Evidence-based model
MIECHV eligible
Released in 1979 through 2025
Impact studies rated high or moderate quality
Skip to: Effectiveness Implementation
Promoting First Relationships® (PFR) seeks to promote children’s social-emotional development. It does so by helping caregivers read and understand children’s cues, identify their children’s unmet needs, and use sensitive and responsive behaviors. PFR serves caregivers of children from birth through age 5. A trained home visitor video records the caregiver interacting with the child in the home, and the home visitor and caregiver together view and reflect on the recordings. PFR also provides caregivers with information about the social and emotional needs of young children and strategies to meet their needs. The model is designed to be delivered through hour-long home visits once a week for 10 to 14 weeks, but the time can be extended based on a family’s needs.
Where to find out more
Parent-Child Relationship Programs, University of Washington
1705 NE Pacific Street, Health Sciences Building F-346, Box 357231, Seattle, WA 98195
This model meets criteria established by the U.S. Department of Health and Human Services for an evidence-based home visiting model.
Does not meet criteria for an evidence-based home visiting model for Native communities.
For more information about manuscripts, search the research database.
For more information on the criteria used to rate research, please see details of HomVEEʼs methods and standards.
Released in 1979 through 2025
Eligible for review
Impact studies rated high or moderate quality
To see details on each manuscript HomVEE reviewed in well-designed research, click on the manuscript counts in the table.
Favorable:
A finding showing a statistically significant impact on an outcome measure in a direction that is beneficial for children and parents.
No effect:
Findings are not statistically significant.
Unfavorable:
A finding showing a statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents.
Ambiguous findings are excluded from this table. An ambiguous finding is a statistically significant impact on an outcome measure in a direction that is not clearly beneficial for or potentially harmful to children and/or parents.
| Outcomes | Manuscripts | Favorable Findings | No Effects Findings | Unfavorable Findings |
|---|---|---|---|---|
| Child Development and School Readiness | View 4 Manuscripts | 4 | 25 | 0 |
| Child Health | Not measured | - | - | - |
| Family Economic Self-Sufficiency | Not measured | - | - | - |
| Linkages and Referrals | Not measured | - | - | - |
| Maternal Health | View 3 Manuscripts | 0 | 10 | 0 |
| Positive Parenting Practices | View 6 Manuscripts | 17 | 19 | 0 |
| Reductions In Child Maltreatment | View 2 Manuscripts | 1 | 2 | 0 |
| Reductions in Juvenile Delinquency, Family Violence, and Crime | Not measured | - | - | - |
Well-designed impact studies about this model were conducted in the following locations:
In this section:
Support Availability
Service Delivery
Model services, adaptions and enhancements, model intensity and length.
Dr. Jean Kelly developed Promoting First Relationships® (PFR) at the University of Washington in 1998. The model is based on attachment theory and emphasizes the importance of developing strong early relationships with caregivers for children’s social, emotional, behavioral, language, and cognitive development. The model seeks to strengthen caregiver-child relationships by helping caregivers read and understand children’s cues—and the unmet needs behind challenging behaviors—and by supporting caregivers’ use of sensitive and responsive behaviors.
PFR serves caregivers of children from birth through age 5.
PFR seeks to promote children’s social-emotional development by strengthening secure and healthy parent-child relationships.
Highlights
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 PFR.
Throughout training and model implementation, the PFR trainer team provides regular check-ins and technical assistance.
Highlights
The primary service PFR offers is home visits. During a home visit, the home visitor records the caregiver with the child, and together the visitor and caregiver watch and reflect on the recording. Key activities when watching videos include the following:
The model uses the PFR curriculum available for purchase from PCRP. The curriculum includes a series of activities and discussions and covers the following topics:
PFR can be delivered virtually under certain circumstances, such as family illness, family preference, or when travel is not safe or possible.
Home visiting requirements: PFR is designed to be delivered through hour-long home visits once a week.
Additional requirements: No additional requirements.
