in warmth, whereas no such changes were reported by treatment parents. These results were not duplicated in Cohort 2. As for parent- child and other family relationships, Cohort 1 treatment parents reported significantly improved relationships with both the target child and with other family members, whereas the control group parents did not. For Cohort 2, however, no significant group differences on any measures of family relationship changes were found.

No significant overall effects were found in the use of parenting practices promoted by the program for either Cohort 1 or Cohort 2 treatment parents. However, regarding specific practices, Cohort 2 treatment parents reported significant increases in their use of praise, while control parents reported decreases. In addition, Cohort 2 treatment parents reported significant decreases in their use of spanking, while no change was reported by the control group. Neither of these findings was true for Cohort 1.

No significant overall results were obtained for total behavior problems of boys and girls in Cohort 1. However, for Cohort 2, parents reported significant decreases in overall "delinquent behaviors" for both boys and girls. Regarding specific problem behaviors, Cohort 1 treatment parents reported significant reduc-

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tions in withdrawn behaviors and hyperactive behaviors in boys, as well as significant decreases in sexual problem behaviors in girls. In contrast, Cohort 1 control group parents reported increases in all of these categories in their children. While Cohort 1 treatment parents reported no significant effects for social competency for boys or girls, a significant effect was found for Cohort 2 treatment girls.

The 1-year follow-up was conducted using 48 of the 64 original families in the Cohort 1 treatment group. A comparison of posttest and follow-up results found no significant changes for parental acceptance/rejection. However, an increased use of hostile or aggressive parenting practices was found for treatment parents. With regard to changes in children, no significant changes in total behavior problems or social competency were found, though a significant finding for specific behavior problems was obtained. For boys, a significant reduction in reported uncommunicative behaviors was found.

In sum, Myers et al. (1992) report positive effects for the four variables investigated, though the specific findings of each cohort study were not typically replicated in the other. This fact is puzzling, as the EBPP was led by the same group of trainers in both cohorts, and the participants in Cohorts 1 and 2 were matched demographically. While any positive findings are laudable, the fact that the findings could not be replicated even within the same study raises questions concerning the effectiveness of the program. The findings of the 1-year follow up are modest at best.

Methodological Critique

Medway (1989) asserts that "less than half of the studies of group parent education have employed adequate experimental procedures" (p. 242), which makes it difficult to properly evaluate the effectiveness of parent training programs. Indeed, Alvy's (1988) study is plagued by methodological flaws. Specifi- cally, Alvy neglected to report adequate demographic data on the participants, failed to include a control group, did not use standardized measures with adequate psychometrics for each variable investigated, and obtained no follow-up data. In addition, Alvy failed to use more than one standardized measure, which is particularly questionable, as self-report measures have been associated with response bias. Thus Alvy's findings, which support culturally adapted programs, cannot be taken at face value.

Overall, the design of Myers et al.'s (1992) study has many positive features. These researchers included 109 parents in their treatment groups and 64 parents in their control groups-numbers that are significantly higher than those found for most sample sizes in studies of standard programs. Indeed, Dembo et al. (1985) found that of the fifteen behavioral program studies they reviewed, sample sizes greater than 30 were used in only three. Myers et al.'s inclusion of control groups is commendable in itself, as Dembo et al. note that many studies could not be included in their analysis because of the absence of control groups. In addition, Myers et al. included a long-term follow-up 1 year after the intervention. Dembo et al. found that less than one third of the behavioral program studies they reviewed incorporated a follow-up at such a long postintervention interval; typically, follow-up periods were under 6 months.

However, Myers et al.'s (1992) sampling procedures may have confounded

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their results. One central problem was the nonrandom assignment of participants to treatment and control groups. In addition, although an initial pool of 489 volunteers were identified, the study included only 173 parents, excluding those who were not able to participate in the programs (which began 3 months after the recruitment). The treatment group was composed only of parents who had attended more than seven sessions. The authors argue that a cutoff point of seven sessions was necessary because of evidence that participation in at least 50% of the program is necessary to yield measurable learning effects (Alvy, Harrison, Rosen, & Fuentes, as cited in Myers et al., 1992). This contradicts the review by Dembo at al. (1985), who were unable to "determine whether or not favorable outcomes were a function of insufficient amount of training time" (p. 170). Myers et al.'s inclusion of only high-attendance parents seems to influence the study in the direction of favorable results, particularly given the differential findings of Alvy (1988) for low and high attendees. Because of these sampling issues, their findings should be viewed cautiously.

