the changing nature of parental responsibility essay

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• v.15(1); Jan-Feb 2021

Parenting and Child Development: A Relational Health Perspective

A child’s development is embedded within a complex system of relationships. Among the many relationships that influence children’s growth and development, perhaps the most influential is the one that exists between parent and child. Recognition of the critical importance of early parent-child relationship quality for children’s socioemotional, cognitive, neurobiological, and health outcomes has contributed to a shift in efforts to identify relational determinants of child outcomes. Recent efforts to extend models of relational health to the field of child development highlight the role that parent, child, and contextual factors play in supporting the development and maintenance of healthy parent-child relationships. This review presents a parent-child relational health perspective on development, with an emphasis on socioemotional outcomes in early childhood, along with brief attention to obesity and eating behavior as a relationally informed health outcome. Also emphasized here is the parent–health care provider relationship as a context for supporting healthy outcomes within families as well as screening and intervention efforts to support optimal relational health within families, with the goal of improving mental and physical health within our communities.

‘Viewing development through the lens of relational health reflects recognition of the critical role that relationships play in children’s social, emotional, health, and cognitive outcomes.’

“In order to develop normally, a child requires progressively more complex joint activity with one or more adults who have an irrational emotional relationship with the child. Somebody’s got to be crazy about that kid. That’s number one. First, last and always.”—Urie Bronfenbrenner “If a community values its children it must cherish their parents.”—John Bowlby

Introduction

Bronfenbrenner recognized the critical importance of the emotional relationship between a child and an adult, whereas Bowlby’s observation underscores the responsibility of communities and practitioners in supporting healthy child development by supporting parents. The belief that we can support children directly, without supporting their parents, overlooks the complex system of relationships within which children develop. 1 Together, Bronfenbrenner and Bowlby remind us that to support healthy development, we must focus on the emotional quality of the relationships within which the child participates—as well as consider how the larger community supports those relationships.

Yet parenting is a broad topic and an exhaustive review is beyond the scope of any one article. Informed by the field of infant mental health with its explicit relational focus 2 and in an effort to contribute to our understanding of parenting as multiply determined, 3 we focus our discussion here on the construct of relational health as a tool for promoting socioemotional and physical health among young children. Relational health reflects a sense of “connectedness” with attuned others, including caregivers, family members, and other individuals within the community. 4 Such a focus is consistent with the field of lifestyle medicine—which considers the environment as a social determinant of health and well-being 5 —and research on health and social behavior, which highlights parents as significant influences on children’s health. 6 Viewing development through the lens of relational health reflects recognition of the critical role that relationships play in children’s social, emotional, health, and cognitive outcomes. 3 Accordingly, the revised Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC-05) 7 considers how characteristics of the broader caregiving environment, such as coparenting quality and other close relationships, relate to developmental and mental health diagnoses. 2

Relational Health Within Primary Care: The Parent-Provider Relationship

We suggest that the parent-provider relationship provides a potentially valuable, although far less emphasized, context for promoting relational health. We present a review of the literature surrounding relational health science and encourage the health care provider to view their patients through the relational health lens. When considered from this angle, for children and their caregivers, the relationship is the patient. As health care providers endeavor to encourage healthy lifestyle choices in the families they serve, each decision a family makes—whether to the benefit or detriment—will occur in the context of their relationships. The health care provider must learn to consider and then acknowledge the family support relationships present in the exam room, the waiting room, and at home to best engage a family’s healthy choices. When caring for patients through this approach, the provider will consider the patient’s treatment choices in their realistic and relational context, rather than as compliant versus noncompliant. Moreover, by acknowledging the provider’s own relationship to the family, the provider can become a supportive member of the treatment decision team rather than an information broker, motivational interviewer, or reticent supplier of difficult-to-follow advice.

The relational health perspective considers the practitioner as a supportive (or unsupportive) “other” in navigating the sometimes difficult, uncertain, or fear-provoking experience of parenting a child from preconception through adulthood. An awareness of relational health in pediatric and adult medicine settings may increase positive outcomes in both parents and children through increased empathy. Specifically, during challenging situations, the practitioner should assess and address relationship quality rather than judging parenting or assigning sole credit or blame to either the parent or child. The focus lies in identifying strengths and opportunities in service to the relationship. 4

Relational Health Within Families: The Parent-Child Relationship

A relational health perspective on development embodies a family systems perspective as well, which recognizes the interconnectedness of individuals and relationships within families 8 and the bidirectional, transactional nature of relationships 9 ; parents affect children and children affect parents. 10 A relational health approach to understanding parent-child relationships emphasizes the dyadic connection between parent and child. Although a multitude of factors have been explored as correlates and predictors of parenting and child outcomes, we focus here on a subset of the factors that may influence relational health, with the goal of increasing practitioners’ understanding of relationship-focused approaches to health promotion within families.

Parent-Child Attachment Relationships: Parental Sensitivity and Reflective Functioning

One of the most influential relationship-focused frameworks for understanding development is attachment theory. An extensive literature describes the early parent-child attachment relationship as an enduring, emotional bond that enables children to explore the environment, 11 yet maintain the proximity and contact necessary for healthy development. Parent-infant attachment relationships, therefore, provide the earliest contexts for children’s relational health. Secure attachment balances developmentally appropriate exploration of the world with seeking closeness and comfort from the caregiver when distressed. Secure parent-child attachment relationships are associated with a range of positive social and emotional outcomes in children. 12 , 13 Conversely, disorganized attachment, a form of insecure attachment, is a risk factor for poorer developmental outcomes 14 and has been linked to disturbed caregiving behavior. 15 - 17 Efforts aimed at increasing security within these critical early relationships remain of interest to researchers and clinicians. 18 Interventions including Attachment and Biobehavioral Catch-up (ABC), 19 , 20 Circle of Security, 21 and Video Intervention for Positive Parenting and Sensitive Discipline (VIPP-SD) 22 have been effective in promoting secure attachment and positive child outcomes (including fewer behavior problems) via creation of measurable, positive changes in parents’ sensitive and responsive behavior, a key factor in secure attachment. 23 , 24 Yet these interventions are not widely available to the public, thus limiting the ability of clinicians to offer them to their patients and families.

Perhaps the most effective mediator toward creating change in parental sensitivity and responsiveness is fostering growth in a parent’s reflective functioning (RF). RF reflects the extent to which a parent can consider the mental states (ie, thoughts, feelings, intentions) that may motivate the behavior of self and other. 25 This capacity can be described in terms of both self-focused RF and child-focused RF. 26 , 27 Interventions such as Minding the Baby 28 , 29 and Mothering from the Inside Out 30 , 31 appear effective in supporting healthy relational outcomes via a focus on growing RF. The concept of RF is also relevant for understanding how adults’ own early relational experiences may affect their parenting. 32

Recommendations for Providers

These 2 elements of parenting—sensitive, responsive caregiving and RF—support the formation of secure parent-child relationships. 24 We suggest that health care providers use thoughtful questioning that may support parental RF, as recently suggested and detailed by Ordway et al. 33 Health care providers can also demonstrate and model RF and help build this capacity in families via routine care and also in medically intensive environments. In environments such as the neonatal intensive care unit (NICU), for example, barriers to parent-neonate relational health development are prominent because of parents coping with fears of infant death and infants experiencing frequent stressors. 34 - 39 Although NICU staff recognize the critical role they play in supporting early parent-child relational health and promoting positive socioemotional outcomes among infants born prematurely, 40 this role may come secondary to the provision of direct medical support to neonates. Professionals’ engagement in reflective practice, with its focus on awareness of the mental and feeling states of self and others, 41 may be one pathway toward promoting positive infant outcomes via the provision of greater psychological support to parents of premature and medically fragile newborns. Building reflective capacity among a range of health care providers may further strengthen the foundation of early relational health within families. 33

Mothering, Fathering, and Grandparenting

Although attachment perspectives historically have emphasized the mother-child relationship, attachment theory and research has been extended to a variety of other caregiver-child relationships, including father-child relationships. 42 - 44 A family systems perspective 8 on relational health suggests that to understand development, we must consider how mother-child and father-child relationships may independently or interactively contribute to developmental outcomes.

Rigorous recent research indicates that children benefit socially and emotionally when fathers are more involved in their lives. 45 Moreover, the benefits of father involvement hold for nonresident as well as resident fathers. 46 Yet fathers’ engagement in parenting is multiply determined, 47 and individual, family, and institutional-level factors may all play important roles in predicting paternal involvement. At an individual level, a father’s identity as a parent, 48 , 49 as well as a father’s attitudes and beliefs about his role in his child’s life, 50 , 51 matter for his engagement. At the family level, evidence highlights the quality of the father’s relationship with a child’s mother. For example, mothers are more likely to be gatekeepers within families, controlling fathers’ access to children as well as the quantity and quality of fathers’ interactions with their children. 52 , 53 At a policy level, compared with countries such as Sweden where paternal leave is supported, the lack of paid paternal leave within the United States may also present barriers to fathers’ involvement with their young children as well as erode fathers’ sense of efficacy in the parental role. 54

Above and beyond these individual, family, and policy variables, mothers’ and fathers’ parenting may differ and uniquely predict developmental outcomes. For example, mothers may be the primary providers of emotional security for children via the establishment of early parent-child attachment relationships, whereas for fathers, exploration of the world may be a primary emphasis in parenting. 55 Fathers’ more stimulating play style—often involving rough-and-tumble play—may promote positive outcomes in children, including developmentally appropriate risk taking and establishment of autonomy. 56 , 57 Mothers, by contrast, are more likely to engage in object-mediated teaching interactions as well as providing structure for their children. 58 However, though mothers and fathers may have interaction styles that differ, the fact remains that many children in the United States are raised in households headed by mothers and may experience wide variability in contact with their biological fathers. 59 This fact, coupled with increasing acceptance and prevalence of families headed by same-sex parents, cautions against a return to the belief that to develop optimally, children require both fathers and mothers (known as the “essential father” hypothesis). 60

We must also recognize that nonparental primary caregivers may play a central role in the care and raising of young children. For example, the increasing number of grandparent-headed households means that more grandparents—with their own sets of strengths and challenges—are making health and wellness decisions for children and may require a unique set of supports from health care providers. 61 Even when not primary caregivers, many grandparents—especially maternal grandmothers—report being involved and influential in their grandchildren’s lives. 62 In fact, involvement of maternal grandmothers with grandchildren may buffer young children from the risks to their development posed by difficult temperament and harsh parenting by mothers. 63 A wider relational health perspective suggests that grandparents (both custodial and noncustodial) be considered as potential sources of support in children’s health and well-being.

Shifting demographics suggest that fathers, nonparental caregivers, and grandparents play an active and involved role in the lives of children. As providers, recognition of the range of relationships in which the child is embedded is critical. Examining potential biases around who is most knowledgeable or best equipped to care for children may help providers approach each adult who is involved in the child’s life as a potential partner in health promotion. 64

Coparenting Relationships

The recognition that children develop within relationships between multiple caregivers, including mothers, fathers, grandparents, and others, makes it critical to also consider the health of the relationships among these adults (ie, coparents) who share responsibility for raising particular children. 65 , 66 Whereas constructs such as marital quality or marital satisfaction focus on the intimate partner relationship, the coparenting relationship, although related, is separate and distinct. Coparenting reflects a wider range of relationship structures and processes specific to parenting. 67 , 68 For example, coparenting relationships occur among a variety of individuals who share responsibility for parenting, whether romantically involved or not, 65 , 69 such as same-sex parents, adoptive parents, divorced or never married parents, and mothers and maternal grandmothers. 70

Consistent with a family systems perspective, 8 better coparenting relationship quality is associated with children’s positive social and emotional development over and above the effects of both romantic relationship quality between parents (if present) and mothers’ and fathers’ parenting. 71 Notably, coparenting relationship quality among same-sex parents shows similar associations with children’s socioemotional development. 72 If supportive, coparenting relationships may help caregivers, especially fathers, promote children’s positive socioemotional development, 73 but undermining or conflictual coparenting relationships may have a detrimental effect on child development. For instance, although grandmother involvement may benefit children, conflict between mothers and grandmothers can be detrimental to children’s socioemotional development. 63 , 74 Thus, prevention and intervention programs have been developed to support effective relationships between coparents. 75 , 76 For example, Feinberg’s Family Foundations program targets couples expecting their first child and focuses on building strong coparenting relationships across the transition to parenthood 77 , 78 —a critical foundation for parent-child relational health.

