American Indian or Alaska Native
7%
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.
Peer Reviewed
Study Registration: ClinicalTrials.gov
Study design characteristics contributing to rating
| Design | Attrition | Baseline equivalence | Confounding factors? | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low |
Not assessed for randomized controlled trials with low attrition |
No |
Yes, details reported below for findings on valid, reliable outcomes |
Notes from the review of this manuscript
The findings for the immediate post-intervention follow-up received a high evidence rating. The findings measured at six months post-intervention received a low evidence rating because attrition was high, and the findings did not satisfy the baseline equivalence requirement. The authors’ analyses controlled for whether the child experienced multiple removals from the birth home, for the caregiver type (biologically-related or foster), and for the age of the child. The authors’ analyses also controlled for the baseline measures of the following findings: caregiver sensitivity, support, commitment, understanding of toddlers, parenting stress, child's attachment security, engagement, competence, and problem behavior. Some findings in the manuscript were not eligible for review because they measured growth from the immediate post-test to the six-month follow-up and did not measure the impact of the intervention. Information that demonstrated the reliability of the outcome measures and baseline equivalence of the intervention and comparison groups was based on correspondence with the authors.
Child Development and School Readiness
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Attachment security: Toddler Attachment Sort-45 (TAS45, modified version of Attachment Q-Sort, using trilemmas) | Post-intervention | High | 0.16 | Not statistically significant, p= 0.41 | 175 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Attachment security: Toddler Attachment Sort-45 (TAS45, modified version of Attachment Q-Sort, using trilemmas) | Post-intervention | High | Not statistically significant, p= >0.10 | 175 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Competence: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 11 item subscale) | Post-intervention | High | 0.42 | Statistically significant, p= 0.03 | 163 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Competence: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 11 item subscale) | Post-intervention | High | Not statistically significant, p= >0.10 | 175 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Problem behavior: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 31 item subscale) | Post-intervention | High | 0.02 | Not statistically significant, p= 0.92 | 163 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Problem behavior: Brief Infant Toddler Social and Emotional Assessment (BITSEA, 31 item subscale) | Post-intervention | High | Not statistically significant, p= >0.10 | 175 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample |
Maternal Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Stress-Difficult Child: Parenting Stress Index-Short Form (PSI-SF, Difficult Child subscale, 12 items) | Post-intervention | High | 0.22 | Not statistically significant, p= 0.22 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Stress-Difficult Child: Parenting Stress Index-Short Form (PSI-SF, Difficult Child subscale, 12 items) | Post-intervention | High | Not statistically significant, p= >0.10 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Stress-Dysfunctional Interaction: Parenting Stress Index-Short Form (PSI-SF, Parent-Child Dysfunction subscale, 11 items) | Post-intervention | High | 0.13 | Not statistically significant, p= 0.48 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Stress-Dysfunctional Interaction: Parenting Stress Index-Short Form (PSI-SF, Parent-Child Dysfunction subscale, 11 items) | Post-intervention | High | Not statistically significant, p= >0.10 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample |
Positive Parenting Practices
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Commitment: This Is My Baby (TIMB) | Post-intervention | High | 0.17 | Not statistically significant, p= 0.35 | 169 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Commitment: This Is My Baby (TIMB) | Post-intervention | High | Not statistically significant, p= >0.10 | 169 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Engagement: Indicator of Parent-Child Interaction (IPCI, 9 item subscale) | Post-intervention | High | 0.15 | Not statistically significant, p= 0.39 | 173 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Engagement: Indicator of Parent-Child Interaction (IPCI, 9 item subscale) | Post-intervention | High | Not statistically significant, p= >0.10 | 173 children | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Sensitivity: Nursing Child Assessment Teaching Scale (NCATS, without 6 items on child distress) | Post-intervention | High | 0.41 | Statistically significant, p= 0.02 | 167 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Support: Indicator of Parent-Child Interaction (IPCI, 15 items) | Post-intervention | High | 0.11 | Not statistically significant, p= 0.49 | 173 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Support: Indicator of Parent-Child Interaction (IPCI, 15 items) | Post-intervention | High | Not statistically significant, p= >0.10 | 173 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | ||
| Understanding of toddlers: Raising a Baby (RAB, 16 items) | Post-intervention | High | 0.36 | Statistically significant, p= 0.04 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample | |
| Understanding of toddlers: Raising a Baby (RAB, 16 items) | Post-intervention | High | Statistically significant, p= <0.01 | 175 caregivers | PFR vs. EES, one county in Washington state, 2007-2010, full sample |
This study included participants from the following locations:
- Washington
Study Participants
Study participants were caregiver and child dyads residing in and recruited from one county in Washington State. The study authors recruited eligible dyads through referrals from the Department of Child and Family Services. To be eligible, the child in the dyad had to be between the ages of 10 and 24 months with a court-ordered placement that resulted in a change in primary caregiver within the prior 7 weeks. The caregivers all spoke English, and caregivers were foster parents or biological parents (or adult kin). More than one-quarter (27 percent) of the caregivers were biological parents, 31 percent were other kin, and 42 percent were foster parents. Of 427 dyads contacted to participate in the study, 210 were eligible and randomly assigned to either the Promoting First Relationships – Home Visiting Intervention Model (105 dyads) or to the comparison group (105 dyads). Some children (29 in total) had a placement change within 4 months of study enrollment. However, these children and their caregivers remained in the intervention condition to which they were first assigned. The study sample at the immediate post-intervention follow-up included 175 dyads: 86 in the PFR group and 89 in the comparison group. Children were an average of 18 months old at the time of enrollment. Most caregivers and children were White (77 percent of caregivers and 57 percent of children); 10 percent of caregivers and 14 percent of children were Black and 9 percent of caregivers and 10 percent of children were Hispanic or Latino. About one-quarter of dyads reported household incomes less than $20,000 per year. Caregivers reported an average of 13 years of education.
Setting
The study took place in one county in Washington State.
Intervention condition
Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.
Comparison Conditions
The comparison group members were not offered intervention services through Promoting First Relationships. Dyads assigned to the comparison group received Early Education Support, which consisted of three monthly 90-minute home visits conducted by home visitors with bachelor’s degrees. The home visitor helped connect families to resources such as Early Head Start, early intervention, housing, mental health services, and child care; and suggested activities to promote the child's growth and development.
Subgroups examined
There were no subgroups reported in the manuscript.
Funding Sources
This research was supported by Award Number R01 MH077329 from the National Institute of Mental Health and Award Number P30 HD02274 from the National Institute of Child Health and Human Development.