Other aspects of the Myers et al. (1992) study are also problematic. Of behavioral studies employing follow-up measures, most have found maintenance of treatment effects but few additional gains (Dembo et al., 1985). As reviewed earlier, Myers et al. found maintenance of child behavior outcomes for some areas, but negative results regarding parental use of hostile parenting practices for the Cohort 1 treatment group. Curiously, the researchers neglected to discuss the variable quality offamily relationships in the follow-up.

Myers et al. (1992) also failed to justify their use of only one segment of the experimental group at follow-up. Although they claim that "positive results were more evident in Cohort 2" (p. 145), only a portion of Cohort 1 parents (48 of 64) were used for the follow-up. Although a chi-square goodness-of-fit test computed by the first author of the present article yielded no significant demographic differences between Cohorts 1 and 2, both groups should have been included at follow-up. In addition, it would have been helpful to conduct a statistical comparison of those who were and were not examined at follow-up, to see if any significant group differences would result. Furthermore, although Myers et al. (1992) investigated time generalization, they failed to discuss generalization across settings (i.e., in school behaviors of children), despite their claim of using teacher ratings of child behavior in their data.

While the Myers et al. (1992) study has many positive methodological features not found in much of the recent literature in the field, including Alvy's (1988) study, it also appears to be plagued by common research problems found in previous studies of parent education programs. Dembo et al. (1985) caution that more than one type of outcome measure should be employed in order to obtain a more realistic picture of a program's results. However, both Alvy and Myers et al. relied exclusively on self-report data, which may be confounded by social desir- ability. Furthermore, some of Myers et al.'s data were obtained through the use of measures that have not been sufficiently tested for reliability and validity, such as the Parenting Practices Inventory by Alvy and Arrington and the Retrospective Family Relationships Questionnaire by Alvy (both cited in Myers et al., 1992). In addition, although demographic data are reported for the participants, no analyses were performed to determine whether there were any differences between low and high attendees.

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Critique of Findings

Medway (1989) states that four categories of outcome measures may be employed to evaluate parent education programs: changes in parent attitude, changes in parent behavior, changes in child attitude, and changes in child behavior. Alvy (1988) clearly investigated only one outcome, changes in parent attitude. This is unfortunate, because it limits the evaluation of the program's results. In particular, Alvy investigated the change in parent attitude resulting from participation in culturally adapted STEP, PET, and Confident Parenting programs. These programs differ in theoretical orientation but collectively address all four outcome categories in their curricula. Information on the other three variables would have been highly informative.

Still, Alvy's (1988) study does yield an important finding. It has been com- monly reported in the parent education literature that attendance and attrition are highly problematic. By analyzing his results according to low and high attendees, Alvy provided specific evidence to support the notion that the efficacy of programs is restrained by poorer outcomes for low attendees. However, to conclude from significant findings only for a high-attendance group that a program has been successful is a questionable tactic.

The quantitative analysis of study findings using effect sizes is the crux of meta- analysis, as developed by Gene Glass (1976). Effect sizes indicate the magnitude of a study's findings and serve as a basis for comparison among studies that may differ in methodology and measures. Glass, McGaw, and Smith (1981) described in detail the use of effect sizes in social science research, and Cedar and Levant (1990) and Medway (1989) have recently applied the techniques to the quantitative analysis of parent education literature. Generally, effect sizes are computed by taking the difference in means between the experimental and control groups and dividing the result by the standard deviation of the control group; effect sizes can also be computed from other values, such as significance test results (Glass et al., 1981). Unfortunately, Alvy's (1988) findings cannot be interpreted this way, as he failed to use a control group and provided data that are insufficient for the estimation of an effect size. This is regrettable, since an effect size, a statistic reflective of the strength of a study's findings, can serve as a point of comparison with other studies.

Myers et al.'s (1992) findings are also difficult to compare to those of other published studies of behavioral programs. The majority of efficacy studies of behavioral programs utilize independent observer ratings of parent and child behavior change as major measures of program effectiveness, in addition to changes in parents' attitudes. However, Myers et al. (1992) neglected to use such ratings of behavior change. The fact that they did not use independent observer ratings is especially curious in light of the fact that many of the interviews were conducted in parents' homes, where observer ratings might have been undertaken. In addition, they failed to find significant self-reported changes in the use of parenting practices. Perhaps their results would have been more robust had they utilized more than one type of measurement. Dembo et al. (1985) noted that studies employing data recorded by independent observers or parents generally yielded more favorable results than did studies employing measures of parent attitude.