Coparenting research highlights the role of supportive versus undermining coparenting for children’s development. Often, the extent to which coparents support or undermine one another stems from whether they share the same views on parenting goals and practices and have a similar perspective on the child’s development. Thus, when interacting with patients, we suggest inquiring about the extent of agreement versus disagreement among the adults who make decisions regarding the child’s health and development. For example, the primary custodial parent may emphasize healthy food choices and regular physical activity, whereas the nonresidential coparent may provide markedly different choices during visitation periods. Alternatively, one parent may have concerns about a child’s language or motor development, whereas a grandparent may continually emphasize that the child is “just fine.” These discrepancies in perceptions of typical versus atypical development may delay or interfere with prevention efforts, medical diagnosis, and treatment. Disagreements among multiple caregivers may create stress and tension within families, and challenges with coparenting can be addressed through prevention and intervention programs.

Parental Characteristics That Contribute to Parenting and Relational Health

Psychosocial resources and mental health.

Belsky’s early model of parenting competence suggests that multiple factors affect parenting and child outcomes, with parents’ psychosocial resources playing a prominent role. 3 Individual differences between parents in their personality characteristics affect the quality of their parenting. 79 In particular, higher openness, conscientiousness, extraversion, and agreeableness, and lower neuroticism has been related to more optimal parenting cognitions, practices, and behaviors, including parental warmth and support for autonomy. 79 - 81

For parents with common mental health issues such as anxiety and depression, the experience of parenting may be especially challenging. Maternal depression has been linked consistently with more negative and disengaged parenting behavior and lower engagement in healthy feeding and sleep practices. 82 Less research has considered fathers’ mental health in relation to their parenting, 83 although there has been a recent increase in attention to fathers’ antenatal and postnatal depression, 84 and fathers who experience postpartum depression demonstrate lower levels of developmentally appropriate positive engagement with their infant children. 83 Anxiety disorders in fathers as well as mothers have been linked with more overinvolved parenting behavior that does not foster age-appropriate independence in children. 85

Although prevalence rates suggest the importance of considering parental anxiety and depression, other mental health disorders should be considered as well. For example, for mothers diagnosed with borderline personality disorder, higher levels of negative affectivity as well as lower rates of effortful control 86 and sensitivity, and support for child autonomy 87 have been reported. Less maternal sensitivity has also been reported among mothers with obsessive compulsive disorder. 88

Screening for parental mental health concerns from pregnancy (or from pregnancy planning) throughout the child’s development is consistent with a relational health approach. Beyond screening, health care providers can become aware of evidence-based treatments that may support healthy outcomes in children by supporting maternal mental health and parenting skills. 89 For example, the attachment-based, group intervention Mom Power, which emphasizes parenting, self-care, and engagement in treatment, holds promise for supporting positive outcomes for children by supporting maternal mental health and parenting competence. 90 With increased knowledge of evidence-based treatments for fathers’ mental health and parenting, we may be able to move beyond a focus on mothers to provide all parents with a stronger support system and resource base for effective parenting.

Parental Developmental History and Adverse Experiences in Childhood

According to Belsky’s model of the determinants of parenting, a parent’s psychosocial resources stem from their developmental history. 3 The experience of adversity and toxic stress during development may affect brain architecture , 91 a term used to convey how early experiences help build the structural foundation for healthy brain development. Under conditions of sustained, persistent stress such as maltreatment or neglect, the hypothalamic pituitary adrenal axis may be affected, contributing to atypical diurnal patterns of cortisol and increased risk over the course of development. 92 As our understanding of the impact of toxic stress on children has grown, the focus on understanding patterns of intergenerational transmission of impaired parenting has grown as well. Experiences of adversity and toxic stress in one generation are linked to poorer parenting and developmental outcomes in the next generation. 93 Thus, improving the quality of the caregiving environment as early as possible may help improve stress responding in young children. 92

Foundational work on adverse childhood experiences (ACEs) as predictors of physical, relational, and behavioral health has contributed to a growing understanding of the dose-response relation between experiences of adversity in early childhood (conceptualized as exposure to abuse and household dysfunction) and well-being in adulthood 94 as well as the experience of parenting. 95 Pregnant women reporting higher levels of ACEs in early childhood, for example, exhibit more hostile parenting toward their own infants; this pattern of hostile parenting then increases the child’s risk for poorer developmental outcomes. 96

In response to growing recognition of the impact of adversity and toxic stress within families, in 2012, the American Academy of Pediatrics (AAP) released a policy statement recommending education for health professionals on ACEs along with 2-generational screening for ACEs within families. 97 , 98 By screening for parental and child ACEs, health providers may be able to provide referrals to trauma-informed therapeutic supports within the community that can help build or rebuild relational health.

Yet, in the face of adversity, the presence of individuals who are connected to the child, such as family members, can help mitigate its negative effects. 4 In addition to exploring multiple factors related to the experience of adversity, a relational health perspective suggests the importance of identifying and growing supportive connections. For example, the neurosequential model of therapeutics focuses on relational health and connectedness with others. 99 Results from recent work with this model highlight the importance of promoting the health, safety, and positivity of the parent-child relationship.

Although pediatric health care providers are aware of the impact of ACEs on parenting and developmental outcomes, additional research, education, and resources are necessary to support practitioners in identifying and addressing these impacts within families. 100 The limitations and potential cost-benefit analysis of screening for ACEs must also be considered because screening without provision of adequate referrals to evidence-based treatments may undermine the possible value of the screen. 101 Moreover, identification of appropriate screening tools for ACEs remains an important consideration. Focusing on the experiences of adversity as an ACE score that relates to poorer health outcomes may confuse correlation with causation; thus, to best inform policy and practice, factors such as timing of adversity, the overall pattern of stress, and the absence or availability of protective factors must be considered. 4 Yet through increased awareness of ACEs (both the parent’s and the child’s) as well as other psychosocial risk factors for impaired relational health, professionals can widen their lens of assessment when interacting with parents and children during medical visits.

Child Characteristics That Contribute to Parenting and Parent-Child Relational Health

Another set of key factors in the quality of parenting and parent-child relationships involves characteristics of the child. Recognizing the bidirectional nature of relationships between parents and children, Bornstein noted that “caregiving is a two-way street.” 102 Although early literature emphasized the parents’ impact on the child, a relational health approach to development suggests that we consider child contributions to parenting as well as to the overall parent-child relationship. Among a number of child characteristics that may affect parent-child relational health, research has focused on child temperament and age as well as children with special health care needs.

Temperament

Although early research on temperament emphasized the child’s inborn characteristics (eg, rhythmicity, mood) and temperament types such as easy, difficult, and slow to warm up, 103 our current understanding of temperament reflects the interplay between biological and environmental factors over the course of an individual’s development. 104 Definitions of temperament typically include individual differences in activity, emotionality, attention, and self-regulation. 104 However, particularly relevant to the experience of parenting is the temperamental characteristic of reactivity, defined as the extent to which the child is predisposed to experiencing strong negative and/or positive emotions, which may reflect the sensitivity of the nervous system to environmental stimuli. 105

Although difficult child temperament has long been viewed as a risk factor for poorer parent-child relational health, 106 more recent theory and research on the concept of differential susceptibility suggest that children with difficult or highly reactive temperaments may be more susceptible to both the negative and positive effects of the parenting environment. 105 , 107 For example, children with more difficult temperaments, reflecting higher levels of reactivity, may be particularly susceptible to the detrimental effects of negative parenting. 108 In contrast, for highly reactive children, the experience of more positive parenting is associated with fewer child behavior problems 109 and greater social competence. 110 Parenting intervention studies have further shown that more reactive children appear to benefit more from experimentally induced positive changes in parenting. 111 Thus, it is important for practitioners to shift their perspectives on “difficult” children from vulnerability to opportunity and support parents in adopting a similar view. Indeed, to the extent that the biological parents of a highly reactive child may share similar underlying genetic sensitivities, 112 these parents may be especially responsive to practitioners’ efforts, just as their children are particularly responsive to their parenting.

Because the demands and challenges of parenting change as a function of children’s age, parents must have opportunities to gain research-informed recommendations for supporting relational health with their children from birth throughout the life span. For example, within early childhood, toddlers’ and preschoolers’ growing autonomy and self-awareness creates new demands and opportunities for both parent and child. Thus, supporting parents in reflecting on the thoughts, feelings, and beliefs regarding their child’s increasing autonomy could be one strategy for supporting relational health as children move through the early childhood years. Moreover, the roles of various parenting practices for supporting children’s self-regulatory capabilities may differ across early childhood, with responsiveness most critical in infancy and other forms of support becoming more critical during the preschool years. 113 Research must, therefore, identify which practices are most relevant, at which age, 113 and for which outcome of interest. Doing so will help practitioners provide targeted support to families, based on parents’ concerns regarding their child’s particular social and emotional strengths and challenges.

Special Health Care Needs

Children with special health care needs represent a growing demographic, 114 and expert recommendations continue to promote early detection in primary care. 115 , 116 Just as providers should consider the parent factors contributing to relational health, the child’s contribution to parent-child relationships is paramount. Within the family context, a child with a developmental disability and/or special health care needs may require disproportionate resources and time compared with neurotypical siblings. 117 The child’s condition may translate into added health care costs and increased stress for parents along with decreased access to social support and leisure activities within the community. 118 , 119 For example, a systematic review of parenting stress in the face of chronic child illness indicated that among parents who were parenting a child with chronic illness, significantly higher levels of parenting stress were found; in turn, this stress was related to lower levels of psychological adjustment among parents and children. 120 Among parents of children with autism specture disorder (ASD), higher levels of parenting stress and psychological distress have also been reported. 121 , 122 These higher levels of parental stress and distress may, in turn, affect parental availability and sensitivity, thus affecting relational health.

In light of the evidence on child contributions to parenting and developmental outcomes, it seems important to consider the “what” and “how” of child contributions to relational health. Identifying the ways in which child characteristics influence and interact with parenting behaviors and relational health may provide practitioners with the tools and questions necessary to shift from a focus on the effects of parenting on children to also consider how parenting has been influenced by the child and how the overall health of the relationship has been shaped by both relational partners.

Contextual and Process Variables That May Affect Relational Health

Although the bidirectional nature of parent-child relationships underscores the importance of considering parent and child contributions to relational health, a family systems approach, coupled with a bioecological approach, suggests that the social and contextual contexts in which parent-child relationships are embedded should be considered as well.

Parent-Child Feeding Practices

The promising protective role of healthy parent-child relationships in the development of obesity 123 in early childhood is also evident, perhaps via links with more optimal self-regulation in young children. 124 , 125 For example, theoretical models 125 and research 126 on the development of appetite self-regulation and positive physical activity habits, 127 , 128 which are critical to weight-related health throughout the life span, highlight the important role of parenting. Parental behaviors such as permissiveness or indulgence have been associated with weight status and obesity in childhood. More specifically, allowing children too much freedom regarding food choices in society’s obesogenic food environment can increase children’s risk for obesity. 123 Similarly, unrestricted, unmonitored screen time has also been associated with unhealthy weight status. 129 Yet the question remains to what extent these cycles occur within families, whereby parents’ lack of control over their own food choices and screen time contribute to unhealthy weight status for their children and the unhealthy weight status of children contributes to parents’ continued struggles with their own food choices and activity levels. Thus, a family-level relational approach to understanding risks for obesity may be particularly advantageous.

