Implementing Promoting First Relationships®—Home Visiting Options

Promoting First Relationships^® (PFR), based on attachment theory, posits that developing strong early relationships with parents and other caregivers^* is the key to healthy social, emotional, behavioral, language, and cognitive development in children. The model aims to promote parent/caregiver-child relationships by helping parents/caregivers read and understand children’s cues and the unmet needs behind challenging behaviors, and by supporting parents’/caregivers’ use of sensitive and responsive caregiving behaviors.

PFR can be used in multiple settings. The PFR-Home Visiting Options include two versions of PFR that are used with parents in the home: (1) PFR-Home Visiting Promotion Model and (2) PFR-Home Visiting Intervention Model. The only difference between the versions is that in the PFR-Home Visiting Intervention Model, home visitors must have a master’s degree. The PFR-Early Learning Model is used with caregivers responsible for group child care. The PFR-Pediatric Primary Care Model can be used one-on-one with parents during pediatric well-child visits for children from birth through age 2 years. The information in this profile describes the PFR-Home Visiting Promotion Model, but the information also applies to the PFR-Home Visiting Intervention Model unless specified otherwise.

*In this profile, the term “caregiver” refers to child care providers.

Parent-Child Relationship Programs (PCRP) at the Barnard Center for Infant Mental Health and Development at the University of Washington provides training and support to implement the PFR-Home Visiting Promotion Model. The Barnard Center for Infant Mental Health and Development developed the model.

On an as needed basis, PFR master trainers can provide agencies with 60- to 90-minute technical assistance sessions to address implementation issues.

The PFR-Home Visiting Promotion Model serves parents of children from birth through age 5 years.

The PFR-Home Visiting Promotion Model seeks to promote children’s social-emotional development by fostering secure and healthy parent-child relationships.

The PFR-Home Visiting Promotion Model involves home visitors providing feedback to parents based on video recordings of the parent’s interactions with the child. The home visitor makes video recordings of the parent interacting with the child at home, and the home visitor and parent view and reflect on the recordings. The home visitor highlights positive interactions observed and offers instructive comments to enhance caregiving. The home visitor also helps the parent reflect on their own behavior, feelings, and needs during the interaction, as well as on those of the child. In addition, the PFR-Home Visiting Promotion Model provides parents with information, including handouts, on the social and emotional needs of young children, and strategies to meet these needs. The home visitor and the parent discuss ways to handle challenging behaviors and explore the parent’s own social-emotional development and how that influences caregiving.

The PFR-Home Visiting Promotion Model uses the PFR curriculum, which is available for purchase from PCRP. The curriculum includes an outline of activities and discussions and covers the following topics:

• Elements of a healthy relationship;
• Attachment theory and secure relationships;
• Reflective capacity building;
• Development of self for infants and toddlers;
• Challenging behaviors;
• Strategies for working with parents/caregivers; and
• Intervention planning.

The curriculum package includes a manual and 20 reproducible handouts for parents and caregivers.

The PFR-Home Visiting Promotion Model is designed to provide weekly hour-long home visits for 10 to 14 weeks. The model can be extended based on a family’s needs.

The PFR-Home Visiting Promotion Model has been adapted for use with American Indian families.

PCRP oversees all adaptations and enhancements to the PFR-Home Visiting Options.

The PFR-Home Visiting Promotion Model can be implemented by a variety of agencies, including child welfare, early intervention, public health, early education, and mental health.

PCRP requires home visitors to meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

Staff with backgrounds in a range of areas—including infant mental health, public health, early intervention, early education, and social work—can deliver the PFR-Home Visiting Promotion Model. Agencies must have at least two trained home visitors who receive reflective supervision regularly in order to deliver the PFR-Home Visiting Promotion Model.

For the PFR-Home Visiting Promotion Model, PCRP requires that home visitors have at least a two-year degree, and prefers that they have a bachelor’s degree. For the PFR-Home Visiting Intervention Model, home visitors must have a master’s degree. All home visitors must have prior experience working with children and their parents from birth through age 5 years and should have strong parent-child observation and parent engagement skills. Supervisors must have at least a bachelor’s degree, and experience both working with children and their parents from birth through age 5 years and providing reflective supervision.

Agencies must provide home visitors with reflective supervision at least once per month. PFR agency trainers (home visitors who participate in the agency train-the trainer process) and PFR master trainers do not supervise home visitors per se, but they do provide reflective consultation. In agencies with an agency PFR trainer, the agency PFR trainer provides monthly reflective consultation to the home visitors. For agencies without an agency PFR trainer, PCRP offers monthly group reflective consultation to home visitors. PFR master trainers lead small-group meetings during which the trainer provides consultation on PFR skills and concepts and provides reflective consultation, offering space and time for home visitors to engage in reflective practice. PCRP strongly recommends, but does not require, this monthly consultation with the PFR master trainer for agencies that do not have an agency trainer. PCRP requires agency PFR trainers to participate in monthly reflective practice consultation with a master PFR trainer from PCRP. The master PFR trainer provides consultation on PFR skills and concepts, and space and time for agency trainers to reflect on their own delivery of PFR and the PFR training they provide.

PCRP requires home visitors to participate in a two-day Learner workshop (Level 1 training). During the workshop, home visitors watch and discuss videos of caregiver-child interactions, review and discuss case studies, role play, and practice reflective dialogue.^* On-site and online workshops are available. PCRP recommends that supervisors also attend the Level 1 training to supervise and support their staff who are implementing the model. Please contact the model developer for additional information about the pre-service training requirement.

After completing the Level 1 training, home visitors begin serving families and participating in a 4-month Skill-Building Certified Mentored training (Level 2 training).^** During the first 5 weeks, home visitors watch recorded PFR sessions of parent-child interactions and discuss the sessions weekly with a PFR master trainer. During the following 10 weeks, home visitors receive weekly online mentoring from their PFR master trainer while they implement the curriculum with a parent-child dyad at their own site. During this period, home visitors also record themselves delivering PFR sessions, and the PFR master trainer provides feedback. Please contact the model developer for additional information about the ongoing professional development requirement.

*For all PFR model versions, practitioners receive the same Level 1 training regardless of the delivery setting or population with whom they plan to work. There is not a separate Level 1 training for the PFR-Home Visiting Promotion Model.

**There is not a separate Level 2 training for home visitors. The Certified Mentored training is offered to practitioners who work with parents in the home and with caregivers.