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It may be more appropriate to compare the Myers et al. (1992) study with studies of reflective and Adlerian parenting programs, which have tended to use similar attitude measures. Indeed, Myers et al.'s modest positive findings of parent attitudinal change are less consistent with studies of behavioral parenting programs than with studies of reflective and Adlerian programs, which, like the Myers et al. study, have failed to show consistent effects but have noted attitudinal change on one or more scales of an individual parent report measure. However, in comparison with these reflective and Adlerian studies, Myers et al.'s results are conspicuously lacking in significant positive findings of increased parental acceptance of children, which have been particularly noted in PET studies (Dembo et al., 1985).

The overall strength of Myers et al.'s (1992) mixed findings, as reflected in effect sizes, is weaker than that found in most of the traditional parent education literature. A mean effect size of 0.21 was calculated for the Myers et al. study using scores for both cohorts on the three measures of change in parental attitude and behavior. This small effect size is weaker than other effect sizes reported in meta-analytic studies of parental change resulting from participation in parent education programs. Specifically, this effect size is somewhat smaller than the average parent attitude effect size of 0.41 found in Cedar and Levant's (1990) review of 26 PET studies and considerably smaller than Medway's (1989) mean effect size of 0.76 for parental measures of 12 behavioral, 7 Adlerian, and 5 PET studies. When attitudinal and behavioral change are examined separately, Myers et al. yields mean effect sizes of 0.31 for attitudinal measures and -0.01 for behavioral change. Although this shows support for the efficacy of the EBPP on parental attitude change, the effect sizes are still small in comparison with previous findings for standard programs. In particular, Medway found mean effect sizes of 0.70 for attitudinal measures and 0.79 for behavioral measures.

Myers et al.'s (1992) effect size for child behavior problems and competencies was calculated to be 0.05 using the data for girls and boys in Cohorts 1 and 2 on the Child Behavior Checklist (CBCL). Again, this is significantly smaller than the effect size found by Medway (1989) for child measures (0.80) and essentially suggests that there is little relation between the program and child outcomes. Overall, Myers et al.'s findings appear to be significantly less robust than those found in the general literature on parental attitude change.

These relatively weak findings may be due in part to the population studied by Myers et al. (1992). Researchers have noted that the majority of studies on parent education have been conducted on middle-class parents (Alvy, 1994; Dembo et al., 1985). However, Myers et al. made notable efforts to conduct their study on low-income parents, using features such as monetary incentives and in-home interviews to ensure an adequate sample. Their moderate findings may be due in part their having investigated a low-income population; such populations have typically produced weaker results than middle-class samples (Dembo et al., 1985).

Summary

Although the pilot study reported by Alvy (1988) failed to use an adequate experimental design, some support was found for the culturally adapted Confident Parenting and PET programs, which subsequently evolved into the EBPP. Also,

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Alvy's finding that significant program effects differed as a result of duration of program attendance was noteworthy. Unlike Alvy, Myers et al. (1992) employed a methodology that is generally comparable with methodologies found elsewhere in the literature. Specific aspects of it, such as the relatively large sample size and use of follow-up measures, are commendable. However, a few significant depar- tures from convention may have significantly affected Myers et al.'s findings. In particular, their reliance on only one type of measurement, parent report in interviews and questionnaires, and their strong sampling bias bring into question the accuracy of their findings. However, as some positive results were found, there is a need to reinvestigate the effectiveness of the EBPP using multiple measures that are more consistent with the behavioral philosophy of the program. In particular, independent observer ratings or parent-recorded data would be a better measure of the main goal of the program, that is, behavioral change. Such research is needed to clarify whether Myers et al.'s modest findings are due to program inefficiencies or to methodological flaws in their study.

Research on Programs for Hispanic Parents

Alvy (1994) cites three studies which have investigated the effectiveness of Los Nifios Bien Educados. Unfortunately, two were not referenced, and one could not be obtained (K. T. Alvy, personal communication, July 20, 1995). Furthermore, Alvy's brief description of these studies did not contain any numerical data, which precludes an in-depth analysis of these studies. The reader is referred to Alvy (1994) for qualitative information about the efficacy of Los Nifios Bien Educados.

By contrast, several studies of the Houston PCDC program have been published, and the effects of this program on both parent and child outcomes have been examined.