Given that parents’ attitudes and beliefs can shape a range of parenting behaviors related to health and wellness, including feeding practices, exploring relational correlates and predictors of feeding practices beginning in infancy seems prudent. Parents’ feeding practices provide a unique window into parent-child relationship health, because from birth, feeding makes up a critical part of parents’ daily interactions with young children. Decisions regarding breastfeeding and/or bottle-feeding can cause considerable stress for parents. 130 And although children’s eating behavior emerges early and is relatively stable over time, eating is influenced more by external factors across development. 131

Mothers who use food to soothe their distressed infants or toddlers have reported lower parenting self-efficacy and higher child negativity. 132 Using food to soothe was also linked with higher weight status among children, particularly for children who were perceived as having more negative temperaments. 132 Among preschoolers, parents’ use of food for the purpose of emotion regulation was associated with children’s increased intake of sweets when not hungry, a pattern that may reflect the early origins of children’s emotional eating. 133

Eating behaviors and nutrition are important components of lifestyle medicine. In promoting healthy eating behavior and weight outcomes for children, health care professionals can consider how parents’ attitudes may shape their feeding practices—above and beyond a child’s weight status—and how dyadic and family-level interactions around food may support or undermine relational health. From birth, providers can recognize that decisions regarding feeding (eg, breast and/or formula; homemade meals versus fast food) may be multiply determined and best understood through a relational health lens, where parent and child factors are viewed as contributing to parenting practices, practices that may differ from recommended best practices for promoting child health outcomes.

The Household Environment: Family Chaos, Technology, and Social Media Use

The home environment represents an important context for parent-child relational health, including the quality of parenting as well as children’s well-being and health. 134 - 138 Recent research, focused on household chaos, has highlighted the role of disorder/disorganization 139 and instability/turbulence 140 for understanding parenting quality and family well-being. Lower levels of household chaos (evidenced by greater organization, stability, and predictability) are associated with higher-quality parenting behavior than home environments characterized as noisy, crowded, unpredictable, and disorganized. 138 Among preschoolers, recent evidence suggests that higher rates of household chaos are also associated with higher screen use. 141

In fact, parents’ and children’s increasing engagement with, and reliance on, technology and social media suggest the need for providers to consider technology and social media as interactive partners. For example, Facebook may provide new parents with an important source of social capital, 142 and parents report using the internet to gain information about pediatric health. 143 , 144 Yet parents (and grandparents) do not report universally positive effects of their technology use. For example, parents may experience a range of internal tensions surrounding their use of mobile technology, such as cognitive, emotional, and relationship tension. 145 Researchers are documenting how technology may interrupt the flow of interaction patterns between children and their parents—a concept known as technoference. 146 For example, higher levels of child internalizing and externalizing behavior problems have been reported by mothers who also reported higher levels of technoference in their interactions with their children. 146

Supporting parents in identifying, reducing, or coping with household chaos, as well as technoference, may be promising avenues for supporting relational health. Because the experience of chaos in the home environment often co-occurs with poverty 139 as well as parental mental health symptoms, 147 screening and intervention approaches aimed at identifying and addressing the multiple co-occurring factors that relate to family chaos may be warranted. Moreover, gauging the perceived impact of technology and social media use on parent-child relational health may be an important area of inquiry for health practitioners.

Cultural Context and Relational Health

Understanding relational health requires us to also consider the impact of race, ethnicity, and culture on parent-child relationships; accordingly, consideration of diversity has moved to the forefront of our current research and practice efforts. Although broad parenting goals are remarkably similar across diverse cultures, 102 the processes by which parents in varying cultural contexts seek to achieve these goals may differ. For example, some scholars have suggested that the concept of sensitivity, the primary determinant of secure attachment according to attachment theorists, may be biased toward more individualistic cultures because it is focused on meeting the child’s individual needs. 148 Moreover, the meaning of parenting constructs such as controlling behavior may vary across cultures. For example, Asian American parents may emphasize strict control of children as part of culturally embedded approaches to parenting, which are not equivalent to western notions of harsh/controlling parenting and do not appear to have negative effects on their children’s development. 149 , 150

These debates can support practitioners in reflecting on how their own beliefs about what is the “best” kind of parenting to promote relational health and positive child outcomes may be shaping their messaging for parents. For example, among immigrant families, attention to acculturation—the process of adapting to a new culture—rather than parenting behavior, per se, may provide a window into relational health. For example, acculturation may happen at different rates for children and parents, and greater discrepancies in the level of acculturation may contribute to increased parent-child conflict. 151

The roles of culture, race, and ethnicity in parenting practices are particularly apparent with respect to discipline practices. For example, higher rates of corporal punishment, including spanking, are generally reported by African American parents, in comparison to Hispanic or white parents, 152 although recent evidence suggests similar endorsement of spanking by African American and Hispanic mothers, along with longitudinal associations between endorsement of spanking and children’s later internalizing and externalizing behaviors. 153 Evidence continues to highlight the negative impact of corporal punishment on children 154 and the AAP’s 2018 statement on effective discipline emphasizes the need for positive alternatives to corporal punishment and spanking. 155 And, although many parents report spanking their young children, these same parents may also be looking for nonphysical, effective alternatives for guiding their children’s behavior. 156

Understanding how cultural beliefs and practices shape parents’ expectations and socialization goals may help us better define what relational health is, both within and across diverse families. Health care professionals can be a source of guidance and support for parents to choose discipline strategies that align with research and support parent-child relational health. When practitioners recognize the larger context in which parents’ discipline decisions are embedded, they may more readily identify the beliefs, histories, and socialization goals that underlie families’ discipline practices. Health providers can recognize parents’ concerns regarding children’s behavior and provide culturally responsive, research-informed, preventive recommendations for helping parents identify alternative strategies to the use of corporal punishment and physical discipline.

Reducing Risks to Relational Health: Screening and Referral

Given that the parent-child relationship is critical for healthy development, health providers must adopt a dyadic-level, family systemic, and culturally informed approach to screening, referring, and treating parent-child dyads to integrate research with practice. Equipping health professionals with knowledge of relational health may provide a solid foundation for supporting parent-child relational health from birth. For example, evidence from research with pediatric residents suggests that training in a parent-child relational framework was effective in supporting residents’ observational skills and knowledge of child development. 157

An emphasis on transactional associations within families further underscores the importance of screening and early intervention to support child and parental well-being and use of positive parenting practices. 10 Commonly used assessments in parent-child attachment research, such as the Strange Situation Procedure 158 Attachment Q-Set, 159 are labor-intensive and were not developed as clinically relevant screening tools. Moreover, even when insecurity in the parent-child relationship is suspected, access to attachment-based interventions (ie, VIPP-SD, ABC) may be extremely limited.

Whereas much of the research literature on early parent-child relationships (typically mother-child relationships) has focused on attachment, recent work highlights the dyadic-level construct of emotional connection for understanding early parent-child relational health. The development of the Welch Emotional Connection Screen (WECS) 160 reflects an effort to provide practitioners with a rapid and valid screening tool for parent-child relational health from birth to 5 years. The WECS considers the presence or absence of 4 mutual behaviors that may serve to promote and maintain emotional connection within a parent-child dyad: attraction, facial responsiveness, vocal responsiveness, and sensitivity/reciprocity. Based on the overall interaction, a score of EC+ (connected) or EC− (not connected) is assigned to the dyad.

The WECS developed out of work with the Family Nurture Intervention, which seeks to support the development of emotional connection and coregulation via the provision of calming sessions that focus on the sensory experiences of touch, vocal soothing, and skin-to-skin contact. 161 - 163 Results from an RCT study indicated that mothers and infants participating in the Family Nurture Intervention showed improvements in face-to-face dyadic interaction, including increased frequency and quality of mothers’ touch and for boys, infant’s vocal affect and gaze. 164

Emotional connection, as assessed by the WECS in infancy, has been associated with healthier autonomic responding among infants born prematurely 165 as well as with fewer internalizing and externalizing behavior problems in a full-term, longitudinal sample. 166 Thus, emerging evidence suggests that the WECS holds promise for screening, anticipatory guidance, and referral of early parent-child relationships that may benefit from support and intervention to promote healthy regulatory functioning and decrease risk for later child behavior problems. Efforts are under way to train a range of professionals—from pediatric residents to infant mental health practitioners and home visitors—to be reliable raters of parent-child relational health using the WECS.

In families with elevated risk for maltreatment, the automated self-report survey, the CARTS (Computerized Childhood Attachment and Relational Trauma Screen), reflects a relational approach to the assessment of trauma in childhood. 167 , 168 The CARTS considers what trauma occurred and assesses caregivers’ emotional availability, along with responses to the reported maltreatment. In contrast, the SEEK program (Safe Environment for Every Kid) focuses on risk factors related to child maltreatment, including parental depression, stress, and substance abuse. 168 , 169 Thus, the SEEK program may benefit pediatric primary care professionals through its focus on psychosocial stress within families, which if addressed early, may prevent child maltreatment.

Notably, SEEK embodies a relational health perspective by acknowledging the parent’s love for the child as a pathway to healthy outcomes for both parent and child as well as by acknowledging the relationships between health professionals and parents as protective factors for parents and children. 169 , 170 For example, part of the SEEK program is the SEEK Parent Questionnaire, which begins by empathetically validating the sometimes challenging everyday experience of being a parent while simultaneously offering support to parents dealing with concerning circumstances. SEEK also aims to support relational health through the REAP approach, which encourages health care providers to Reflect-Empathize-Assess-and Plan with parents.

Intervention approaches that incorporate mindfulness practices, such as the 9-week Mindful Parenting course tested in the Netherlands, also hold promise for supporting relational health within families. Mindful Parenting aims to increase awareness, decrease parental stress, and improve coparenting. 171 Both parents participating in the program and their children report reductions in internalizing/externalizing symptomology. The interpersonal focus of mindfulness-based interventions supports healthy parent-child relationships through increased awareness of parent-child interactions as well as positive changes in both child and parent functioning. 172

Summary and Conclusions

Beyond attachment theory, which emphasizes parental sensitivity and responsivity as a primary determinant of attachment security, a relational health science approach offers a wider lens for understanding how parent-child relationships may affect children’s development. A relational health approach recognizes both partners’ contributions to the establishment and maintenance of relational processes and highlights the potential value of the health care provider as a relational partner for parents and children. Our focus here was on socioemotional development; future work will consider how a relational health framework can be applied to a range of parent-child health decisions from vaccinations and sleep behaviors, to physical activity, and medication use.

Although we view primary care as a valuable context for supporting relational health, continued development and validation of screening tools for relational health that are suitable for clinical and applied contexts remain an important goal along with more widespread availability of effective interventions. Moreover, given the existing demands on health care providers, we recognize that a relational health perspective on development may create additional demands on providers. Perhaps a necessary first step is a shift in perspective, more than a shift in practice. By viewing the parent-child relationship as part of the “patient” and, therefore, part of health promotion, the long-term gains may be worth the initial investment.

By networking with community resources, health care providers can build a pipeline of referrals for parents as a component of pediatric and primary care. Offering parent-friendly pamphlets, information sheets, and face-to-face communication that reflects a relational health view on development may help parents see themselves as partners in relational health, rather than as the cause of their child’s mental health, behavioral, or developmental problems. Such negative attributions may contribute to feelings of shame and guilt—feelings that may undermine parenting self-efficacy and parents’ engagement in children’s wellness and treatment. The AAP’s recent call for pediatricians to partner with parents in supporting healthy outcomes through the sharing of information regarding child development and parenting 155 reflects the promise of a relational health approach.

