American Indian or Alaska Native
3%
Source
Peer reviewed?
Yes
Pasalich, D. S., Fleming, C. B., Spieker, S. J. Lohr, M. J., & Oxford, M. L. (2019). Does parents' own history of child abuse moderate the effectiveness of the Promoting First Relationships® intervention in child welfare? Child Maltreatment, 24(1), 56-65.
Model(s) Reviewed
Study Registration
Funding Sources
This research was supported by Award Numbers R01 HD061362 and U54HD083091 from the National Institute of Child Health and Human Development.
Study Design
| 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
In the structural equation model in the manuscript, the authors reported the direct effect of the intervention on parental sensitivity, which makes this outcome eligible for review per HomVEE standards. Other findings reported in the manuscript for the structural equation model were mediated by other outcomes and are ineligible for review.
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 old. Most children were White (62 percent); 31 percent were of mixed race or reported 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.
Home Visiting Services
Promoting First Relationships – Home Visiting Intervention Model consisted of 10 weekly sessions, each lasting 60 to 75 minutes. All sessions took place in the families’ homes. The content of home visits was informed by attachment theory and strategies to help caregivers read their child’s cues. During weekly home visits, home visitors video recorded caregiver-child interactions, including caregiver-child play and caregiving activities, and guided caregivers through reflective feedback about the video recordings. To lead this feedback activity, home visitors highlighted positive interactions and offered instructive comments to enhance caregiving, allowing caregivers to reflect on their behavior. Home visitors also helped caregivers explore their own feelings and needs during the interaction, as well as those of the child. Home visitors and caregivers discussed ways to handle challenging child behaviors and explored the caregiver’s own social-emotional development and how that influences caregiving. In addition, home visitors gave caregivers handouts that contained information on the social and emotional needs of young children and strategies to meet those needs.
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.
Were any subgroups examined?
No
Subgroups examined
No to minor physical abuse history (parent); Moderate to severe physical abuse history (parent); No to minor sexual abuse history (parent); Moderate to severe sexual abuse history (parent); No to minor emotional abuse history (parent); Moderate to severe emotional abuse history (parent)
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 old. Most children were White (62 percent); 31 percent were of mixed race or reported 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.
Home Visiting Services
Promoting First Relationships – Home Visiting Intervention Model consisted of 10 weekly sessions, each lasting 60 to 75 minutes. All sessions took place in the families’ homes. The content of home visits was informed by attachment theory and strategies to help caregivers read their child’s cues. During weekly home visits, home visitors video recorded caregiver-child interactions, including caregiver-child play and caregiving activities, and guided caregivers through reflective feedback about the video recordings. To lead this feedback activity, home visitors highlighted positive interactions and offered instructive comments to enhance caregiving, allowing caregivers to reflect on their behavior. Home visitors also helped caregivers explore their own feelings and needs during the interaction, as well as those of the child. Home visitors and caregivers discussed ways to handle challenging child behaviors and explored the caregiver’s own social-emotional development and how that influences caregiving. In addition, home visitors gave caregivers handouts that contained information on the social and emotional needs of young children and strategies to meet those needs.
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.
Were any subgroups examined?
No
Subgroups examined
No to minor physical abuse history (parent); Moderate to severe physical abuse history (parent); No to minor sexual abuse history (parent); Moderate to severe sexual abuse history (parent); No to minor emotional abuse history (parent); Moderate to severe emotional abuse history (parent)
Findings that rate moderate or high in this manuscript
| 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 | 0.23 | Statistically significant, p= 0.01 |
247 mother/child dyads | PFR vs. R&R, Washington state 2011-2014 |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- Washington