Promoting First Relationships

About the program

Promoting First Relationships (PFR) is a relationship- and strengths-based home visiting program that aims to help families facing adversity. PFR service providers are trained to focus on the relationship between the parent and child. Providers employ observational skills using video-based feedback with parents. PFR seeks to increase caregivers’ awareness of their children’s social and emotional needs, including their need for a sense of safety and security, and to enhance caregivers’ understanding of their own needs as parents.

Who does it work for?

An RCT with 247 participants (final sample 228) was conducted in the USA (Oxford et al. 2016). The families who participated in the study had been reported to child protection services with allegations of child maltreatment. To participate, families needed to meet the following inclusion criteria:

• Be conversant in English
• Have housing
• Live in Snohomish, southern Skagit or northern King County in Washington State
• Have a child aged 10-24 months; and
• Have an open case with an allegation of maltreatment of any type recorded in the database of the regional child protective service office at least two weeks prior.

In the study, children were aged 10-24 months, with a mean age of 16.4 months. The sample was made up of Indigenous (1%); Asian (2%); African American (4%); Mixed/other (31%); and White (62%). 79% received food stamps and 31% were employed full or part-time. The proportion of parents that graduated from high school or had a General Education Diploma was 76%, and 47% lived with a spouse or partner. The PFR program was delivered to the intervention group. The control group received up to three occasions of phone-based resource and referral services.

This review did not identify any evidence that the program has been evaluated in Australia.

What outcomes does it contribute to?

Positive outcomes:

Out-of-home placement: Oxford and colleagues (2016) found that 13.0% of the children in the control group had been removed from the home at 15 months post baseline, compared to 5.6% of the children in the intervention group. The chances of removal from the birth parent home were 2.5 times greater for children in the control group than for children in the intervention group at any given time.

No effect:

Child abuse reports: Unsubstantiated: The same study failed to demonstrate a significant effect on new maltreatment allegations (Oxford et al. 2016). Whilst between enrolment and one year post intervention there were new allegations for 36 (29.0%) of the children in the intervention group and 42 (31.6%) of the children in the control group, survival models indicated that chances of a new allegation did not differ significantly by condition.

Negative outcomes:

None

Is the program effective?

Overall, the program had a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

The program consists of weekly home visits for ten weeks, by community-based service providers with master’s degrees in social work or counselling, who are certified to deliver the program. The parent and child are video-recorded playing together five times during the 10-week PFR program. The PFR provider will then review the video-recorded play session with the parent, typically the week following the date on which the session was recorded. The provider and parent reflect on the recorded interactions, noting what the child is doing in relation to the caregiver’s behaviour and what the caregiver is doing in response to the child.

How much does it cost?

Information not available

Where does the evidence come from?  

An RCT with 247 child protective services cases in the USA (Oxford et al. 2018). The sample included 247 cases taken from the Washington State Department of Social and Health Services (DSHS) database in the USA. 228 cases remained at post-program follow-up.

Further resources

• https://pfrprogram.org
• Oxford, M.L., Spieker, S.J., Lohr, M.J., and Fleming, C.B. (2016). Promoting First Relationships ®: Randomized trial of a 10-week home visiting program with families referred to child protective services, Child Maltreatment, 21, 267-277.