Returning to the opening quote from Bowlby, we suggest that health care providers are in a strong position to serve children by valuing their parents and viewing child development through the lens of relational health. Perhaps by uncovering who that person is—the one who is “irrationally crazy” about the child, as Bronfenbrenner advised—professionals can help cultivate and reinforce that connection. And in its absence, we can seek to identify ways to build a web of relational health for the child and for the parent, a web that can support each partner in service to the relationship.

Acknowledgments

We are grateful to Ariana Shahinfar, Robert Ludwig, and Mark Lopez for feedback on an earlier version of this article.

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

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval: Not applicable, because this article does not contain any studies with human or animal subjects.

Informed Consent: Not applicable, because this article does not contain any studies with human or animal subjects.

Trial Registration: Not applicable, because this article does not contain any clinical trials.

Parenting Matters: Supporting Parents of Children Ages 0-8 (2016)

Chapter: 1 introduction, 1 introduction.

Parents are among the most important people in the lives of young children. 1 From birth, children are learning and rely on mothers and fathers, as well as other caregivers acting in the parenting role, to protect and care for them and to chart a trajectory that promotes their overall well-being. While parents generally are filled with anticipation about their children’s unfolding personalities, many also lack knowledge about how best to provide for them. Becoming a parent is usually a welcomed event, but in some cases, parents’ lives are fraught with problems and uncertainty regarding their ability to ensure their child’s physical, emotional, or economic well-being.

At the same time, this study was fundamentally informed by recognition that the task of ensuring children’s healthy development does not rest solely with parents or families. It lies as well with governments and organizations at the local/community, state, and national levels that provide programs and services to support parents and families. Society benefits socially and economically from providing current and future generations of parents with the support they need to raise healthy and thriving children ( Karoly et al., 2005 ; Lee et al., 2015 ). In short, when parents and other caregivers are able to support young children, children’s lives are enriched, and society is advantaged by their contributions.

To ensure positive experiences for their children, parents draw on the resources of which they are aware or that are at their immediate disposal.

___________________

1 In this report, “parents” refers to the primary caregivers of young children in the home. In addition to biological and adoptive parents, main caregivers may include kinship (e.g., grandparents), foster, and other types of caregivers.

However, these resources may vary in number, availability, and quality at best, and at worst may be offered sporadically or not at all. Resources may be close at hand (e.g., family members), or they may be remote (e.g., government programs). They may be too expensive to access, or they may be substantively inadequate. Whether located in early childhood programs, school-based classrooms, well-child clinics, or family networks, support for parents of young children is critical to enhancing healthy early childhood experiences, promoting positive outcomes for children, and helping parents build strong relationships with their children (see Box 1-1 ).

The parent-child relationship that the parent described in Box 1-1 sought and continues to work toward is central to children’s growth and

development—to their social-emotional and cognitive functioning, school success, and mental and physical health. Experiences during early childhood affect children’s well-being over the course of their lives. The impact of parents may never be greater than during the earliest years of life, when children’s brains are developing rapidly and when nearly all of their experiences are created and shaped by their parents and by the positive or difficult circumstances in which the parents find themselves. Parents play a significant role in helping children build and refine their knowledge and skills, as well as their learning expectations, beliefs, goals, and coping strategies. Parents introduce children to the social world where they develop understandings of themselves and their place and value in society, understandings that influence their choices and experiences over the life course.

PURPOSE OF THIS STUDY

Over the past several decades, researchers have identified parenting-related knowledge, attitudes, and practices that are associated with improved developmental outcomes for children and around which parenting-related programs, policies, and messaging initiatives can be designed. However, consensus is lacking on the elements of parenting that are most important to promoting child well-being, and what is known about effective parenting has not always been adequately integrated across different service sectors to give all parents the information and support they need. Moreover, knowledge about effective parenting has not been effectively incorporated into policy, which has resulted in a lack of coordinated and targeted efforts aimed at supporting parents.

Several challenges to the implementation of effective parenting practices exist as well. One concerns the scope and complexity of hardships that influence parents’ use of knowledge, about effective parenting, including their ability to translate that knowledge into effective parenting practices and their access to and participation in evidence-based parenting-related programs and services. Many families in the United States are affected by such hardships, which include poverty, parental mental illness and substance use, and violence in the home. A second challenge is inadequate attention to identifying effective strategies for engaging and utilizing the strengths of fathers, discussed later in this chapter and elsewhere in this report. Even more limited is the understanding of how mothers, fathers, and other caregivers together promote their children’s development and analysis of the effects of fathers’ parenting on child outcomes. A third challenge is limited knowledge of exactly how culture and the direct effects of racial discrimination influence childrearing beliefs and practices or children’s development ( National Research Council and Institute of Medicine, 2000 ). Despite acknowledgment of and attention to the importance of culture in

the field of developmental science, few studies have explored differences in parenting among demographic communities that vary in race and ethnicity, culture, and immigrant experience, among other factors, and the implications for children’s development.

In addition, the issue of poverty persists, with low-income working families being particularly vulnerable to policy and economic shifts. Although these families have benefited in recent years from the expansion of programs and policies aimed at supporting them (discussed further below), the number of children living in deep poverty has increased ( Sherman and Trisi, 2014 ). 2 Moreover, the portrait of America’s parents and children has changed over the past 50 years as a result of shifts in the numbers and origins of immigrants to the United States and in the nation’s racial, ethnic, and cultural composition ( Child Trends Databank, 2015b ; Migration Policy Institute, 2016 ). Family structure also has grown increasingly diverse across class, race, and ethnicity, with fewer children now being raised in households with two married parents; more living with same-sex parents; and more living with kinship caregivers, such as grandparents, and in other household arrangements ( Child Trends Databank, 2015b ). Lastly, parenting increasingly is being shaped by technology and greater access to information about parenting, some of which is not based in evidence and much of which is only now being studied closely.

The above changes in the nation’s demographic, economic, and technological landscape, discussed in greater detail below, have created new opportunities and challenges with respect to supporting parents of young children. Indeed, funding has increased for some programs designed to support children and families. At the state and federal levels, policy makers recently have funded new initiatives aimed at expanding early childhood education ( Barnett et al., 2015 ). Over the past several years, the number of states offering some form of publicly funded prekindergarten program has risen to 39, and after slight dips during the Great Recession of 2008, within-state funding of these programs has been increasing ( Barnett et al., 2015 ). Furthermore, the 2016 federal budget allocates about $750 million for state-based preschool development grants focused on improved access and better quality of care and an additional $1 billion for Head Start programs ( U.S. Department of Education, 2015 ; U.S. Department of Health and Human Services, 2015 ). The federal budget also includes additional funding for the expansion of early childhood home visiting programs ($15 billion over the next 10 years) and increased access to child care for low-income working families ($28 billion over 10 years) ( U.S. Department

2 Deep poverty is defined as household income that is 50 percent or more below the federal poverty level (FPL). In 2015, the FPL for a four-person household was $24,250 ( Office of the Assistant Secretary for Planning and Evaluation, 2015 ).

of Health and Human Services, 2015 ). Low-income children and families have been aided as well in recent years by increased economic support from government in the form of both cash benefits (e.g., the Earned Income Tax Credit and the Child Tax Credit) and noncash benefits (e.g., Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program), and millions of children and their families have moved out of poverty as a result ( Sherman and Trisi, 2014 ).

It is against this backdrop of need and opportunity that the Administration for Children and Families, the Bezos Family Foundation, the Bill & Melinda Gates Foundation, the Centers for Disease Control and Prevention, the David and Lucile Packard Foundation, the Health Resources and Services Administration, the U.S. Department of Education, the Foundation for Child Development, the Heising-Simons Foundation, and the Substance Abuse and Mental Health Services Administration (SAMHSA) requested that the National Academies of Sciences, Engineering, and Medicine empanel a committee to conduct a study to examine the state of the science with respect to parenting knowledge, attitudes, and practices tied to positive parent-child interactions and child outcomes and strategies for supporting them among parents of young children ages 0-8. The purpose of this study was to provide a roadmap for the future of parenting and family support policies, practices, and research in the United States.

The statement of task for the Committee on Supporting the Parents of Young Children is presented in Box 1-2 . The committee was tasked with describing barriers to and facilitators for strengthening parenting capacity and parents’ participation and retention in salient programs and services. The committee was asked to assess the evidence and then make recommendations whose implementation would promote wide-scale adoption of effective strategies for enabling the identified knowledge, attitudes, and practices. Given the multi- and interdisciplinary nature of the study task, the 18-member committee comprised individuals with an array of expertise, including child development, early childhood education, developmental and educational psychology, child psychiatry, social work, family engagement research, pediatric medicine, public and health policy, health communications, implementation science, law, and economics (see Appendix D for biosketches of the committee members).

WHAT IS PARENTING?

Conceptions of who parents are and what constitute the best conditions for raising children vary widely. From classic anthropological and human development perspectives, parenting often is defined as a primary mechanism of socialization, that is, a primary means of training and preparing children to meet the demands of their environments and take advantage

of opportunities within those environments. As Bornstein (1991, p. 6) explains, the “particular and continuing task of parents and other caregivers is to enculturate children . . . to prepare them for socially accepted physical, economic, and psychological situations that are characteristic of the culture in which they are to survive and thrive.”

Attachment security is a central aspect of development that has been

defined as a child’s sense of confidence that the caregiver is there to meet his or her needs ( Main and Cassidy, 1988 ). All children develop attachments with their parents, but how parents interact with their young children, including the extent to which they respond appropriately and consistently to their children’s needs, particularly in times of distress, influences whether the attachment relationship that develops is secure or insecure. Young chil-

dren who are securely attached to their parents are provided a solid foundation for healthy development, including the establishment of strong peer relationships and the ability to empathize with others ( Bowlby, 1978 ; Chen et al., 2012 ; Holmes, 2006 ; Main and Cassidy, 1988 ; Murphy and Laible, 2013 ). Conversely, young children who do not become securely attached with a primary caregiver (e.g., as a result of maltreatment or separation) may develop insecure behaviors in childhood and potentially suffer other adverse outcomes over the life course, such as mental health disorders and disruption in other social and emotional domains ( Ainsworth and Bell, 1970 ; Bowlby, 2008 ; Schore, 2005 ).

More recently, developmental psychologists and economists have described parents as investing resources in their children in anticipation of promoting the children’s social, economic, and psychological well-being. Kalil and DeLeire (2004) characterize this promotion of children’s healthy development as taking two forms: (1) material, monetary, social, and psychological resources and (2) provision of support, guidance, warmth, and love. Bradley and Corwyn (2004) characterize the goals of these investments as helping children successfully regulate biological, cognitive, and social-emotional functioning.

Parents possess different levels and quality of access to knowledge that can guide the formation of their parenting attitudes and practices. As discussed in greater detail in Chapter 2 , the parenting practices in which parents engage are influenced and informed by their knowledge, including facts and other information relevant to parenting, as well as skills gained through experience or education. Parenting practices also are influenced by attitudes, which in this context refer to parents’ viewpoints, perspectives, reactions, or settled ways of thinking with respect to the roles and importance of parents and parenting in children’s development, as well as parents’ responsibilities. Attitudes may be part of a set of beliefs shared within a cultural group and founded in common experiences, and they often direct the transformation of knowledge into practice.