Studies of Child Outcomes

Johnson and Breckenridge (1982) conducted a study of 64 Houston PCDC program children and 64 control children using a pretest-posttest design. These children were randomly assigned to treatment and control groups, and an analysis of the two groups revealed no significant demographic differences between them. Mothers were interviewed in their homes by bilingual research assistants. A variation of the Behavior Assessment Interview, which yields information on 12 child behavior variables (e.g., selfish, resistant, temper problems), was employed to obtain descriptions of child behavior. Using a multivariate analysis of covariance, the authors found significant main effects for both program status and gender. Control children were found to have significantly higher scores on the extroversion and destructive scales than the treatment group, with control boys scoring significantly higher than girls on destructive, resistant, and dependent scales. With no significant differences between program boys and girls, the authors found that program and control boys differed significantly on three scales: destructiveness, high activity, and emotional sensitivity. Johnson and Breckenridge concluded that the program resulted in greater changes for boys than for girls because "control girls presented few behavior problems while control boys presented many" (p. 313) and because of previous findings that boys tend to manifest behavior problems at an earlier age than girls. Consequently, the results of their

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study are mixed, as behavioral change was found for only a segment of the treatment group and only on some scales of the outcome measure.

Johnson and Walker (1987) conducted a unique follow-up study of Houston PCDC experimental and control children 5 to 8 years after their completion of the program. School data were obtained when the children were in Grades 2 through 5 using two teacher rating scales-the AML (Cowen et al., as cited in Johnson & Walker, 1987) and the Classroom Behavior Inventory (CBI; Schaefer & Edgerton, as cited in Johnson & Walker, 1987). Due to the late follow-up, many of the original program participants were unreachable, and the sample represented only 59% of the original five PCDC cohorts, for a total of 51 program children and 88 control children. Analyses indicated no significant demographic differences between those that were studied and those who were unreachable. Multivariate analyses of variance on AML scores revealed significantly more acting out problems for control children than for program children, with control children rated as more impulsive, obstinate, restless, disruptive, and involved in fights. This was due to a significant gender difference, with control boys rated as having more behavior problems. However, the authors note that their AML data distribu- tions were positively skewed, even after data transformation, and, consequently, the statistical findings may not be truly applicable. On the CBI, program children were rated as being significantly more considerate and less hostile, and control boys were found to be significantly more dependent than program boys. Thus, the authors concluded that the results of the two measures were in "general agree- ment" that program children presented fewer aggressive behavior problems than control children even many years after participation in the program.

Methodological Critique The Johnson and Breckenridge (1982) study is praiseworthy on many counts.

Their overall sample size was large (N = 128), and they employed random assignment to treatment and control groups. Also noteworthy was their attempt to give parents informed consent by explaining the random assignment when recruit- ing. In addition, the interview ratings were done without the interviewers' knowledge of each child's research status, which minimized the potential for experi- menter bias. However, their study also contained methodological flaws common to the field. Specifically, the authors used only one type of outcome measure, mothers' self-report, which is subject to response bias. In addition, they used only one measure, the Behavior Assessment Interview, and neglected to report any reliability or validity data to justify its use. As with studies on the EBPP, independent observer ratings of child behavior would have been beneficial. Although the authors explained that this was not feasible due to finances and their geographi- cally scattered sample, using an instrument such as Caldwell's Home Observation of the Maternal Environment may have been possible, because the interviews were conducted at home.

Similarly, Johnson and Walker's (1987) experimental methodology had strong points, such as a large sample size, teacher ratings done without knowledge of each child's status, and analysis of demographic differences for possible sample bias. However, they also failed to use more than one type of outcome measure, and of the two teacher-report instruments used, only one (the AML) was reported to have adequate reliability and validity.

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The mixed findings of Johnson and Breckenridge (1982) are weak in comparison to the child outcomes from the EBPP (Myers et al., 1992) and the general parent education literature. An overall effect size of -0.02 was calculated for their findings on boys' and girls' behaviors, which suggests that the program had little effect on long-term change in children.

In contrast, Johnson and Walker (1987) provided modest findings for the efficacy of the Houston PCDC program. A mean effect size of 0.33 was computed for child behavior change on the AML, indicating overall weaker results in comparison to findings of traditional programs. However, even these results must be interpreted with caution. Although Johnson and Walker noted the skewness of their AML data, they did not provide adequate information about it (e.g., skewness coefficients), nor did they reject the measure altogether, as would have been reasonable for such unrepresentative data. Indeed, if the data were extremely skewed, it is questionable whether their positive findings provide a realistic picture of the results of the program.

