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Chicago Parent Program

The Chicago Parent Program (CPP) is a parenting skills training program that aims to reduce behavior problems in children ages 2 to 5 by improving parenting self-efficacy and promoting positive parenting behavior and child discipline strategies. CPP is grounded in the belief that parents play a critical role in shaping their child's behavior and personality through their position as role models, as social learning theory suggests, and through the quality and consistency of their behavioral interaction with their child. CPP is implemented in 11 weekly group sessions followed by a booster session 4 to 8 weeks later. These 2-hour sessions are facilitated by two trained group leaders and use video vignettes, more than 250 in all, to depict parent-child interactions at home and in various community settings (e.g., grocery store, Laundromat). The scenes, which present challenging situations parents typically face with their children, stimulate discussion and problem-solving related to child behavior and parenting skills. Sessions focus on building positive relationships with children (e.g., having child-centered time, maintaining family routines and traditions, using praise and encouragement), child behavior management skills (e.g., following through with consequences, using effective forms of discipline), stress management, and problem-solving skills. Following each session, parents complete practice assignments to help them apply the skills they learned.

CPP was originally developed to meet the needs of low-income African American and Latino parents raising young children in urban communities. These populations were the focus of the two studies reviewed for this summary, both of which were conducted in daycare centers with the parents of enrolled children. CPP has been used with culturally and socioeconomically diverse audiences. CPP group leaders must have a minimum of a high school degree or equivalent and must successfully complete a 2-day CPP group leader training.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: August 2012
1: Child behavior problems
2: Parenting self-efficacy
3: Corporal punishment
4: Follow-through on discipline
Outcome Categories Family/relationships
Social functioning
Ages 0-5 (Early childhood)
18-25 (Young adult)
26-55 (Adult)
Genders Male
Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Other community settings
Geographic Locations Urban
Implementation History Since its development in 2002, the intervention has reached over 1,000 parents in 16 States and the District of Columbia through implementations in early childhood centers, Head Start sites, preschool programs, social service agencies, and schools for teen mothers. The program is also being replicated in numerous communitywide prevention initiatives, including the Harlem Children's Zone in New York City and Project LAUNCH programs in Chicago and the District of Columbia.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations CPP materials have been translated into Spanish. CPP also has been adapted for a family-based obesity prevention intervention that conveys messages about healthy eating, physical activity, and sleep within a general parenting program.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: August 2012

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Gross, D., Garvey, C., Julion, W., Fogg, L., Tucker, S., & Mokros, H. (2009). Efficacy of the Chicago Parent Program with low-income African American and Latino parents of young children. Prevention Science, 10(1), 54-65.  Pub Med icon

Study 2

Gross, D., Breitenstein, S., Julion, W., Garvey, C., Ridge, A., & Fogg, L. (2012). Study 2: Chicago Parent Program replication report.

Supplementary Materials

Breitenstein, S. M., Fogg, L., Garvey, C., Hill, C., Resnick, B., & Gross, D. (2010). Measuring implementation fidelity in a community-based parenting intervention. Nursing Research, 59(3), 158-165.  Pub Med icon

Supporting Document for the Reliability and Validity of Outcome Measures: Chicago Parent Program