Parenting knowledge, attitudes, and practices are shaped, in part, by parents’ own experiences (including those from their own childhood) and circumstances; expectations and practices learned from others, such as family, friends, and other social networks; and beliefs transferred through cultural and social systems. Parenting also is shaped by the availability of supports within the larger community and provided by institutions, as well as by policies that affect the availability of supportive services.

Along with the multiple sources of parenting knowledge, attitudes, and practices and their diversity among parents, it is important to acknowledge the diverse influences on the lives of children. While parents are central to children’ development, other influences, such as relatives, close family friends, teachers, community members, peers, and social institutions, also

contribute to children’s growth and development. Children themselves are perhaps the most essential contributors to their own development. Thus, the science of parenting is framed within the theoretical perspective that parenting unfolds in particular contexts; is embedded in a network of relationships within and outside of the family; and is fluid and continuous, changing over time as children and parents grow and develop.

In addition, it is important to recognize that parenting affects not only children but also parents themselves. For instance, parenting can enrich and give focus to parents’ lives; generate stress or calm; compete for time with work or leisure; and create combinations of any number of emotions, including happiness, sadness, fulfillment, and anger.

STUDY CONTEXT

As attention to early childhood development has increased over the past 20 years, so, too, has attention to those who care for young children. A recent Institute of Medicine and National Research Council report on the early childhood workforce ( Institute of Medicine and National Research Council, 2015 ) illustrates the heightened focus not only on whether young children have opportunities to be exposed to healthy environments and supports but also on the people who provide those supports. Indeed, an important responsibility of parents is identifying those who will care for their children in their absence. Those individuals may include family members and others in parents’ immediate circle, but they increasingly include non-family members who provide care and education in formal and informal settings outside the home, such as schools and home daycare centers.

Throughout its deliberations, the committee considered several questions relevant to its charge: What knowledge and attitudes do parents of young children bring to the task of parenting? How are parents engaged with their young children, and how do the circumstances and behaviors of both parents and children influence the parent-child relationship? What types of support further enhance the natural resources and skills that parents bring to the parenting role? How do parents function and make use of their familial and community resources? What policies and resources at the local, state, and federal levels assist parents? What practices do they expect those resources to reinforce, and from what knowledge and attitudes are those practices derived? On whom or what do they rely in the absence of those resources? What serves as an incentive for participation in parenting programs? How are the issues of parenting different or the same across culture and race? What factors constrain parents’ positive relationships with their children, and what research is needed to advance agendas that can help parents sustain such relationships?

The committee also considered research in the field of neuroscience,

which further supports the foundational role of early experiences in healthy development, with effects across the life course ( Center on the Developing Child, 2007 ; National Research Council and Institute of Medicine, 2009 ; World Health Organization, 2015 ). During early childhood, the brain undergoes a rapid development that lays the foundation for a child’s lifelong learning capacity and emotional and behavioral health (see Figure 1-1 ). This research has provided a more nuanced understanding of the importance of investments in early childhood and parenting. Moreover, advances in analyses of epigenetic effects on early brain development demonstrate consequences of parenting for neural development at the level of DNA, and suggest indirect consequences of family conditions such as poverty that operate on early child development, in part, through the epigenetic consequences of parenting ( Lipinia and Segretin, 2015 ).

This report comes at a time of flux in public policies aimed at supporting parents and their young children. The cost to parents of supporting their children’s healthy development (e.g., the cost of housing, health care, child care, and education) has increased at rates that in many cases have offset the improvements and increases provided for by public policies. As noted above, for example, the number of children living in deep poverty has grown since the mid-1990s ( Sherman and Trisi, 2014 ). While children represent approximately one-quarter of the country’s population, they make up 32 percent of all the country’s citizens who live in poverty ( Child Trends Databank, 2015a ). About one in every five children in the United States is now growing up in families with incomes below the poverty line, and 9 percent of children live in deep poverty (families with incomes below 50%

of the poverty line) ( Child Trends Databank, 2015a ). The risk of growing up poor continues to be particularly high for children in female-headed households; in 2013, approximately 55 percent of children under age 6 in such households lived at or below the poverty threshold, compared with 10 percent of children in married couple families ( DeNavas-Walt and Proctor, 2014 ). Black and Hispanic children are more likely to live in deep poverty (18 and 13%, respectively) compared with Asian and white children (5% each) ( Child Trends Databank, 2015a ). Also noteworthy is that child care policy, including the recent increases in funding for low-income families, ties child care subsidies to employment. Unemployed parents out of school are not eligible, and job loss results in subsidy loss and, in turn, instability in child care arrangements for young children ( Ha et al., 2012 ).

As noted earlier, this report also comes at a time of rapid change in the demographic composition of the country. This change necessitates new understandings of the norms and values within and among groups, the ways in which recent immigrants transition to life in the United States, and the approaches used by diverse cultural and ethnic communities to engage their children during early childhood and utilize institutions that offer them support in carrying out that role. The United States now has the largest absolute number of immigrants in its history ( Grieco et al., 2012 ; Passel and Cohn, 2012 ; U.S. Census Bureau, 2011 ), and the proportion of foreign-born residents today (13.1%) is nearly as high as it was at the turn of the 20th century ( National Academies of Sciences, Engineering, and Medicine, 2015 ). As of 2014, 25 percent of children ages 0-5 in the United States had at least one immigrant parent, compared with 13.5 percent in 1990 ( Migration Policy Institute, 2016 ). 3 In many urban centers, such as Los Angeles, Miami, and New York City, the majority of the student body of public schools is first- or second-generation immigrant children ( Suárez-Orozco et al., 2008 ).

Immigrants to the United States vary in their countries of origin, their reception in different communities, and the resources available to them. Researchers increasingly have called attention to the wide variation not only among but also within immigrant groups, including varying premigration histories, familiarity with U.S. institutions and culture, and childrearing

3 Shifting demographics in the United States have resulted in increased pressure for service providers to meet the needs of all children and families in a culturally sensitive manner. In many cases, community-level changes have overwhelmed the capacity of local child care providers and health service workers to respond to the language barriers and cultural parenting practices of the newly arriving immigrant groups, particularly if they have endured trauma. For example, many U.S. communities have worked to address the needs of the growing Hispanic population, but it has been documented that in some cases, eligible Latinos are “less likely to access available social services than other populations” ( Helms et al., 2015 ; Wildsmith et al., 2016 ).

strategies ( Crosnoe, 2006 ; Fuller and García Coll, 2010 ; Galindo and Fuller, 2010 ; Suárez-Orozco et al., 2010 ; Takanishi, 2004 ). Immigrants often bring valuable social and human capital to the United States, including unique competencies and sociocultural strengths. Indeed, many young immigrant children display health and learning outcomes better than those of children of native-born parents in similar socioeconomic positions ( Crosnoe, 2013 ). At the same time, however, children with immigrant parents are more likely than children in native-born families to grow up poor ( Hernandez et al., 2008 , 2012 ; National Academies of Sciences, Engineering, and Medicine, 2015 ; Raphael and Smolensky, 2009 ). Immigrant parents’ efforts to raise healthy children also can be thwarted by barriers to integration that include language, documentation, and discrimination ( Hernandez et al., 2012 ; Yoshikawa, 2011 ).

The increase in the nation’s racial and ethnic diversity over the past several decades, related in part to immigration, is a trend that is expected to continue ( Colby and Ortman, 2015 ; Taylor, 2014 ). Between 2000 and 2010, the percentage of Americans identifying as black, Hispanic, Asian, or “other” increased from 15 percent to 36 percent of the population ( U.S. Census Bureau, 2011 ). Over this same time, the percentage of non-Hispanic white children under age 10 declined from 60 percent to 52 percent, while the percentage of Hispanic ethnicity (of any race) grew from about 19 percent to 25 percent ( U.S. Census Bureau, 2011 ); the percentages of black/African American, American Indian/Alaska Native, and Asian children under age 10 remained relatively steady (at about 15%, 1%, and 4-5%, respectively); and the percentages of children in this age group identifying as two or more races increased from 3 percent to 5 percent ( U.S. Census Bureau, 2011 ).

The above-noted shifts in the demographic landscape with regard to family structure, including increases in divorce rates and cohabitation, new types of parental relationships, and the involvement of grandparents and other relatives in the raising of children ( Cancian and Reed, 2008 ; Fremstad and Boteach, 2015 ), have implications for how best to support families. Between 1960 and 2014, the percentage of children under age 18 who lived with two married parents (biological, nonbiological, or adoptive) decreased from approximately 85 percent to 64 percent. In 1960, 8 percent of children lived in households headed by single mothers; by 2014, that figure had tripled to about 24 percent ( Child Trends Databank, 2015b ; U.S. Census Bureau, 2016 ). Meanwhile, the proportions of children living with only their fathers or with neither parent (with either relatives or non-relatives) have remained relatively steady since the mid-1980s, at about 4 percent (see Figure 1-2 ). Black children are significantly more likely to live in households headed by single mothers and also are more likely to live in households where neither parent is present. In 2014, 34 percent of black

children lived with two parents, compared with 58 percent of Hispanic children, 75 percent of white children, and 85 percent of Asian children ( Child Trends Databank, 2015b ).

From 1996 to 2015, the number of cohabiting couples with children rose from 1.2 million to 3.3 million ( Child Trends Databank, 2015b ). Moreover, data from the National Health Interview Survey show that in 2013, 30,000 children under age 18 had married same-sex parents and 170,000 had unmarried same-sex parents, and between 1.1 and 2.0 million were being raised by a parent who identified as lesbian, gay, or bisexual but was not part of a couple ( Gates, 2014 ).

More families than in years past rely on kinship care (full-time care of children by family members other than parents or other adults with whom children have a family-like relationship). When parents are unable to care for their children because of illness, military deployment, incarceration, child abuse, or other reasons, kinship care can help cultivate familial and community bonds, as well as provide children with a sense of stability and belonging ( Annie E. Casey Foundation, 2012 ; Winokur et al., 2014 ). It is estimated that the number of children in kinship care grew six times the rate of the number of children in the general population over the past decade ( Annie E. Casey Foundation, 2012 ). In 2014, 7 percent of children lived in households headed by grandparents, as compared with 3 percent in 1970 ( Child Trends Databank, 2015b ), and as of 2012, about 10 percent of American children lived in a household where a grandparent was present ( Ellis and Simmons, 2014 ). Black children are twice as likely as the overall population of children to live in kinship arrangements, with about 20 percent of black children spending time in kinship care at some point

during their childhood ( Annie E. Casey Foundation, 2012 ). Beyond kinship care, about 400,000 U.S. children under age 18 are in foster care with about one-quarter of these children living with relatives ( Child Trends Databank, 2015c ). Of the total number of children in foster care, 7 percent are under age 1, 33 percent are ages 1-5, and 23 percent are ages 6-10 ( Child Trends Databank, 2015c ). Other information about the structure of American families is more difficult to come by. For example, there is a lack of data with which to assess trends in the number of children who are raised by extended family members through informal arrangements as opposed to through the foster care system.

As noted earlier, fathers, including biological fathers and other male caregivers, have historically been underrepresented in parenting research despite their essential role in the development of young children. Young children with involved and nurturing fathers develop better linguistic and cognitive skills and capacities, including academic readiness, and are more emotionally secure and have better social connections with peers as they get older ( Cabrera and Tamis-LeMonda, 2013 ; Harris and Marmer, 1996 ; Lamb, 2004 ; Pruett, 2000 ; Rosenberg and Wilcox, 2006 ; Yeung et al., 2000 ). Conversely, children with disengaged fathers have been found to be more likely to develop behavioral problems ( Amato and Rivera, 1999 ; Ramchandani et al., 2013 ). With both societal shifts in gender roles and increased attention to fathers’ involvement in childrearing in recent years, fathers have assumed greater roles in the daily activities associated with raising young children, such as preparing and eating meals with them, reading to and playing and talking with them, and helping them with homework ( Bianchi et al., 2007 ; Cabrera et al., 2011 ; Jones and Mosher, 2013 ; Livingston and Parker, 2011 ). In two-parent families, 16 percent of fathers were stay-at-home parents in 2012, compared with 10 percent in 1989; 21 percent of these fathers stayed home specifically to care for their home or family, up from 5 percent in 1989 ( Livingston, 2014 ). At the same time, however, fewer fathers now live with their biological children because of increases in nonmarital childbearing (U.S. Census Bureau, 2015).