Studies of Child and Parent Outcomes

Johnson (1981) investigated the degree of change in parent and child behavior by assessing the stability of mothers' attitudes and behaviors and children's general intellectual functioning (referred to as "behavioral continuity") as a result of participation in the Houston PCDC program. Of the 100 eligible families, less than half were available for evaluation (44 experimental, 48 control). Johnson found no differences between this group and those who had dropped out of the program. Program participants and controls were evaluated using two observational mother-child interaction procedures, the Maternal Interaction Structured Situation (MISS), by Johnson, Kahn, and Davilla (as cited in Johnson, 1981), and Caldwell's Home Observation of the Maternal Environment (HOME; as cited in Johnson, 1981). On the MISS, videotaped samples of mother-child interaction are rated on five scales: affectionateness, use of praise, use of criticism, encouragement of the child's verbalizations, and total score. The HOME involves an in- home interview and observational period of 1 to 1 1/2 hours, in which the presence or absence of maternal behaviors and characteristics of the home are noted. The six subscales of the HOME include emotional and verbal responsiveness of the mother, avoidance of restriction and punishment, and maternal involvement with the child. Three attitudinal measures were also employed with the mothers, the Traditional Family Ideology, the Index of Achievement Values, and the Child Rearing Beliefs questionnaire. Children's measures included the Bayley Scales of Infant Development, the Stanford-Binet Intelligence Scale, and Palmer's Concept Familiarity Index (as cited in Johnson, 1981). Various combinations of these measures were utilized at three points in time: 1, 2, and 3 years of age.

The authors found different results each time the measures were administered. At age 1, no significant differences were found between program and control groups (for mothers as well as children) on either the MISS or the HOME. However, at age 2, significant differences between program and control mothers were found on the Praise and Mother Encouragement of Child Verbalization scales of the MISS, but these differences favored the control group. Later analyses

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revealed that this may have been due to inadvertent methodological flaws (control children were systematically tested at later dates than program children). How- ever, on the HOME at age 2, treatment mothers were found to score higher on the Provision of Appropriate Play Materials and Opportunity for Variety in Daily Routines scales. More consistent differences in favor of the program mothers were found at age 3. Program mothers scored significantly better than control mothers on the Affection, Criticism, and Mother's Encouragement of Child's Verbaliza- tion scales of the MISS, as well as on the Emotional Responsiveness, Avoidance of Restriction, Provision of Appropriate Play Materials, and Total Score scales of the HOME. Viewing the correlation data, Johnson (1981) concluded that the control mothers evidenced more cross-time stability than the program mothers, which suggests that the Houston PCDC program had a significant effect on changing program mothers' behaviors. However, this was not evident on all of the scales of each measure, and Johnson noted that program mothers showed stability equal to that of the control mothers on some scales. Consequently, although the program had an impact on program mothers, not all of their behaviors were susceptible to change.

Regarding mothers' attitudinal change, no significant differences were found at any of the time samplings. Johnson (1981) suggests that this may be due in part to a response set (e.g., a tendency to answer yes) as well as an overall allegiance to cultural values that were unmodified by the mothers' participation in the program.

Johnson (1981) found mixed correlations of child stability on measures of general intelligence for the program and control children. Overall, stability correlations for program children were similar to those for control children, which suggests the same degree of change. The only significant difference favoring program children was on child verbalization when scores at 2 and 3 years of age were compared.

In conclusion, Johnson (1981) states that "no general statement could be made about the effect of an intervention on behavioral stability" (p. 198). However, he also asserts that evidence of the program's success in changing behaviors was evident, more so for mothers than for children.

Andrews et al. (1982) also reported on the changes in parent and child attitudes and behaviors that resulted from participation in the Houston PCDC program. Their sample included a total of 97 mother-child pairs and 119 control participants from the first two cohorts to complete the program. These families were randomly assigned and analyzed for initial demographic equivalence. A significant difference in total incomes favoring the experimental groups was found, but no significant difference was found for per capita income, and the authors dismissed the differences as negligible. Two observational measures were employed to investi- gate maternal behavioral outcome, the MISS and the HOME. The outcome measures for children were measures of general intellectual ability: the Bayley Scales of Infant Development, the Stanford-Binet intelligence scale, and the Concept Familiarity Index.

Data were analyzed using a multivariate analysis of variance for the combined results of mothers in Cohorts 1 and 2. At the conclusion of the program, program mothers were found on the MISS to be more affectionate, use less criticism, and demonstrate significantly greater encouragement of their children's verbalization.

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Total HOME scores were also significantly higher for the program mothers than for the control mothers. In addition, program mothers were significantly more emotionally responsive and provided more appropriate play materials than control mothers at the conclusion of the program.

A two-way analysis of variance was used to assess child outcomes. The only significant findings were significantly higher Bayley scores at 24 months for program children but significantly greater child verbalization (MISS) at 24 months for control children. Thus, while Andrews et al. (1982) found positive results for the mothers, their findings were much weaker regarding child outcomes.