Service duration: Families typically receive services for 10 to 14 weeks, but services can be extended based on a family’s needs.
The developer allows implementing agencies to offer an enhanced version of PFR (the Home Visiting Promotion Model), which broadens the pool of candidates whom agencies can hire as home visitors. In this version, staffing requirements can be tailored so programs better match the needs of the communities they serve: Home visitors can have a bachelor’s degree, or a two-year degree with experience, instead of the typically required master’s degree. There are no other differences.
PFR can be delivered in multiple settings, including group child care settings, pediatric care settings, and parent groups. HomVEE has not reviewed research about PFR in settings other than the home.
Before 2026, HomVEE reported findings for PFR as two separate home visiting models: (1) PFR—Home Visiting Intervention Model and (2) PFR—Home Visiting Promotion Model. HomVEE now recognizes and reports both as PFR, designating the model previously referred to as the PFR—Home Visiting Promotion Model as the enhanced version.
PFR has been implemented with Native families. Examples of how PFR can be tailored for implementation in Native communities include the following:
Highlights
Staff. Agencies that implement PFR must have home visitors and supervisors. They may also have PFR Agency Trainers (that is, home visitors who participate in the Agency Trainer training). More information about the Agency Trainer training can be found in the “Ongoing professional development” section of this brief.
Education and experience. PFR can be delivered by home visitors with a range of professional backgrounds, including infant mental health, public health, early intervention, early education, and social work. Home visitors must have experience working with children from birth through age 5 and their parents, and should demonstrate strong skills in observing parent-child interactions and engaging parents. Home visitors must have a master’s degree unless they are delivering the enhanced version of the model. If they are delivering the enhanced version, staffing requirements are tailored so that home visitors must have at least a two-year degree and preferably a bachelor’s degree.
Supervisors must have at least a bachelor’s degree and experience working with children from birth through age 5 and their parents.
Supervision. PFR distinguishes between supervision and consultation based on who provides the support. Reflective supervision is provided by a supervisor, while reflective consultation is provided by a PFR Agency Trainer or PFR Lead Trainer. Agencies must provide reflective consultation to home visitors at least once a month. For more information, please contact the model developer.
Preservice training. PCRP requires home visitors to complete a two-day Learner workshop (Level 1 training) prior to working with families. During the workshop, home visitors watch and discuss videos of caregiver-child interactions, review and discuss case studies, participate in role-play, and practice reflective dialogue. On-site and online workshops are available. PCRP recommends supervisors also attend the Level 1 training to supervise and support staff implementing the model. Please contact the model developer for more information about the preservice training requirement.
Ongoing professional development. After home visitors complete Level 1 training and begin working with families, PCRP requires them to participate in a four-month Skill-Building Certified Mentored training (Level 2 training). In the first five weeks, home visitors watch recorded PFR sessions of parent-child interactions and discuss them weekly with a PFR Lead Trainer. In the next 10 weeks, home visitors receive weekly online mentoring from their PFR Lead Trainer while implementing the curriculum with a parent-child dyad at their site. The home visitors record these PFR sessions and receive feedback from the Lead Trainer.
PFR also offers Level 3 Agency Trainer training, in which home visitors complete an additional 15-week training program to become PFR Agency Trainers. Agency Trainers may provide Level 2 Skill-Building Certified Mentored training to staff at their agency.
Please contact the model developer for more information about the requirement for ongoing professional development.
A variety of agencies can implement PFR, including child welfare, early intervention, public health, early education, and mental health agencies.
PCRP requires home visitors to meet ongoing fidelity guidelines. Please contact the model developer for more information about these guidelines.
Highlights
HomVEE requests input and feedback from the model developers on their profiles. The information in this implementation profile reflects feedback, if provided, from this model’s developer. HomVEE reserves the right to edit the profile for clarity and consistency. The description of the implementation of the model here may differ from how the model was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Model developers are encouraged to notify HomVEE of any changes to their contact information on this page.