In addition, as alluded to earlier, parents of young children face trans-formative changes in technology that can have a strong impact on parenting and family life ( Collier, 2014 ). Research conducted by the Pew Internet and American Life Project shows that, relative to other household configurations, married parents with children under age 18 use the Internet and cell phones, own computers, and adopt broadband at higher rates ( Duggan and Lenhart, 2015 ). Other types of households, however, such as single-parent and unmarried multiadult households, also show high usage of technology, particularly text messaging and social media ( Smith, 2015 ). Research by the Pew Research Center (2014) shows that many parents—25 percent in

one survey ( Duggan et al., 2015 )—view social media as a useful source of parenting information.

At the same time, however, parents also are saturated with information and faced with the difficulty of distinguishing valid information from fallacies and myths about raising children ( Aubrun and Grady, 2003 ; Center on Media and Human Development, 2014 ; Dworkin et al., 2013 ; Future of Children, 2008 ). Given the number and magnitude of innovations in media and communications technologies, parents may struggle with understanding the optimal use of technology in the lives of their children.

Despite engagement with Internet resources, parents still report turning to family, friends, and physicians more often than to online sources such as Websites, blogs, and social network sites for parenting advice ( Center on Media and Human Development, 2014 ). Although many reports allude to the potentially harmful effects of media and technology, parents generally do not report having many concerns or family conflicts regarding their children’s media use. On the other hand, studies have confirmed parents’ fears about an association between children’s exposure to violence in media and increased anxiety ( Funk, 2005 ), desensitization to violence ( Engelhardt et al., 2011 ), and aggression ( Willoughby et al., 2012 ). And although the relationship between media use and childhood obesity is challenging to disentangle, studies have found that children who spend more time with media are more likely to be overweight than children who do not (see Chapter 2 ) ( Bickham et al., 2013 ; Institute of Medicine, 2011 ; Kaiser Family Foundation, 2004 ).

The benefits of the information age have included reduced barriers to knowledge for both socially advantaged and disadvantaged groups. Yet despite rapidly decreasing costs of many technologies (e.g., smartphones, tablets, and computers), parents of lower socioeconomic position and from racial and ethnic minority groups are less likely to have access to and take advantage of these resources ( Center on Media and Human Development, 2014 ; File and Ryan, 2014 ; Institute of Medicine, 2006 ; Perrin and Duggan, 2015 ; Smith, 2015 ; Viswanath et al., 2012 ). A digital divide also exists between single-parent and two-parent households, as the cost of a computer and monthly Internet service can be more of a financial burden for the former families, which on average have lower household incomes ( Allen and Rainie, 2002 ; Dworkin et al., 2013 ).

STUDY APPROACH

The committee’s approach to its charge consisted of a review of the evidence in the scientific literature and several other information-gathering activities.

Evidence Review

The committee conducted an extensive review of the scientific literature pertaining to the questions raised in its statement of task ( Box 1-2 ). It did not undertake a full review of all parenting-related studies because it was tasked with providing a targeted report that would direct stakeholders to best practices and succinctly capture the state of the science. The committee’s literature review entailed English-language searches of databases including, but not limited to, the Cochrane Database of Systematic Reviews, Medline, the Education Resources Information Center (ERIC), PsycINFO, Scopus, and Web of Science. Additional literature and other resources were identified by committee members and project staff using traditional academic research methods and online searches. The committee focused its review on research published in peer-reviewed journals and books (including individual studies, review articles, and meta-analyses), as well as reports issued by government agencies and other organizations. The committee’s review was concentrated primarily, although not entirely, on research conducted in the United States, occasionally drawing on research from other Western countries (e.g., Germany and Australia), and rarely on research from other countries.

In reviewing the literature and formulating its conclusions and recommendations, the committee considered several, sometimes competing, dimensions of empirical work: internal validity, external validity, practical significance, and issues of implementation, such as scale-up with fidelity ( Duncan et al., 2007 ; McCartney and Rosenthal, 2000 ; Rosenthal and Rosnow, 2007 ).

With regard to internal validity , the committee viewed random-assignment experiments as the primary model for establishing cause- and-effect relationships between variables with manipulable causes (e.g., Rosenthal and Rosnow, 2007 ; Shadish et al., 2001 ). Given the relatively limited body of evidence from experimental studies in the parenting literature, however, the committee also considered findings from quasi-experimental studies (including those using regression discontinuity, instrumental variables, and difference-in-difference techniques based on natural experiments) ( Duncan et al., 2007 ; Foster, 2010 ; McCartney et al., 2006 ) and from observational studies, a method that can be used to test logical propositions inherent to causal inference, rule out potential sources of bias, and assess the sensitivity of results to assumptions regarding study design and measurement. These include longitudinal studies and limited cross-sectional studies. Although quasi- and nonexperimental studies may fail to meet the “gold standard” of randomized controlled trials for causal inference, studies with a variety of internal validity strengths and weaknesses can collectively provide useful evidence on causal influences ( Duncan et al., 2014 ).

When there are different sources of evidence, often with some differences in estimates of the strength of the evidence, the committee used its collective experience to integrate the information and draw reasoned conclusions.

With regard to external validity , the committee attempted to take into account the extent to which findings can be generalized across population groups and situations. This entailed considering the demographic, socioeconomic, and other characteristics of study participants; whether variables were assessed in the real-world contexts in which parents and children live (e.g., in the home, school, community); whether study findings build the knowledge base with regard to both efficacy (i.e., internal validity in highly controlled settings) and effectiveness (i.e., positive net treatment effects in ecologically valid settings); and issues of cultural competence ( Bracht and Glass, 1968 ; Bronfenbrenner, 2009 ; Cook and Campbell, 1979 ; Harrison and List, 2004 ; Lerner et al., 2000 ; Rosenthal and Rosnow, 2007 ; Whaley and Davis, 2007 ). However, the research literature is limited in the extent to which generalizations across population groups and situations are examined.

With regard to practical significance , the committee considered the magnitude of likely causal impacts within both an empirical context (i.e., measurement, design, and method) and an economic context (i.e., benefits relative to costs), and with attention to the salience of outcomes (e.g., how important an outcome is for promoting child well-being) ( Duncan et al., 2007 ; McCartney and Rosenthal, 2000 ). As discussed elsewhere in this report, however, the committee found limited economic evidence with which to draw conclusions about investing in interventions at scale or to weigh the costs and benefits of interventions. (See the discussion of other information-gathering activities below.) Also with respect to practical significance, the committee considered the manipulability of the variables under consideration in real-world contexts, given that the practical significance of study results depend on whether the variables examined are represented or experienced commonly or uncommonly among particular families ( Fabes et al., 2000 ).

Finally, the committee took into account issues of implementation , such as whether interventions can be brought to and sustained at scale ( Durlak and DuPre, 2008 ; Halle et al., 2013 ). Experts in the field of implementation science emphasize not only the evidence behind programs but also the fundamental roles of scale-up, dissemination planning, and program monitoring and evaluation. Scale-up in turn requires attending to the ability to implement adaptive program practices in response to heterogeneous, real-world contexts, while also ensuring fidelity for the potent levers of change or prevention ( Franks and Schroeder, 2013 ). Thus, the committee relied on both evidence on scale-up, dissemination, and sustainability from empirically based programs and practices that have been implemented and

evaluated, and more general principles of implementation science, including considerations of capacity and readiness for scale-up and sustainability at the macro (e.g., current national politics) and micro (e.g., community resources) levels.

The review of the evidence conducted for this study, especially pertaining to strategies that work at the universal, targeted, and intensive levels to strengthen parenting capacity (questions 2 and 3 from the committee’s statement of task [ Box 1-2 ]), also entailed searches of several databases that, applying principles similar to those described above, assess the strength of the evidence for parenting-related programs and practices: the National Registry of Evidence-Based Programs and Practices (NREPP), supported by SAMHSA; the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which is funded by the state of California; and Blueprints for Healthy Youth Development, which has multiple funding sources. Although each of these databases is unique with respect to its history, sponsors, and objectives (NREPP covers mental health and substance abuse interventions, CEBC is focused on evidence relevant to child welfare, and Blueprints describes programs designed to promote the health and well-being of children), all are recognized nationally and internationally and undergo a rigorous review process.

The basic principles of evaluation and classification and the processes for classification of evidence-based practices are common across NREPP, CEBC, and Blueprints. Each has two top categories—optimal and promising—for programs and practices (see Appendix B ; see also Burkhardt et al., 2015 ; Means et al., 2015 ; Mihalic and Elliot, 2015 ; Soydan et al., 2010 ). Given the relatively modest investment in research on programs for parents and young children, however, the array of programs that are highly rated remains modest. For this reason, the committee considered as programs with the most robust evidence not only those included in the top two categories of Blueprints and CEBC but also those with an average rating of 3 or higher in NREPP. The committee’s literature searches also captured well-supported programs that are excluded from these databases (e.g., because they are recent and/or have not been submitted for review) but have sound theoretical underpinnings and rely on well-recognized intervention and implementation mechanisms.

Other reputable information sources used in producing specific portions of this report were What Works for Health (within the County Health Rankings and Roadmaps Program, a joint effort of the Robert Wood Johnson Foundation and the University of Wisconsin); the What Works Clearinghouse of the U.S. Department of Education’s Institute of Education Services; and HHS’s Home Visiting Evidence of Effectiveness (HomVEE) review.

In addition, the committee chose to consider findings from research using methodological approaches that are emerging as a source of innovation and improvement. These approaches are gaining momentum in parent-

ing research and are being developed and funded by the federal government and private philanthropy. Examples are breakthrough series collaborative approaches, such as the Home Visiting Collaborative Innovation and Improvement Network to Reduce Infant Mortality, and designs such as factorial experiments that have been used to address topics relevant to this study.

Other Information-Gathering Activities

The committee held two open public information-gathering sessions to hear from researchers, practitioners, parents, and other stakeholders on topics germane to this study and to supplement the expertise of the committee members (see Appendix A for the agendas of these open sessions). Material from these open sessions is referenced in this report where relevant.

As noted above, the committee’s task included making recommendations related to promoting the wide-scale adoption of effective strategies for supporting parents and the salient knowledge, attitudes, and practices. Cost is an important consideration for the implementation of parenting programs at scale. Therefore, the committee commissioned a paper reviewing the available economic evidence for investing in parenting programs at scale to inform its deliberations on this portion of its charge. Findings and excerpts from this paper are integrated throughout Chapters 3 through 6 . The committee also commissioned a second paper summarizing evidence-based strategies used by health care systems and providers to help parents acquire and sustain knowledge, attitudes, and practices that promote healthy child development. The committee drew heavily on this paper in developing sections of the report on universal/preventive and targeted interventions for parents in health care settings. Lastly, a commissioned paper on evidence-based strategies to support parents of children with mental illness formed the basis for a report section on this population. 4

In addition, the committee conducted two sets of group and individual semistructured interviews with parents participating in family support programs at community-based organizations in Omaha, Nebraska, and Washington, D.C. Parents provided feedback on the strengths they bring to parenting, challenges they face, how services for parents can be improved, and ways they prefer to receive parenting information, among other topics. Excerpts from these interviews are presented throughout this report as “Parent Voices” to provide real-world examples of parents’ experiences and to supplement the discussion of particular concepts and the committee’s findings.