Johnson, Kahn, and Leler (1976) conducted an in-depth analysis of the latter four of the seven cohorts to complete the Houston PCDC program. The sample of eligible families was recruited by visits to their homes. Eligibility was determined using two family rating scales that identified the salient variables of income and maternal employment. Families that were eligible and agreed to participate re- gardless of group assignment were then randomly assigned in approximately equal numbers to treatment and control groups, though the last two cohorts contained two control groups, one that was provided with medical and community services and one that received no services. Due to attrition (typically because the family moved), data were obtained on only a portion of the original sample, though the authors state that analyses indicated no significant differences between those who dropped out and those who remained. Thus, a total sample size of 183 was used (82 experimental, 101 control).

Because the goal of the program was to produce behavioral change, the authors relied heavily on two behavioral measures of parental change, the MISS and the HOME, as had previous studies of the Houston PCDC program. However, attitudinal measures such as the Traditional Family Ideology, Index of Achievement Values, Locus of Control Scale, and Child Rearing Beliefs were also included, as were other measures of language fluency. Measures of child outcomes included the Bayley Scales of Infant Development, the Stanford-Binet test, and two language development indexes. Various combinations of these measures were administered when the children were 12, 24, and 36 months of age. In addition, one cohort (Cohort D) was interviewed to obtain their impressions of and attitudes toward the program.

The authors essentially dismiss the findings on the attitudinal scales, stating that although "some significant group differences in the right direction have been found,...our impression is that the patterns are largely chance [i.e., response set]" (Johnson et al., 1976, pp. 119-120). However, they reported qualitative information on the program's success and noted particularly that their interview of Cohort D revealed overwhelmingly favorable results, as "all of the mothers said they would recommend the program to another mother" (Johnson et al., 1976, p. 109).

In contrast to their dismissal of attitudinal findings, Johnson et al. (1976) describe in detail the findings of the behavioral measures. On the MISS, program mothers showed greater overall affection, encouragement of child verbalization, and use of praise than control mothers. On the HOME, program mothers in Cohort F had significantly higher total scores than control mothers at 36 months. Program mothers also demonstrated significantly better organization of the environment and provision of appropriate play materials. Somewhat similar results were found for Cohort G on the HOME, with higher total scores for program mothers as well

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as greater provision of appropriate play materials. Cohort G treatment mothers were also found to be significantly more emotionally and verbally responsive and less punitive and restrictive than control mothers. On the measures of child outcomes, program children obtained significantly higher overall scores on both the Bayley scales and the Stanford-Binet scale than control children. The authors conclude that their study found a "general pattern of results indicating that program goals had been obtained" (Johnson et al., 1976, p. 9).

Methodological Critique

Overall, the three studies of parent and child outcomes resulting from the Houston PCDC program-Johnson (1981), Andrews et al. (1982), and Johnson et al. (1976)-are methodologically sound. Their randomization of treatment and control groups, statistical checks for demographic differences in the sample, use of multiple outcome measures, and attention to interrater reliability are all positive features. The five parent outcome measures employed generally appear to be solid. Only the Child Rearing Beliefs questionnaire has not been published, and the MISS was developed by the program to evaluate mother-child interaction at the center. Validity and reliability data for the HOME, but not for the other instruments, have been reported elsewhere. However, Andrews et al. and Johnson et al. failed to use all child measures at all three points of inquiry (e.g., the Stanford-Binet test at 24 months). This unnecessarily complicates the interpreta- tion of their results. In addition, although it would appear that all three studies had adequate to large sample sizes, there is some confusion in the numbers reported. This is particularly true for Andrews et al. Although in describing their sample they report the inclusion of 97 program and 119 control mother-child pairs, in their statistical analyses of outcomes measures significantly different sample sizes are reported: 44 program and 47 control mothers for the MISS and HOME total, 38 program and 53 control mothers for the HOME subscales, and no numbers for child data. While mild disparities can be expected to result from occurrences such as incomplete interviews, such large differences are significant, and the absence of an explanation from the authors is troubling.


The data reported in Johnson (1981) were insufficient to calculate an effect size for the study. However, their results seem modest at best and, more likely, small in comparison to the general literature due to the many outcome instruments employed that did not yield significant results. In contrast, the results of the Andrews et al. (1982) study fail to show overall support for the efficacy of the Houston PCDC program. The effect size for MISS ratings was -0.31, while the mean effect size for HOME ratings was 0.24, yielding a mean effect size for parental change of -0.04. Similarly, the mean effect size for child outcomes was -0.10. These effect sizes indicate that program participants fared worse overall than control families, though the difference is slight. Whereas the overall effects were negative, some moderate to large positive effect sizes were found for individual subscales (e.g., maternal encouragement of child verbalization and Bayley scores at 24 months). Unfortunately, even these findings were not unilat- erally present across time samplings.

