Promoting First Relationships®—Home Visiting Options

Model effectiveness research report last updated: 2021

Effects shown in research

Child development and school readiness

Findings rated high

Oxford, M. L., Hash, J. B., Lohr, M. J., Bleil, M., Unützer, J., & Spieker, S. J. (2020). Randomized trial of Promoting First Relationships® for new mothers who received community mental health services in pregnancy. Unpublished manuscript submitted to HomVEE.

Promoting First Relationships^®—Home Visiting Intervention Model

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Difficultness	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	225 infants	Unadjusted mean = 2.23	Unadjusted mean = 2.71	Mean difference = -0.48	Study reported = -0.22	Not statistically significant, p = 0.11	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations. Unadjusted mean.
Difficultness	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	252 infants	Adjusted mean = 2.23	Adjusted mean = 2.71	Difference = -0.49	Study reported = -0.16	Not statistically significant, p= 0.09	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Adjusted to control for preferred language and baseline measure.
Dysregulation	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	243 infants	Unadjusted mean = 54.82	Unadjusted mean = 55.33	Mean difference = -0.51	Study reported = -0.04	Not statistically significant, p = 0.77	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations. Unadjusted mean.
Dysregulation	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	252 infants	Adjusted mean = 54.82	Adjusted mean = 55.33	Difference = -0.56	Study reported = -0.04	Not statistically significant, p= 0.75	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Adjusted to control for preferred language.
Externalizing behavior	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	243 infants	Unadjusted mean = 59.24	Unadjusted mean = 62.54	Mean difference = -3.30	Study reported = -0.28	Statistically significant, p = 0.03	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations. Unadjusted mean.
Externalizing behavior	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	252 infants	Adjusted mean = 59.24	Adjusted mean = 62.54	Difference = -3.27	Study reported = -0.28	Statistically significant, p= 0.03	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Adjusted to control for preferred language.
Internalizing behavior	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	243 infants	Unadjusted mean = 53.64	Unadjusted mean = 54.93	Mean difference = -1.29	Study reported = -0.12	Not statistically significant, p = 0.37	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations. Unadjusted mean.
Internalizing behavior	FavorableUnfavorable or ambiguousNo Effect	12 months of age	PFR vs. comparison, Washington 2015-2020, full sample	252 infants	Adjusted mean = 53.64	Adjusted mean = 54.93	Difference = -1.22	Study reported = -0.11	Not statistically significant, p= 0.39	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention. Adjusted to control for preferred language.

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.

Promoting First Relationships^®—Home Visiting Intervention Model

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort	FavorableUnfavorable or ambiguousNo Effect	6 months post-intervention	PFR vs. R&R, Washington state 2011-2014	211 parent/child dyads	Unadjusted mean = -1.05	Unadjusted mean = -0.99	Mean difference = -0.06	HomVEE = -0.18	Not statistically significant, p = 0.20	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. R&R, Washington state 2011-2014	225 parent/child dyads	Unadjusted mean = -0.96	Unadjusted mean = -0.92	Mean difference = -0.04	HomVEE = -0.09	Not statistically significant, p = 0.48	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = -1.02	Unadjusted mean = -1.00	Mean difference = -0.02	Study reported = -0.05	Not statistically significant, p = 0.69	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = 11.82	Unadjusted mean = 11.80	Mean difference = 0.02	HomVEE = 0.00	Not statistically significant, p = 0.98	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	6 months post-intervention	PFR vs. R&R, Washington state 2011-2014	211 parent/child dyads	Unadjusted mean = 11.23	Unadjusted mean = 11.87	Mean difference = -0.64	Study reported = -0.08	Not statistically significant, p = 0.56	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. R&R, Washington state 2011-2014	225 parent/child dyads	Unadjusted mean = 11.01	Unadjusted mean = 12.19	Mean difference = -1.18	HomVEE = -0.18	Not statistically significant, p = 0.18	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
Child emotion regulation - Behavior Rating Scales (BRS)	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = 3.82	Unadjusted mean = 3.96	Mean difference = -0.07	Study reported = -0.11	Not statistically significant, p = 0.43	Findings adjusted for baseline values of the outcomes, age of the child at baseline, and months between baseline and postintervention assessment.
Child engagement/exploration - Behavior Rating Scales (BRS)	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = 4.15	Unadjusted mean = 4.25	Mean difference = -0.06	Study reported = -0.11	Not statistically significant, p = 0.45	Findings adjusted for baseline values of the outcomes, age of the child at baseline, and months between baseline and postintervention assessment.
Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = 0.56	Unadjusted mean = 0.56	Mean difference = 0.00	HomVEE = 0.00	Not statistically significant, p = 1.00
Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	6 months post-intervention	PFR vs. R&R, Washington state 2011-2014	211 parent/child dyads	Unadjusted mean = 0.62	Unadjusted mean = 0.57	Mean difference = 0.05	HomVEE = 0.16	Not statistically significant, p = 0.26
Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. R&R, Washington state 2011-2014	225 parent/child dyads	Unadjusted mean = 0.52	Unadjusted mean = 0.51	Mean difference = 0.01	HomVEE = 0.03	Not statistically significant, p = 0.83
Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	3 months post-intervention	PFR vs. R&R, Washington state 2011-2014	215 parent/child dyads	Unadjusted mean = 17.55	Unadjusted mean = 17.41	Mean difference = 0.14	HomVEE = 0.05	Not statistically significant, p = 0.73
Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	6 months post-intervention	PFR vs. R&R, Washington state 2011-2014	211 parent/child dyads	Unadjusted mean = 17.72	Unadjusted mean = 17.78	Mean difference = -0.06	HomVEE = -0.02	Not statistically significant, p = 0.88
Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. R&R, Washington state 2011-2014	225 parent/child dyads	Unadjusted mean = 17.40	Unadjusted mean = 17.37	Mean difference = 0.03	HomVEE = 0.01	Not statistically significant, p = 0.94

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.

Promoting First Relationships^®—Home Visiting Intervention Model

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Outcome measure	Effect	Follow-up timing	Sample	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
Attachment security: Toddler Attachment Sort-45 (TAS45, modified version of Attachment Q-Sort, using trilemmas)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	175 children	Not reported	Not reported	Not reported	Not available	Not statistically significant, p= >0.10	Finding estimated with hierarchical linear model (HLM).
Attachment security: Toddler Attachment Sort-45 (TAS45, modified version of Attachment Q-Sort, using trilemmas)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	175 children	Adjusted mean = 0.58	Adjusted mean = 0.54	Mean difference = 0.04	Study reported = 0.16	Not statistically significant, p= 0.41
Competence: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 11 item subscale)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	163 children	Adjusted mean = 17.35	Adjusted mean = 16.38	Mean difference = 0.97	Study reported = 0.42	Statistically significant, p= 0.03
Competence: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 11 item subscale)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	175 children	Not reported	Not reported	Not reported	Not available	Not statistically significant, p= >0.10	Finding estimated with hierarchical linear model (HLM).
Problem behavior: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 31 item subscale)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	175 children	Not reported	Not reported	Not reported	Not available	Not statistically significant, p= >0.10	Negative effect is favorable to the intervention. Finding estimated with hierarchical linear model (HLM).
Problem behavior: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 31 item subscale)	FavorableUnfavorable or ambiguousNo Effect	Post-intervention	PFR vs. EES, one county in Washington state, 2007-2010, full sample	163 children	Adjusted mean = 10.81	Adjusted mean = 10.72	Mean difference = 0.09	Study reported = -0.02	Not statistically significant, p= 0.92	Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

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