Outcomes

Outcome 1: Child behavior problems
Description of Measures Child behavior problems were assessed using two measures: the Eyberg Child Behavior Inventory (ECBI) and the Dyadic Parent-Child Interactive Coding System--Revised (DPICS-R). The ECBI is a 36-item survey completed by parents of children 2-16 years old. Each item presents a behavior that is measured along two scales: the Intensity Scale and the Problem Scale. On the Intensity Scale, the parent indicates the frequency of the child behavior on a scale of 1 (the behavior never happens) to 7 (the behavior is always happening). On the Problem Scale, the parent indicates whether he or she considers the child behavior to be a problem ("yes" or "no"). The DPICS-R was used by researchers to code the frequency of seven child behaviors observed in videotaped play and clean-up sessions. Child behavior problems were measured by the summed frequencies of the following behaviors: noncompliance, destructive behavior, physically negative behavior, crying, whining, yelling, and "smart talk." Assessments were conducted at baseline, at the conclusion of the intervention (3 months after baseline), and at 6 months and 1 year after the intervention.
Key Findings Daycare centers matched on multiple criteria were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, children of intervention group parents exhibited fewer behavior problems during play sessions (p < .01) and clean-up sessions (p < .01) than children of control group parents, findings that had small effect sizes (Cohen's d = 0.43 for play sessions and Cohen's d = 0.46 for clean-up sessions). A second set of analyses compared children of parents with different levels of exposure to the intervention: (1) those with a high dose of the intervention (i.e., attended at least 6 the 11 core sessions), (2) those with a low dose of the intervention (i.e., attended less than 6 of the 11 core sessions), and (3) those in the control group. Over time, from baseline through 1-year follow-up, the high-dose intervention group had greater improvement in behavior problems compared with the two other groups as measured by the ECBI Intensity Scale (p < .05) and DPICS-R (p < .001 for play sessions and clean-up sessions). The effect sizes for these findings were small to medium (Cohen's d = 0.31 for the ECBI Intensity Scale, Cohen's d = 0.64 for DPICS-R during play sessions, and Cohen's d = 0.46 for DPICS-R during clean-up sessions).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 2: Parenting self-efficacy
Description of Measures Parenting self-efficacy was assessed using the Toddler Care Questionnaire (TCQ). This 38-item scale measures parenting confidence in managing tasks and situations pertinent to raising young children (e.g., toilet training, setting limits in destructive behavior). Scores range from 38 to 190, with higher scores indicating greater parenting confidence. Assessments were conducted at baseline, at the conclusion of the intervention (3 months after baseline), and at 6 months and 1 year after the intervention.
Key Findings In one study, daycare centers were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, no significant difference was found between intervention group and control group parents in parenting self-efficacy. A second set of analyses compared parents with different levels of exposure to the intervention: (1) those with a high dose of the intervention (i.e., attended at least 6 of the 11 core sessions), (2) those with a low dose of the intervention (i.e., attended less than 6 of the 11 core sessions), and (3) those in the control group. Over time, from baseline through 1-year follow-up, the high-dose intervention group had greater improvement in parenting self-efficacy compared with the two other groups (p < .05). This finding had a small effect size (Cohen's d = 0.37).

In another study, daycare centers were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, parents in the intervention group reported greater parenting self-efficacy than parents in the control group (p < .01).
Studies Measuring Outcome Study 1, Study 2
Study Designs Quasi-experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 3: Corporal punishment
Description of Measures Corporal punishment was measured using the Corporal Punishment subscale of the Parenting Questionnaire (PQ). This subscale contains 4 items measuring parent use of corporal punishment in response to a child's misbehavior. Parents rated each item on a scale from 1 (almost never) to 5 (very often). Assessments were conducted at baseline, at the conclusion of the intervention (3 months after baseline), and at 6 months and 1 year after the intervention.
Key Findings In one study, daycare centers matched on multiple criteria were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, intervention group parents used less corporal punishment than control group parents (p < .05), a finding with a small effect size (Cohen's d = 0.24). A second set of analyses compared parents with different levels of exposure to the intervention: (1) those with a high dose of the intervention (i.e., attended at least 6 of the 11 core sessions), (2) those with a low dose of the intervention (i.e., attended less than 6 of the 11 core sessions), and (3) those in the control group. Over time, from baseline through 1-year follow-up, the high-dose intervention group had greater decreases in use of corporal punishment compared with the two other groups (p < .01). This finding had a small effect size (Cohen's d = 0.30).