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In contrast, the effect sizes for Johnson et al. (1976) were significantly stronger than those found for Andrews et al. (1982). For parental behavior change in Cohorts F and G, as measured on the HOME, the mean effect size was computed to be 0.45, while an effect size of 0.68 for child outcomes was calculated using Stanford-Binet data for Cohorts D, E, F, and G. However, these effect sizes were calculated using available data and do not reflect all of the findings of the study, because data for MISS and Bayley results were insufficient for the calculation of effect sizes, and data from only two cohorts were reported. This may be important, as the findings of Johnson et al. (1976) were inconsistent, with significant results on some but not all scales of a particular measure and on a particular scale for some but not all cohorts. As the overall effect sizes of these studies suggest mixed results, it seems that the magnitude of the change in both parents and children produced by participation in the Houston PCDC program is weaker than the change reported in the literature for traditional programs.

Summary It is unusual in the parent education literature for many studies to be conducted

on the same program. Thus the substantial amount of research on the Houston PCDC program is notable. In general, these studies were conducted with well designed methodology, particularly in their use of informed consent, random assignment, equivalence analysis for experimental and control groups, and multiple outcome measures. However, while their mixed results are somewhat comparable with the general findings of parent education efficacy studies, their overall findings on the efficacy of the Houston PCDC program are modest at best.

Conclusions

A summary of the effect sizes for parent and child outcomes in the studies reviewed is provided in Table 4. Unfortunately, it was possible to calculate only eight such effect sizes. These vary greatly, ranging from -0.31 to 0.68. This is curious in light of the fact that six of the eight effect sizes are for studies that investigated the Houston PCDC program using virtually identical measures. Consequently, it may be that the variance depicted is reflective not of true program effects, but rather of other confounding factors.

TABLE 4 Effect sizes for studies on culturally sensitive parent education programs

Study Mean parent ES Mean child ES Target group

Alvy (1988) African American Andrews et al. (1982) -0.04 -0.10 Hispanic Johnson (1981) -Hispanic Johnson et al. (1976) 0.45 0.68 Hispanic Johnson &

Breckenridge (1982) -0.02 Hispanic Johnson & Walker (1987) 0.33 Hispanic Myers et al. (1992) 0.21 0.05 African American Note. A dash indicates that an effect size was not computed due to insufficient data.

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Generally, the studies reviewed manifest weak support for the efficacy of culturally sensitive parent education programs, though some moderate effect sizes are present. The mean effect sizes of 0.31 (SD = .20) for parent outcomes and 0.19 (SD = .28) for child outcomes suggest that the programs are somewhat more effective in producing overall change in parents than in children. These effect sizes are small in comparison to overall effect sizes found for traditional parent education. For instance, Medway (1989) reviewed studies of traditional behavioral, PET, and Adlerian programs and found mean effect sizes of 0.76 for parent measures and 0.80 for child measures.

However, this large discrepancy may be a function of the procedures used to calculate effect sizes. The computation of the effect sizes in this review generally included all measures in a given study, and effect sizes were computed using subscale scores when possible. Where authors such as Myers et al. (1992) reported only significance on specific scales, an effect size of zero was entered into the equation for each scale on which no significance was reported, so as not to inflate the statistic. This was not the case in Medway's (1989) meta-analysis, as he included effect sizes from studies in which only certain measures were used. His failure to include nonsignificant and insignificant findings on other measures, as well as his use of total scores rather than subscale scores, may have skewed his effect sizes. Thus it may be more appropriate to compare the effect sizes found in the current review to those of Cedar and Levant (1990). Though they investigated only PET studies, their calculation of effect sizes more closely approximates the procedures used here. They found overall effect sizes of 0.47 for parent measures and 0.18 for child measures, which are comparable to the effect sizes found here. In sum, the evidence collectively suggests that culturally sensitive programs do produce some positive change in both parent and child outcomes; however, these effects are not as strong as those found for traditional programs.

