About the program

The Promoting First Relationships^® (PFR) program is a 10-week home visiting service that aims to support families to build positive connections, strengthen parent/carer confidence and increase parent/carer caregiving through use of strengths-based, reflective video feedback and curriculum.

Program structure

The PFR program is delivered weekly, for 1 hour, over a 10-week period with parents/carers and their children.  

Facilitators follow a program manual and observe interactions between parents/carers and their children via video recordings. Video recordings are used to help parents/carers reflect on their child’s social and emotional needs and how they respond to those needs. Facilitators then support parents/carers to better respond to their child’s needs; in the process building parenting confidence and competence. 

Evaluation and effectiveness

PFR has been extensively tested using randomised control trials with diverse populations of caregivers with toddlers (Oxford, Spieker et al., 2016; Spieker et al., 2012). The results of these and other studies (Pasalich et al, 2016, Spieker et al, 2014, Oxford et al, 2023) show that families, including families with the greatest need, positively benefit from the program.

For example, results from Oxford, Spieker and colleagues’ (2016) study of families who were under investigation by Child Protective Services for maltreatment (n=247), demonstrated statistically significant effects on parent understanding of toddlers, parent sensitivity, and child atypical affective communication. The study demonstrated non-significant effects on parent stress, child social-emotional competence and child emotion-regulation.  

An older study examined the outcomes of 210 families who were randomised into intervention and control groups (Spieker et al., 2012). In similar findings to the Oxford et al., paper (2016), parents/carers who attended PFR demonstrated improved levels of parental sensitivity compared to those in the control group. However, there were no major differences between the two groups on child security outcomes.

Visit the PFR website for further research.

References

Oxford, M. L., Spieker, S. J., Lohr, M. J., & 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(4), 267–277. https://doi.org/10.1177/1077559516668274  

Oxford, M. L., Hash, J. B., Lohr, M. J., Fleming, C. B., Dow-Smith, C., & Spieker, S. J. (2023). What works for whom? Mother’s psychological distress as a moderator of the effectiveness of a home visiting intervention. Infant Mental Health Journal, 44(3), 301–318. https://doi.org/10.1002/imhj.22050

Pasalich DS, Fleming CB, Oxford ML, Zheng Y, Spieker SJ. (2016). Can parenting intervention prevent cascading effects from placement instability to insecure attachment to externalizing problems in maltreated toddlers? Child Maltreatment, 21(3):175-185. doi:10.1177/1077559516656398

Spieker, S. J., Oxford, M. L., Kelly, J. F., Nelson, E. M., & Fleming, C. B. (2012). Promoting first relationships: Randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment, 17(4), 271–286. https://doi.org/10.1177/1077559512458176

Oxford, M.L., Spieker, S.J., Lohr, M.J., & 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(4):267-277. doi:10.1177/1077559516668274