In another study, daycare centers were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, parents in the intervention group reported less use of corporal punishment than parents in the control group (p < .001).
Studies Measuring Outcome Study 1, Study 2
Study Designs Quasi-experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 4: Follow-through on discipline
Description of Measures Follow-through on discipline was measured using a modified subscale of the Parenting Questionnaire (PQ). Researchers selected 6 items from the PQ's 23-item Demandingness subscale to create the Follow Through on Discipline subscale. The selected items measure the parent's ability to set and maintain a standard of behavior for his or her toddler (e.g., "My child can talk me into letting him/her off easier than I had intended," "My child convinces me to change my mind after I have refused a request," "I threaten punishment but do not end up punishing my child"). Parents rated each item on a scale from 1 (almost never) to 5 (very often). Assessments were conducted at baseline, at the conclusion of the intervention (3 months after baseline), and at 6 months and 1 year after the intervention.
Key Findings In one study, daycare centers matched on multiple criteria were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, no difference was found between intervention group and control group parents in follow-through on discipline. A second set of analyses compared parents with different levels of exposure to the intervention: (1) those with a high dose of the intervention (i.e., attended at least 6 of the 11 core sessions), (2) those with a low dose of the intervention (i.e., attended less than 6 of the 11 core sessions), and (3) those in the control group. Over time, from baseline through 1-year follow-up, the high-dose intervention group had greater improvement in follow-through on discipline compared with the two other groups (p < .01). This finding had a small effect size (Cohen's d = 0.29).

In another study, daycare centers were randomly assigned to the intervention group or a no-intervention control group. Over time, from baseline through 1-year follow-up, parents in the intervention group reported greater follow-through on discipline than parents in the control group (p < .01).
Studies Measuring Outcome Study 1, Study 2
Study Designs Quasi-experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 0-5 (Early childhood)
18-25 (Young adult)
26-55 (Adult) 		56% Male
44% Female 		58.9% Black or African American
32.8% Hispanic or Latino
4.7% White
3.6% Race/ethnicity unspecified
Study 2 18-25 (Young adult)
26-55 (Adult) 		52% Male
48% Female 		55% Black or African American
45% Hispanic or Latino

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Child behavior problems 3.5 3.5 3.0 3.8 3.3 3.3 3.4
2: Parenting self-efficacy 3.5 3.5 3.5 3.8 3.3 3.5 3.5
3: Corporal punishment 3.3 3.3 3.5 3.8 3.3 3.5 3.4
4: Follow-through on discipline 3.3 3.3 3.5 3.8 3.3 3.5 3.4

Study Strengths

The ECBI, DPICS-R, TCQ, and PQ are gold-standard instruments widely used with diverse populations. A parent advisory council reflective of the study samples' demographics reviewed the measures and provided feedback that was incorporated into the intervention and protocols. Multiple measures were used to assess changes in child behavior. Program implementation was monitored using a validated fidelity checklist, adherence scales, random observations, and review of videotaped sessions. Attrition and missing data were minimal, and attrition rates were similar in the control and intervention groups. The sample size and power were sufficient for statistical analysis. A number of well-defined statistical procedures were conducted to determine program impact.

Study Weaknesses

In both studies, some potential confounding variables could have affected study findings. In one study, for example, the parents in the control group were more likely to be employed and to have a higher income than the parents in the intervention group.
Readiness for Dissemination
Review Date: August 2012

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Breitenstein, S. (2009). The fidelity checklist. Chicago, IL: Author.

Breitenstein, S. (2010). Manual for the fidelity checklist. Chicago, IL: Author.

The Chicago Parent Program. (2002). Unit 1: The value of your attention [DVD]. Chicago, IL: Rush University Medical Center.

The Chicago Parent Program. (2002). Unit 2: Using your authority wisely [DVD]. Chicago, IL: Rush University Medical Center.

The Chicago Parent Program. (2002). Unit 3: Managing your stress [DVD]. Chicago, IL: Rush University Medical Center.

The Chicago Parent Program. (2002). Unit 4: Sticking with the program [DVD]. Chicago, IL: Rush University Medical Center.

