Helping families thrive while developing a strong working alliance: The benefits of Recipe 4 Success

This study explored whether the strength of parent-home visitor working alliances might alter the benefits of Recipe 4 Success, a highly structured food-based curriculum designed to promote parents' sensitive scaffolding, responsive food parenting practices, toddlers' self-regulation, and healthy eating habits. This study included 242 parents and their toddlers residing in the United States, most of whom were living in poverty (37% white, 25% Black, 19% Latiné, 17% Multiracial, and 2% Asian; median income = $1555 per month). Families were randomly assigned to Recipe 4 Success or usual practice home visits within home visitor caseload. Home visitors tended to rate their working alliance as very strong versus less strong. Within-group regression equations revealed that, among families with a less strong working alliance, Recipe 4 Success was more effective than usual practice home visits in improving parents' sensitive scaffolding, responsive food parenting practices, and toddlers' self-regulation. In contrast, among families who had a strong working alliance, Recipe 4 Success was more effective than usual practice home visits in changing toddlers' healthy eating habits, including reducing body mass index for toddlers with overweight/obesity. These findings highlight how families with varying strengths of working alliances may benefit differently from highly structured evidence-based curricula.