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Promoting first relationships: randomized trial of a relationship-based intervention for toddlers in child welfare

Susan J Spieker1, Monica L Oxford, Jean F Kelly

  • 1Department of Family & Child Nursing, University of Washington, Seattle, WA, USA. spieker@uw.edu

Child Maltreatment
|September 6, 2012
PubMed

Insights

Promoting First Relationships (PFR) intervention improved caregiver sensitivity and toddler understanding for children in state care. However, these gains were not sustained at the 6-month follow-up.

Area of Science:

  • Child Development
  • Psychology
  • Social Work

Background:

  • Children in state dependency often experience placement disruptions, impacting their development and caregiver relationships.
  • Effective interventions are needed to support vulnerable families and improve outcomes for toddlers in out-of-home care.

Purpose of the Study:

  • To evaluate the effectiveness of the Promoting First Relationships (PFR) program in enhancing parenting skills and toddler outcomes.
  • To assess the impact of PFR on caregiver sensitivity, understanding of child social-emotional needs, and child competence.

Main Methods:

  • A community-based, randomized controlled trial was conducted with 210 toddlers (10-24 months) experiencing placement disruption.
  • Participants were randomized to a 10-week PFR intervention or a comparison condition, with community providers delivering the intervention.
  • Intent-to-treat analyses were used to compare outcomes between groups from baseline to postintervention and at 6-month follow-up.

Main Results:

  • Caregiver sensitivity, understanding of toddlers' social-emotional needs, and reported child competence significantly improved in the PFR group compared to the comparison group postintervention (effect sizes ranging from d = .36 to d = .42).
  • Within-individual change models indicated significant PFR effects on caregiver sensitivity and understanding.
  • At 6-month follow-up, no significant differences in caregiver or child outcomes were observed between groups, with only 61% of dyads remaining intact.

Conclusions:

  • The Promoting First Relationships intervention shows short-term benefits for improving caregiver-child interactions and understanding in toddlers within state dependency.
  • The lack of sustained effects at follow-up highlights challenges in maintaining intervention gains, possibly due to sample attrition and the complexities of the population.
  • Further research is needed to identify strategies for long-term support and engagement in this vulnerable population.

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