Gross, D., Julion, W., Garvey, C., & Breitenstein, S. (2010). The Chicago Parent Program: Group leader manual (2nd ed.). Chicago, IL: Rush University Medical Center.

Training materials:

  • Chicago Parent Program: Agenda--Day 1 and 2
  • Chicago Parent Program: 8 Keys of Effective Discipline
  • Chicago Parent Program: Glossary of Terms
  • The Chicago Parent Program: Group Leader Training [PowerPoint slides]
  • The Chicago Parent Program: Group Leader Training--Attendance
  • Chicago Parent Program: Group Leader Training Evaluation--Day 1 and 2
  • Chicago Parent Program: Manual Components
  • Chicago Parent Program: Post Assessment Test
  • Chicago Parent Program: Self Assessment Survey
  • Ground Rules

Other implementation materials:

  • Chicago Parent Program Group Leader Certification
  • The Chicago Parent Program: Group Leader Facilitation Model
  • Chicago Parent Program Group Leader Training Course SurveyMonkey registration
  • Chicago Parent Program: 12 Sessions
  • To Submit Audio Recordings of CPP Groups for Fidelity Assessment

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
3.5 4.0 3.3 3.6

Dissemination Strengths

The group leader manual is well organized and easy to follow. For each parent session, the manual provides detailed instructions for conducting the session, scripted discussion questions, and leader notes describing the content that should be reinforced. The videos depict real families that are representative of a culturally and socioeconomically diverse audience. The 2-day, on-site training required for group leaders is interactive and includes discussion, role-play, and a competency-based assessment. The training includes guidance on participant recruitment, engagement, and barrier reduction. The developer is available for brief technical assistance as well as indepth consultation and coaching. Interested group leaders can become certified CPP educators through a process that includes coaching and supervision. Weekly checklists for group leaders strengthen fidelity. The weekly parent satisfaction survey and homework checklists assess the application of program principals and strategies. The developer also reviews and provides feedback on audiotaped parent sessions to support quality assurance.

Dissemination Weaknesses

The program lacks a cohesive document that outlines key implementation information for potential implementers. The weekly parent satisfaction surveys and end-of-program evaluation survey may not be sufficient to assess meaningful parent outcomes. In addition, no guidance is available on how to use the data collected with these instruments for program improvement.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Group leader set, which includes the group leader manual (with weekly group leader checklists, reproducible parent handouts, practice assignments, practice checklists, weekly parent satisfaction survey, and an end-of-program evaluation survey) and set of four DVDs $699 each Yes
Additional group leader manual $85 each No
Color-coded parent handouts (double-sided for English and Spanish) for all 12 sessions $20 per set No
2-day, on-site group leader training
  • In the Chicago metropolitan area, $2,500 for up to 20 participants, plus travel expenses
  • In other cities, $3,000 for up to 20 participants, plus travel expenses
 		Yes
Brief phone and email technical assistance Free No
Phone consultation and coaching $70 per hour No
Fidelity Checklist Competence Scale Included in the group leader manual No
Review of audiotaped parent sessions using the Fidelity Checklist Competence Scale $175 per parent session No

Additional Information

Implementers who would like to become certified CPP educators must attend the 2-day group leader training and pass the competency exam, lead at least two CPP groups, and submit audiotapes of at least three sessions and corresponding weekly group leader checklists.
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Gross, D., Breitenstein, S., Julion, W., Garvey, C., Ridge, A., & Fogg, L. (2012). Study 2: Chicago Parent Program replication report.

Haines, J., Mayorga, A. M., McDonald, J., O'Brien, A., Gross, D., Taveras, E. M., et al. (2012). Embedding weight-related messages within a general parenting programme: Development and feasibility evaluation of Parents and Tots Together. Early Child Development and Care, 182(8), 951-965.
Contact Information

To learn more about implementation or research, contact:
Deborah Gross, D.N.Sc., R.N., FAAN
(410) 614-5311
debgross@jhu.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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