American Indian or Alaska Native
3%
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.
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 that otherwise rate at least moderate |
Notes from the review of this manuscript
All but one of the findings in the manuscript were based on samples from a randomized controlled trial with low attrition. Therefore, HomVEE assigned these findings a high rating, including an outcome in the domain of reductions in child maltreatment that was measured 15 months after the intervention. One finding from the Nursing Child Assessment Teaching Scale, which Hash et al. (2016) also examined, was based on a sample with high attrition. That sample did not satisfy the baseline equivalence requirement based on correspondence with the authors of the Hash et al. (2016) manuscript. Therefore, that specific finding received a low rating. For two regression-adjusted findings denoted below, models controlled for baseline values of the outcomes, age of the child at baseline, and months between baseline and postintervention assessment. One finding for allegations of child maltreatment was not eligible for review because HomVEE only reviews outcome measures of child maltreatment allegations that have been substantiated.
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 |
|---|---|---|---|---|---|---|---|
| Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort | Post-intervention | High | 0.09 | Not statistically significant, p = 0.48 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort | 6 months post-intervention | High | 0.18 | Not statistically significant, p = 0.20 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale | 3 months post-intervention | High | 0.05 | Not statistically significant, p = 0.69 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | Post-intervention | High | 0.18 | Not statistically significant, p = 0.18 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | 3 months post-intervention | High | 0.00 | Not statistically significant, p = 0.98 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | 6 months post-intervention | High | 0.08 | Not statistically significant, p = 0.56 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child emotion regulation - Behavior Rating Scales (BRS) | 3 months post-intervention | High | 0.11 | Not statistically significant, p = 0.43 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child engagement/exploration - Behavior Rating Scales (BRS) | 3 months post-intervention | High | 0.11 | Not statistically significant, p = 0.45 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale | Post-intervention | High | 0.03 | Not statistically significant, p = 0.83 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale | 3 months post-intervention | High | 0.00 | Not statistically significant, p = 1.00 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale | 6 months post-intervention | High | 0.16 | Not statistically significant, p = 0.26 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | Post-intervention | High | 0.01 | Not statistically significant, p = 0.94 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | 3 months post-intervention | High | 0.05 | Not statistically significant, p = 0.73 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA) | 6 months post-intervention | High | 0.02 | Not statistically significant, p = 0.88 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 |
Maternal Health
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Parenting stress: competence - Parent-Child Competence Scale from the Parenting Stress Index-3 (PSI-3) | 3 months post-intervention | High | 0.03 | Not statistically significant, p = 0.80 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parenting stress: competence - Parent-Child Competence Scale from the Parenting Stress Index-3 (PSI-3) | 6 months post-intervention | High | 0.07 | Not statistically significant, p = 0.59 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parenting stress: dysfunctional interaction - Parent-Child Dysfunctional Interaction Scale from Parenting Stress Index (PSI) short form | 3 months post-intervention | High | 0.06 | Not statistically significant, p = 0.67 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parenting stress: dysfunctional interaction - Parent-Child Dysfunctional Interaction Scale from Parenting Stress Index (PSI) short form | 6 months post-intervention | High | 0.09 | Not statistically significant, p = 0.53 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 |
Positive Parenting Practices
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| Parent sensitivity- Nursing Child Assessment Teaching Scale (NCATS) | Post-intervention | High | 0.13 | Not statistically significant, p = 0.32 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parent sensitivity- Nursing Child Assessment Teaching Scale (NCATS) | 3 months post-intervention | High | 0.08 | Not statistically significant, p = 0.55 | 215 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parent understanding of toddler - Raising a Baby Scale | Post-intervention | High | 0.42 | Statistically significant, p < 0.01 | 225 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 | |
| Parent understanding of toddler - Raising a Baby Scale | 6 months post-intervention | High | 0.31 | Statistically significant, p = 0.03 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 |
Reductions In Child Maltreatment
| Outcome Measure | Timing of Follow-Up | Rating | Direction of Effect | Effect Size (Absolute Value) | Stastical Significance | Sample Size | Sample Description |
|---|---|---|---|---|---|---|---|
| CPS-initiated child removals from birth parent | 15 months post-intervention | High | 0.56 | Statistically significant, p= 0.04 | 211 parent/child dyads | PFR vs. R&R, Washington state 2011-2014 |
This study included participants from the following locations:
- Washington
Study Participants
Study participants were caregiver and child dyads residing in Washington State and recruited from families referred to Child Protective Services (CPS). To be eligible, participants had to speak English and live in western Washington State—specifically, in King, Skagit, or Snohomish counties. The child had to be ages 10 to 24 months, and the family had to have an open maltreatment allegation case with CPS at least two weeks before enrollment. Of 514 families contacted after being identified in CPS, 384 were determined eligible, and 247 were randomly assigned to either the Promoting First Relationships – Home Visiting Intervention Model (124 dyads) or to the comparison group (123 dyads). Some children (14 in total) experienced a caregiver change during the study. These children remained in the study in their original intervention condition and completed study assessments with their new caregiver. At the time of enrollment, the average age of a child was 16 months. Most children were White (62 percent); 31 percent were of mixed race or another race, 4 percent were Black, 2 percent were Asian, and 1 percent were American Indian or Alaska Native. Approximately 32 percent of children were Hispanic or Latino. Most caregivers in dyads (90 percent) were women, and most reported their race as White (77 percent).
Setting
The study took place in Western Washington State in six Child Protective Services offices in Snohomish, southern Skagit, and northern King Counties.
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. Instead, these dyads received a Resource and Referral program that included three phone-based sessions. During the first session, a social services provider conducted a 30-minute needs assessment, mailed a packet of referrals and resources, and followed up with two 10-minute check-in calls to the caregiver. The resource packet included about six resources tailored to each individual family based on the needs assessment. Resources included a listing of local service providers offering financial assistance, educational assistance, assistance obtaining household items, housing assistance, and parenting support services.
Subgroups examined
There were no subgroups reported in the manuscript.
Funding Sources
This research was supported by Award Numbers R01 HD061362 and U54HD083091 from the National Institute of Child Health and Human Development.