4 The papers commissioned by the committee are in the public access file for the study and can be requested at https://www8.nationalacademies.org/cp/ManageRequest.aspx?key=49669 [October 2016].

TERMINOLOGY AND STUDY PARAMETERS

As specified in the statement of task for this study ( Box 1-2 ), the term “parents” refers in this report to those individuals who are the primary caregivers of young children in the home. Therefore, the committee reviewed studies that involved not only biolofical and adoptive parents but also relative/kinship providers (e.g., grandparents), stepparents, foster parents, and other types of caregivers, although research is sparse on unique issues related to nontraditional caregivers. The terms “knowledge,” “attitudes,” and “practices” and the relationships among them were discussed earlier in this chapter, and further detail can be found in Chapter 2 ).

The committee recognized that to a certain degree, ideas about what is considered effective parenting vary across cultures and ecological conditions, including economies, social structures, religious beliefs, and moral values ( Cushman, 1995 ). To address this variation, and in accordance with its charge, the committee examined research on how core parenting knowledge, attitudes, and practices differ by specific characteristics of children, parents, and contexts. However, because the research on parenting has traditionally underrepresented several populations (e.g., caregivers other than mothers), the evidence on which the committee could draw to make these comparisons was limited.

The committee interpreted “evidence-based/informed strategies” very broadly as ranging from teaching a specific parenting skill, to manualized parenting programs, to policies that may affect parenting. The term “interventions” is generally used in this report to refer to all types of strategies, while more specific terms (e.g., “program,” “well-child care”) are used to refer to particular types or sets of interventions. Also, recognizing that nearly every facet of society has a role to play in supporting parents and ensuring that children realize their full potential, the committee reviewed not only strategies designed expressly for parents (e.g., parenting skills training) but also, though to a lesser degree, programs and policies not designed specifically for parents that may nevertheless affect an individual’s capacity to parent (e.g., food assistance and housing programs, health care policies).

As noted earlier in this chapter, this report was informed by a life-course perspective on parenting, given evidence from neuroscience and a range of related research that the early years are a critical period in shaping how individuals fare throughout their lives. The committee also aimed to take a strengths/assets-based approach (e.g., to identify strategies that build upon the existing assets of parents), although the extent to which this approach could be applied was limited by the paucity of research examining parenting from this perspective.

GUIDING PRINCIPLES

A number of principles guided this study. First, following the ideas of Dunst and Espe-Sherwindt (2016) , the distinction between two types of family-centered practices—relational and participatory—informed the committee’s thinking. Relational practices are those focused primarily on intervening with families using compassion, active and reflective listening, empathy, and other techniques. Participatory practices are those that actively engage families in decision making and aim to improve families’ capabilities. In addition, family-centered practices focused on the context of successful parenting are a key third form of support for parenting. A premise of the committee is that many interventions with the most troubled families and children will require all these types of services—often delivered concurrently over a lengthy period of time.

Second, many programs are designed to serve families at particular risk for problems related to cognitive and social-emotional development, health, and well-being. Early Head Start and Head Start, for example, are means tested and designed for low-income families most of whom are known to face not just one risk factor (low income) but also others that often cluster together (e.g., living in dangerous neighborhoods, exposure to trauma, social isolation, unfamiliarity with the dominant culture or language). Special populations addressed in this report typically are at very high risk because of this exposure to multiple risk factors. Research has shown that children in such families have the poorest outcomes, in some instances reaching a level of toxic stress that seriously impairs their developmental functioning ( Shonkoff and Garner, 2012 ). Of course, in addition to characterizing developmental risk, it is essential to understand the corresponding adaptive processes and protective factors, as it is the balance of risk and protective factors that determines outcomes. In many ways, supporting parents is one way to attempt to change that balance.

From an intervention point of view, several principles are central. First, intervention strategies need to be designed to have measurable effects over time and to be sustainable. Second, it is necessary to focus on the needs of individual families and to tailor interventions to achieve desired outcomes. The importance of personalized approaches is widely acknowledged in medicine, education, and other areas. An observation perhaps best illustrated in the section on parents of children with developmental disabilities in Chapter 5 , although the committee believes this approach applies to many of the programs described in this report. A corresponding core principle of intervention is viewing parents as equal partners, experts in what both they and their children need. It is important as well that multiple kinds of services for families be integrated and coordinated. As illustrated earlier

in Box 1-1 , families may be receiving interventions from multiple sources delivered in different places, making coordination all the more important.

A useful framework for thinking about interventions is described in the National Research Council and Institute of Medicine (2009) report Preventing Mental, Emotional, and Behavioral Disorders among Young People . Prevention interventions encompass mental health promotion: universal prevention, defined as interventions that are valuable for all children; selected prevention, aimed at populations at high risk (such as children whose parents have mental illness); and indicated prevention, focused on children already manifesting symptoms. Treatment interventions include case identification, standard treatment for known disorders, accordance of long-term treatment with the goal of reduction in relapse or occurrence, and aftercare and rehabilitation ( National Research Council and Institute of Medicine, 2009 ).

The committee recognizes that engaging and retaining children and families in parenting interventions are critical challenges. A key to promoting such engagement may be cultural relevance. Families representing America’s diverse array of cultures, languages, and experiences are likely to derive the greatest benefit from interventions designed and implemented to allow for flexibility.

Finally, the question of widespread implementation and dissemination of parenting interventions is critically important. Given the cost of testing evidence-based parenting programs, the development of additional programs needs to be built on the work that has been done before. Collectively, interventions also are more likely to achieve a significant level of impact if they incorporate some of the elements of prior interventions. In any case, a focus on the principles of implementation and dissemination clearly is needed. As is discussed in this report, the committee calls for more study and experience with respect to taking programs to scale.

REPORT ORGANIZATION

This report is divided into eight chapters. Chapter 2 examines desired outcomes for children and reviews the existing research on parenting knowledge, attitudes, and practices that support positive parent-child interactions and child outcomes. Based on the available research, this chapter identifies a set of core knowledge, attitudes, and practices. Chapter 3 provides a brief overview of some of the major federally funded programs and policies that support parents in the United States. Chapters 4 and 5 describe evidence-based and evidence-informed strategies for supporting parents and enabling the identified knowledge, attitudes, and practices, including universal and widely used interventions ( Chapter 4 ) and interventions targeted to parents of children with special needs and parents who themselves face adversities

( Chapter 5 ). Chapter 6 reviews elements of effective programs for strengthening parenting capacity and parents’ participation and retention in effective programs and systems. Chapter 7 describes a national framework for supporting parents of young children. Finally, Chapter 8 presents the committee’s conclusions and recommendations for promoting the wide-scale adoption of effective intervention strategies and parenting practices linked to healthy child outcomes, as well as areas for future research.

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Decades of research have demonstrated that the parent-child dyad and the environment of the family—which includes all primary caregivers—are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child's brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents' lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger.

Parenting of young children today takes place in the context of significant ongoing developments. These include: a rapidly growing body of science on early childhood, increases in funding for programs and services for families, changing demographics of the U.S. population, and greater diversity of family structure. Additionally, parenting is increasingly being shaped by technology and increased access to information about parenting.

Parenting Matters identifies parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents' use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. This report makes recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. It is meant to serve as a roadmap for the future of parenting policy, research, and practice in the United States.

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Case Study On Family – Parental Responsibility

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Resource Description

My notes for the Family case study of the changing nature of parental responsibility.

CASE STUDY Changing nature of parental responsibility

• Parents can raise their children as they see fit. This is subject to the following general guidelines:
• Provide adequate food and shelter
• Protect children from abuse or neglect
• Provide access to education
• Provide discipline
• Provide medical treatment
• Many of these are governed by the Children and Young Persons (Care and Protection) Act 1998 (NSW).
• Neglect is the failure to provide basic requirements for the proper development of the child (food, shelter, medical care, dental care, hygiene, supervision, emotional support, etc.)
• S. 228 of the Children and Young Persons (Care and Protection) Act 1998 = $22,000 fine, 2 years imprisonment
• S. 43A Crimes Act 1900 = 5 years imprisonment
• NSW Department of Communities and Justice (DCJ) can initiate a Joint Child Protection Response (JCPR) to a suspected incident of child abuse or neglect.
• This involves input between the DCJ, NSW Health, and NSW Police. These have been in place since 2007.
• They offer a coordinated and multi-agency response to issues of neglect and abuse. This increases specialisation and resource sharing.
• A JCPR may investigate abuse/neglect, provide care/support services, refer individual to crisis counselling, etc.
• Parents cannot refuse children an education.
• Children must attend an educational facility from 6-17 after changes made to the Education Act 1990 (NSW) in 2009.
• Parents may educate children at home using approved curricula from NSW Education Standard Authority.
• Failure to enrol a child in school or give access to education is an offence and has a max fine of $5,500.
• Children under 15 can be fined or given community service orders for failing to attend school: s. 22 Education Act 1990.

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What Are The Effects Of Changing The Nature Of Parental Responsibility On The Life Of A Child?

By law, there are some defined duties, powers, authority and responsibilities of parents for their children. These are known as parental responsibility. The responsibilities include child’s growth, education and religion. Give them a proper environment and teach them discipline. You will have to take legal proceedings on your child’s behalf. The key responses in regards to the changing nature of parental responsibility initiated by the legal system are the Family Law (Shared Parental Responsibility) Act 2006 (Cth)

You will find different duties of parents in various statutes. For instance, according to 285, 286 Criminal Code Act 1899, the parents must provide the child all the necessities including medical treatment, lodging, clothing, food and care. Also, it is stated in 176 Education General Provisions Act 2006 QLD, that it is the duty of parents to enrol the child in a school and ensure attendance. The concept of the changing nature of parental responsibility has seen immense change in responding to recognizing the responsibilities parents possess in regard to aligning decisions with the child’s best interest, as particularly stated in Article 3 of Croc.

Who has parental responsibility?

According to the parental responsibility family law act , original parents or artificial surrogacy parents are authorized for parental responsibility. They do not need a court order for that. The grandparents or the step-parents can get involved in the care of the child. They have the authority to make decisions for the child.

It continues till the child is 18 or the marriage ends. The court wants the parents to share their responsibilities even after divorce. So, the child can have love from both parents. Parental responsibility applies whether the parents were married, or they were in a relationship.

Equal shared parental responsibility:

If the child is under 18 and the parents are no longer together, then they can share the responsibilities of the child. It is called equal shared responsibility . None of them can decide the long term issues of the child. For instance, a child’s school, medical treatments and religion.

ALWAYS KNOW YOUR RIGHTS AND KNOW WHERE YOU STAND

It is applicable until the court gives an order in the best interest of the child. It can remove parental responsibility from one or both parents. 

When parents are not together:

When the parents are no longer together, there is a need to make arrangements for the care of the children. The adults and parents can make their own decision . This decision is acceptable until it is in the favour of the safety of the child, else get help from the court.

If the parents are unable to communicate effectively they can request the court to give a parenting order.

The court will decide that:

• With whom the child will live.
• How much time can the child spend with each person?
• Responsibility of each parent.

If a child under age 18  leaves home, the parents or the state can force him to come back. In the case of a child with an age of more than 18, you cannot force them.

Rights of parents:

The parents also have rights. Parents can raise their children according to their wish. They can transfer their beliefs and religion to their children. They can also make decisions for their education and medical treatment. You have all those rights unless the child’s life is at risk.

The working parents have the rights to access the information of child-care services on payments.

The rights of parents do not include the custody of the child. For instance, after separation , the court makes a decision in the favor of the child’s best interest.