Caution should be applied in interpreting these findings. Several factors must be considered. First, the smaller effect sizes found for culturally sensitive programs may reflect not program flaws but rather methodological flaws in the studies reviewed. Indeed, to varying degrees, quantitative studies of the effectiveness of culturally sensitive parent education programs have been hampered by methodological imperfections, such as the nonrandom assignment of participants to treatment and control groups, the lack of follow-up data, and the use of questionable measures. In addition, that traditional programs showed larger effect sizes does not mean that traditional programs are more effective for all populations. The majority of studies on standard programs involved middle-class White parents and children, while the majority of the programs reviewed in this article investigated only low-income, ethnic-minority families. It would be erroneous to conclude from the effect sizes that the traditional programs for the White middle class would be equally effective for minority families of lower socioeconomic status.

In addition, although the magnitudes of the findings of the culturally sensitive programs are generally smaller than those of the traditional programs, this does not negate the evidence that these programs have resulted in significant differences in parental attitudes and behaviors as well as behavioral and intellectual outcomes for children. When studies are examined individually, significant changes in children's behaviors and parents' attitudes can be found. Similarly, although

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not reviewed in this article, qualitative data suggest that the programs are highly efficacious for at least a segment of the population.

Since this review is limited to quantitative studies, the generalizations that can be extrapolated are somewhat circumscribed. While quantitative studies yield important information on the effectiveness of these programs, they are not defini- tive in depicting the scope of program efficacy. Promoting growth and change in relationships between parents and children is a highly complex process. Restrict- ing the evaluation of culturally sensitive parent education programs to quantifiable measures (e.g., occurrence of specific target behaviors) may be reductionistic in light of the intricate nature of interpersonal relationships. For example, some researchers argue that focusing on quantifiable change within a child or parent overlooks the quality of family interaction (Medway, 1989).

Lastly, this review focused only on programs consisting of curricula for childrearing, a specifically defined subset of the larger movement of parent education. Clearly, programs that emphasize strengthening families and parent- child relationships also merit attention. Consequently, the results of this review should be taken as representative not of all culturally sensitive parent education, but rather of a specified subset of that movement.

Suggestions for Future Research

It is encouraging to note that a movement toward multiculturalism has begun in the realm of parent education. Initial efforts to modify programs to be more linguistically acceptable have since evolved into the development of programs designed specifically for target cultural groups. The rationale for encouraging this trend is clear. If parent education is to be effective, it must be made not only available to all populations, but relevant and acceptable to all populations as well. As Slaughter (1988) states, "Program content must be based upon the developers' considered judgment and knowledge of the group's cultural history and immedi- ate social context" (p. 468). However, it is apparent that the research on culturally sensitive parent education has been limited in its focus. Studies of the efficacy of programs for Native Americans and Asian Americans are needed to further guide efforts to serve these populations.

Unfortunately, the efficacy studies of programs for African American and Hispanic parents have been hindered by methodological problems common to most of the parent education literature, such as the absence of control groups and inadequate measures. Future studies should address these methodological problems. Additional research on the EBPP in particular would be welcome. Further- more, the criteria with which these programs have been evaluated have been inconsistent. Some studies have looked only at parent outcome variables, while others have looked at both parent and child outcomes. Information on changes in parent attitudes and behavior, as well as child behavior and emotional changes, are essential. However, the interaction of these factors may be more important, as the overall aim is to influence the parent-child interaction (Reis, Barbera-Stein, & Bennett, 1986). The evaluative instruments used in future studies of culturally sensitive parent education programs should reflect this. In this area, qualitative data may be more revealing than quantitative data, as differences in interpersonal relations may be difficult to quantify. Thus, a review of qualitative data on

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culturally sensitive programs would be particularly informative. Furthermore, studies comparing the efficacy of culturally sensitive programs with traditional parent education, using both qualitative and quantitative data, are needed to more fully evaluate the effectiveness of efforts to serve diverse groups. Due to these shortcomings in the literature, it is difficult to make conclusive statements about the relative efficacy of culturally sensitive parent education programs. Additional well designed studies of the effects of participation in such programs would provide stronger arguments for (or against) their place in the future of parent education.

Note

'Agencies indicating an Asian clientele and listed in the NY Parents Directory: A Guide to Parent Education and Support Programs (10) were contacted by phone in July and August of 1995.

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Authors JEAN CHENG GORMAN is a doctoral student, Department of Applied Psychology,

New York University, Washington Square, New York, NY 10003. Her areas of interest are parenting, Asian families, and pediatric psychology.

LAWRENCE BALTER is Professor, Department of Applied Psychology, New York University, Washington Square, New York, NY 10003. He specializes in parent- child relationships, child development, and media and psychology.

Received by previous editors May 20, 1996 Received by current editors July 3, 1996

Revision received January 23, 1997 Second revision received July 28, 1997

Accepted July 29, 1997

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Documents

Culturally Sensitive Parent Education: A Critical Review of Quantitative Research