A home visiting service for promoting secure and healthy relationships between caregivers and young children.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
Australian Study
Risk of Bias
Cost
Target Age Group
About
Promoting First Relationships (PFR) is a 10-week home visiting service that aims to help families who are facing adversity, including those involved in child welfare support, meet the social and emotional needs of infants and toddlers from birth to age 3. PFR is delivered by service providers with the knowledge, tools and strategies to guide and support caregivers in building nurturing and responsive relationships with their children.
Aims
- Promote parent-child relationships
- Promote the child’s social emotional development
- Build trust and security between the child and parent
- Promote the parent and child’s emotion regulation and self-reflection
- Raise parent competency in addressing children challenging behaviours.
Impact
Evidence suggests that PFR reduced allegations of child maltreatment and improved out of home care. Parents who received PFR scored higher than families in the comparison group in understanding children’s social emotional needs, observed sensitivity to their children and preventing child removal from families in the child protection system observed at 12 months after program completion. This is based on administrative child welfare system data from the state of Washington.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Not found | Not found |
| System | Out-of-home care | Yes | Not found | Not found |
| Child | Mental health/behaviour | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
PFR has an evidence rating of Supported+.
This means that PFR has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, long-term impact on at least one child and family outcome.
This assessment is based on 2 research outputs using the same administrative dataset from the child welfare system in Washington state. Another 7 RCTs were identified but did not count towards the evidence due to concerns with study quality. PFR has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 2 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results in these included studies.
The study was conducted in the United States and does not include Aboriginal children and families. PFR is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The included study used a dataset of participants from the state of Washington, United States.
Sample
- The dataset involved 247 families (124 intervention, 123 control).
- The children ranged from 10 to 24 months old and had been reported to the child protection system with allegations of child maltreatment in the prior 2 weeks.
Implementation
Delivery model, mode and setting
- PFR is delivered in-person, to the parent only, parent and child together or in a group format with other families.
- The program is conducted in a range of settings including the adoptive home, birth family home, foster/kinship home, outpatient clinic, provider or residential care.
Target cohort
- Parents and caregivers of children up to age 3
- Children up to age 3.
Program delivery
- PFR can be conducted with an individual parent-child dyad or in groups of 6 to 8 parent-child dyads.
- The provider videotapes the caregiver-child interaction and uses video feedback on real-life situations to help the caregiver reflect on the underlying needs of the child and how those needs impact behaviour.
- The provider gives positive and instructive feedback to build the caregiver’s competence, focusing on both the child and parent’s social and emotional needs.
- Parents are given handouts for the week that help enhance their insight into their child’s needs.
Duration and intensity
- The recommended duration for delivering PFR is one hour per week over 10 weeks.
Guides and manuals
- There is a manual that provides detailed instructions on delivering PFR to families.
- There are assessments that measure organisational or provider readiness for PFR.
- Once providers have been trained in the PFR model, PFR trainers are available for further consultation to the agency to help support them as they implement the program.
- Fidelity measures include checklists, video feedback and whole session fidelity forms conducted by PFR Master Trainers who conduct initial fidelity checks with providers.
Additional information
The Promoting First Relationships website has more information about the program.
Staffing
- At a minimum, providers are required to have a bachelor’s degree; however, a higher level of education is preferred.
Training
- There are 3 levels of PFR Home Visiting training available.
- Level 1: Knowledge Building is designed to give service providers knowledge about using PFR within their practice. It involves an engaging and interactive 14-hour workshop that is delivered in-person over 2 full days, or virtually over 4 half days.
- Level 2: Skills Building is designed to support providers in becoming certified in the home visiting model. It involves 15 weeks of online, mentored professional development. During this process, providers intervene with a caregiver/child dyad at their own site to deliver the 10-week intervention.
- Level 3: Agency Trainer Training is designed to support providers in growing their FPR expertise and reflective consultation skills and learning how to train others at Level 2. It involves 15 additional weeks of mentoring from a FPR Master Trainer as the provider implements FPR with a second caregiver/child dyad. Only certified providers with high fidelity to the model are eligible to participate.
To our knowledge, PFR is available in Victoria.
The program is delivered by Kids First in the north eastern suburbs of Melbourne and more information about intake is available on their website.
Cost
We were unable to locate any information on the cost of PFR.
References
Studies identified and included in the review
- Oxford ML, Spieker SJ, Lohr MJ and Fleming CB (2016a). Promoting first relationships: Randomized trial of a 10-week home visiting program with families referred to child protective services. Child Maltreatment 21(4): 267-277.
- Pasalich DS, Fleming CB, Spieker SJ, Lohr MJ and Oxford ML (2019). Does Parents' Own History of Child Abuse Moderate the Effectiveness of the Promoting First Relationships® Intervention in Child Welfare? Child Maltreatment 24(1): 56‐65.
Studies identified but not counted towards the evidence rating due to study quality
- Hash JB, Oxford ML, Fleming CB, Ward TM, Spieker SJ and Lohr MJ (2019). Impact of a home visiting program on sleep problems among young children experiencing adversity. Child Abuse and Neglect 89: 143-154.
- Hastings PD, Kahle S, Fleming C, Lohr MJ, Katz LF and Oxford ML (2019). An intervention that increases parental sensitivity in families referred to Child Protective Services also changes toddlers' parasympathetic regulation. Developmental Science 22(1): e12725.
- Nelson EM and Spieker SJ (2013). Intervention effects on morning and stimulated cortisol responses among toddlers in foster care. Infant Mental Health Journal 34(3): 211-221.
- Oxford ML, Fleming CB, Nelson EM, Kelly JF and Spieker SJ (2013). Randomized trial of Promoting First Relationships: Effects on maltreated toddlers' separation distress and sleep regulation after reunification. Children and Youth Services Review 35(12): 1988-1992.
- Oxford ML, Marcenko M, Fleming CB, Lohr MJ and Spieker SJ (2016b). Promoting birth parents' relationships with their toddlers upon reunification: Results from Promoting First Relationships® home visiting program. Children and Youth Services Review 61: 109-116.
- Spieker SJ, Oxford ML and Fleming CB (2014). Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention. Children and Youth Services Review 44: 201-206.
- Spieker SJ, Oxford ML, Kelly JF, Nelson EM and Fleming CB (2012). Promoting first relationships: Randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment 17(4): 271-286.