Changing the nature of parental responsibility in Australia:

The time is not always the same. A happy marriage can turn into separation and then may lead to divorce. So, in this case, parental responsibility can change. It is good if both parents share the responsibilities even after this situation. But, if the parents are unable to make a decision they will need help from the court. The court tries to make a decision to give the child a good life. In this scenario, the court can take or give more rights and responsibilities to each parent. If a parent is earning more he or she will have to donate more in the life of the child. 

But the parents should remember that their decision must not affect the life of the child. They have to try and give equal love to their children. This love will not just make them happy but also they’ll have confidence in them. So, don’t fight in front of your children.

Frequently asked questions:

Let’s discuss some of the most commonly asked questions about parental responsibility.

What is the sole parental responsibility in Australia?

Insole parental responsibility only one parent has complete rights for making major decisions for the child. It is just the opposite of parental responsibility, where both parents have equal rights in making crucial decisions.

How to get sole custody of a child in Australia?

If you want sole custody then you will have to apply to court. Also, you will have to provide a full report which explains all the matters against the other parent. If you can prove to the court that the other parent is not eligible for parenting responsibility then you will get sole custody.

When can a child make decisions?

By law, a child cannot make a decision until he or she turns 18 years.

When a parent is unfit in the eyes of the child?

There are certain conditions when a parent is unfit in the eyes of the court. For instance, abusing, failing to provide the child with necessities. In these situations, the court can reconsider its order.

Is it legal for my husband to take my child away from me?

Sometimes it is illegal to take the child away from the parent. But if you are married and you don’t have a court order then it is legal for the other parent to take the child away. Also, if your partner has sole custody it is legal for him or her to take the child.

For more information on your specific matter, please contact one of our experienced Mackay lawyers at Family Lawyers Mackay .

Parental Responsibility – What is equal shared parenting?

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5 The Content of Parental Responsibilities

• Published: December 2017
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This chapter examines the content of parental responsibilities. It argues that when someone takes on parental responsibilities, she takes on duties to provide a subset of what is collectively owed to all children within a society. That subset must include duties to provide the goods that children are owed that can only be provided by a constant caregiver— filial goods . It also must, in a just society, mean that it is possible for parents to do their duties, yet for the society to remain just. This constraint, along with the constraint that the child’s rights take precedence, allows us to rule out certain putative parental responsibilities a priori. For example, I argue that parents do not have a duty to pass on their wealth to their children.

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3. shifting roles, responsibilities and relationships.

The census data point to a slowly developing but large shift in the roles, responsibilities and focuses of young adults that has led to significant changes in living arrangements. Many groups of young adults have already crossed a tipping point in which they are less likely to be pursuing committed relationships than to be living in the home of their parent(s).

For example, young men are now more likely to be living with mom and/or dad (35%) than to be living with a spouse or partner in their own household (28%). The year that the young adult males “crossed over” was 2009.

Young women have not reached the tipping point yet. In 2014, 35% of young women were living with a spouse or unmarried partner while 29% lived in the home of their parent(s).

Trends in living arrangements for specific groups of young adults indicate that the crossover is being driven by the experiences of more economically disadvantaged young adults, specifically, less-educated young adults and some racial and ethnic minorities.

By 1980 it was already apparent that black young adults were more likely to live at home (30%) than to be living with a spouse or an unmarried partner in their own residence (29%). The crossover point for American Indian young adults occurred in 2007. Hispanic young adults reached the tipping point in 2011 and by 2014 36% lived at home and 30% lived with a spouse or unmarried partner in their own household. As of 2014, white and Asian young adults remain more likely to be married or cohabiting than living with their parent.

Looking at educational attainment, young adults with at least a bachelor’s degree remain the only group more likely to be married or cohabiting than to be living at home. By 2006 it was already the case that young adults who had not completed high school were more likely to live at home than with a partner. Young adults who finished their education at high school were more likely to live in the home of their parent(s) than with a partner in their own household as of 2008. Young adults with “some college,” but not a bachelor’s degree, crossed over in 2010.

The changing composition of young adults and its impact on the ‘living at home’ phenomenon

Since 1960 there have been significant changes in the demographic characteristics of young adults. Young adults are less white, better-educated and less likely to be married.

In general, non-Hispanic white young adults have traditionally been less likely than their black and Hispanic counterparts to live in their parental home. But the growing share of non-whites in the young adult population does not explain the increased prevalence of living at home. The share of white young adults living with their parent(s) increased from 19% in 1960 to 30% in 2014, nearly as sizable an increase as for all young adults. Even in the absence of the racial and ethnic diversification that has occurred, a much greater share of young adults would now be living with mom and/or dad.

Young adults today are slightly younger than young adults in 1960, in that a smaller share of them are in the 30- to 34-year-old age group. But this shift in age composition has only a very modest impact on the trend in living with parents.

Better-educated young adults are less likely to live with their parents, so the improvements in educational attainment tend to decrease living at home.

Declining marriage certainly plays a role and, in some interpretations, can account for the entire increase in living with parents since 1960. Consistently since 1880 the vast majority of married young adults have not lived with their parents; typically 5% or less have done so. Single young adults are many times more likely to live with mom and/or dad. So the shift away from marriage can account for the entire increase in living with parents since 1960.

This does not imply, however, that the shift away from marriage has “caused” the increase in living with parents, because other social and economic factors may have reduced the attractiveness of marriage for young adults and, at the same time, made living independently of parents more difficult.

• Taylor, 2014 . ↩
• Ruggles (2015) makes the same point, indicating that in 1970 77% of 25- to 29-year-olds had a co-residing partner of any kind. By 2014 the rate was 46%. ↩

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Table of contents, young adults in the u.s. are less likely than those in most of europe to live in their parents’ home, a majority of young adults in the u.s. live with their parents for the first time since the great depression, as millennials near 40, they’re approaching family life differently than previous generations, as family structures change in u.s., a growing share of americans say it makes no difference, with billions confined to their homes worldwide, which living arrangements are most common, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

Essay on Responsibility Towards Parents

Students are often asked to write an essay on Responsibility Towards Parents in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Responsibility Towards Parents

Understanding responsibility.

Responsibility is an important part of life. It means doing what you should do, even when it’s hard. For example, we have a responsibility towards our parents. This means we should respect them, help them, and care for them.

Respecting Parents

One of the main responsibilities towards parents is respect. We should always speak politely to our parents. We should listen to what they say and follow their advice. They have more experience than us and they want the best for us.

Helping Parents

Another responsibility is to help our parents. This can be in small ways, like helping with household chores. Or it can be in big ways, like supporting them when they are old or sick. Helping our parents shows that we care about them.

Caring for Parents

The final responsibility is to care for our parents. This means looking after their health and happiness. We should spend time with them, make them feel loved, and make sure they are well. This is a way to thank them for all they have done for us.

In conclusion, our responsibility towards our parents is very important. It involves respect, help, and care. By fulfilling these responsibilities, we can show our parents how much we love and appreciate them.

250 Words Essay on Responsibility Towards Parents

Responsibility is a big word. It means doing what you should do, even when no one is watching. When we talk about our responsibility towards our parents, it means caring for them and respecting them.

Respect for Parents

Respect is the first thing we owe our parents. We should always talk to them politely. We should listen to their advice because they have more experience than us. We should never raise our voice or argue with them. This is how we show them respect.

Caring for our parents is another important responsibility. When they are sick, we should look after them. We should help them with their work when they are tired. We should not let them do all the house chores alone. We can help them by doing small tasks like cleaning our room or washing our dishes.

Helping Parents Financially

When we grow up and start earning, we should also help our parents financially. They have spent their money on our education and well-being. It’s our turn to take care of them now. We should not let them worry about money in their old age.

Spending Time with Parents

Spending time with our parents is also our responsibility. We should talk to them and listen to their stories. We should eat at least one meal with them every day. This will make them feel loved and valued.

To sum up, our responsibility towards our parents includes respect, care, financial help, and spending time with them. If we fulfill these responsibilities, we can make our parents happy and proud.

500 Words Essay on Responsibility Towards Parents

Responsibility is a big word that means doing what you should do. It’s about being dependable and trustworthy. When we talk about responsibility towards our parents, it means doing what we can to make their lives better. This might involve helping them in their daily chores, respecting their wishes, or simply giving them our time and attention.

Why Responsibility Towards Parents is Important

Parents are the most important people in our lives. They love us, care for us, and provide us with everything we need. They spend their lives making sure we are happy and successful. It is only fair that we show them the same love and respect in return. Being responsible towards our parents is a way of showing them that we appreciate all that they have done for us.

Showing Love and Respect

One of the most important ways we can be responsible towards our parents is by showing them love and respect. This can be as simple as listening to them when they talk, being polite, and not arguing with them. We should also respect their opinions, even if we don’t always agree with them. By doing these things, we are showing our parents that we value them and their wisdom.

Helping with Daily Chores

Parents work hard to take care of us. They cook for us, clean our homes, and do many other chores. As children, we can help our parents by doing some of these tasks. This can include washing the dishes, cleaning our rooms, or helping with the shopping. These small acts of help can make a big difference in our parents’ lives. It shows them that we understand their hard work and are willing to share the load.

Spending Time With Parents

Parents love spending time with their children. It makes them happy and gives them a sense of satisfaction. We can show responsibility towards our parents by spending quality time with them. This can include playing games, going for walks, or simply chatting with them. This not only makes our parents happy but also strengthens our bond with them.

In conclusion, being responsible towards our parents is about showing them love, respect, and appreciation. It’s about helping them with daily chores and spending quality time with them. By doing these things, we are not only making our parents’ lives easier but also showing them that we value and appreciate them. Remember, our parents have given us the best of everything, it is our duty to give them the best of ourselves. We should always try to be the best children we can be, not just because it’s our responsibility, but because they deserve it.

Note: This essay is exactly 500 words as per the requirement.

That’s it! I hope the essay helped you.

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• Legal Studies

Family law essay, analysing the changing nature of parental responsibility and same-sex marriages

• Author Bored of Studies
• Creation date Oct 25, 2016

Year 2015 Type Assessment Task Family law essay, analysing the changing nature of parental responsibility and same-sex marriages in relation to our changing society. 24/25 NOTE: This is a legacy resource migrated from an old version of BoredOfStudies. Original Uploader: Anonymous

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Home — Essay Samples — Life — Responsibility — The Nature of Responsibility

The Nature of Responsibility

• Categories: Responsibility

About this sample

Words: 1134 |

Published: Sep 4, 2018

Words: 1134 | Pages: 2 | 6 min read

Works Cited:

• Bartholomew, R. E. (2018). Understanding conversion disorder: A guide for the medical profession. ABC-CLIO.
• Daily.jstor.org. (2017, January 24). The Little Ice Age: A World-Lost. JSTOR Daily. https://daily.jstor.org/the-little-ice-age-a-world-lost/
• Foskett, D. J. (2020). The Salem Witch Trials: A Day-by-Day Chronicle of a Community Under Siege. Rowman & Littlefield.
• Hansen, C. B. (2017). Witches, Magic, and Transgression in the European Middle Ages. Oxford University Press.
• Kirsch, G. E. (2019). The Salem witch trials: A reference guide. ABC-CLIO.
• Norton, M. B. (2016). In the Devil's Snare: The Salem Witchcraft Crisis of 1692. Vintage.
• Rosenthal, B. (2013). Salem story: reading the witch trials of 1692. Cambridge University Press.
• Starkey, M. (2015). The Devil in Massachusetts: A Modern Enquiry into the Salem Witch Trials. Knopf Doubleday Publishing Group.
• Wright, L. (2017). Salem witch trials. Routledge.
• Woolf, A. (2019). The Salem Witch Trials. Pearson Education Limited.

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