Manuscript Detail | Home Visiting Evidence of Effectiveness

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.

Manuscript screening details
Screening decision	Screening conclusion	HomVEE procedures and standards version
Passes screens	Eligible for review	Version 2

Study design details
Rating	Design	Attrition	Baseline equivalence	Compromised randomization	Confounding factors	Valid, reliable measure(s)
High	Randomized controlled trial	Low	Not assessed for randomized controlled trials with low attrition	No	No	Yes, details reported below for findings on valid, reliable outcomes that otherwise rate at least moderate

Notes:

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.

Study characteristics
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 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.
Subgroups examined	This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). 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.
Author affiliation	The authors are affiliated with the University of Washington, which sponsors Promoting First Relationships. Monica Oxford, one of the authors of the study, is the executive director of Promoting First Relationships.
Peer reviewed	Yes

Study Registration:

Clinicaltrials.gov Identifier: NCT01332851. SocialScienceRegistry.org Identifier: None found. Registry of Efficacy and Effectiveness Studies Identifier: None found. Study registration was assessed by HomVEE for Clinicaltrials.gov beginning with the 2014 review, and for other registries beginning with the 2021 review.

Findings that rate moderate or high

Child development and school readiness
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = -0.96	Unadjusted mean = -0.92	Mean difference = -0.04	HomVEE = -0.09	Not statistically significant, p = 0.48	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = -1.05	Unadjusted mean = -0.99	Mean difference = -0.06	HomVEE = -0.18	Not statistically significant, p = 0.20	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child atypical affective communication - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = -1.02	Unadjusted mean = -1.00	Mean difference = -0.02	Study reported = -0.05	Not statistically significant, p = 0.69	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 11.82	Unadjusted mean = 11.80	Mean difference = 0.02	HomVEE = 0.00	Not statistically significant, p = 0.98	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = 11.01	Unadjusted mean = 12.19	Mean difference = -1.18	HomVEE = -0.18	Not statistically significant, p = 0.18	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child behavior problems - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = 11.23	Unadjusted mean = 11.87	Mean difference = -0.64	Study reported = -0.08	Not statistically significant, p = 0.56	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Child emotion regulation - Behavior Rating Scales (BRS)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 3.82	Unadjusted mean = 3.96	Mean difference = -0.07	Study reported = -0.11	Not statistically significant, p = 0.43	Findings adjusted for baseline values of the outcomes, age of the child at baseline, and months between baseline and postintervention assessment.
High	Child engagement/exploration - Behavior Rating Scales (BRS)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 4.15	Unadjusted mean = 4.25	Mean difference = -0.06	Study reported = -0.11	Not statistically significant, p = 0.45	Findings adjusted for baseline values of the outcomes, age of the child at baseline, and months between baseline and postintervention assessment.
High	Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = 0.52	Unadjusted mean = 0.51	Mean difference = 0.01	HomVEE = 0.03	Not statistically significant, p = 0.83
High	Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = 0.62	Unadjusted mean = 0.57	Mean difference = 0.05	HomVEE = 0.16	Not statistically significant, p = 0.26
High	Child secure base behavior - Toddler Attachment Sort-45 (TAS-45), Attachment Q-sort scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 0.56	Unadjusted mean = 0.56	Mean difference = 0.00	HomVEE = 0.00	Not statistically significant, p = 1.00
High	Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 17.55	Unadjusted mean = 17.41	Mean difference = 0.14	HomVEE = 0.05	Not statistically significant, p = 0.73
High	Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = 17.40	Unadjusted mean = 17.37	Mean difference = 0.03	HomVEE = 0.01	Not statistically significant, p = 0.94
High	Child social-emotional competence - Brief Infant Toddler Social and Emotional Assessment (BITSEA)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = 17.72	Unadjusted mean = 17.78	Mean difference = -0.06	HomVEE = -0.02	Not statistically significant, p = 0.88

Maternal health
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Parenting stress: competence - Parent-Child Competence Scale from the Parenting Stress Index-3 (PSI-3)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted proportion = 19.80	Unadjusted proportion = 19.33	Mean difference = 0.47	Study reported = 0.07	Not statistically significant, p = 0.59	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Parenting stress: competence - Parent-Child Competence Scale from the Parenting Stress Index-3 (PSI-3)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 19.73	Unadjusted mean = 19.95	Mean difference = -0.22	Study reported = -0.03	Not statistically significant, p = 0.80	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Parenting stress: dysfunctional interaction - Parent-Child Dysfunctional Interaction Scale from Parenting Stress Index (PSI) short form	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = 21.26	Unadjusted mean = 21.70	Mean difference = -0.44	Study reported = -0.09	Not statistically significant, p = 0.53	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.
High	Parenting stress: dysfunctional interaction - Parent-Child Dysfunctional Interaction Scale from Parenting Stress Index (PSI) short form	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 18.48	Unadjusted mean = 18.80	Mean difference = -0.32	Study reported = -0.06	Not statistically significant, p = 0.67	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.

Positive parenting practices
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	Parent sensitivity- Nursing Child Assessment Teaching Scale (NCATS)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	3 months post-intervention	215 parent/child dyads	Unadjusted mean = 27.77	Unadjusted mean = 27.39	Mean difference = 0.38	HomVEE = 0.08	Not statistically significant, p = 0.55
High	Parent sensitivity- Nursing Child Assessment Teaching Scale (NCATS)	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = 27.34	Unadjusted mean = 26.70	Mean difference = 0.64	HomVEE = 0.13	Not statistically significant, p = 0.32
High	Parent understanding of toddler - Raising a Baby Scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	6 months post-intervention	211 parent/child dyads	Unadjusted mean = 52.40	Unadjusted mean = 50.81	Mean difference = 1.59	HomVEE = 0.31	Statistically significant, p = 0.03	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.
High	Parent understanding of toddler - Raising a Baby Scale	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	Post-intervention	225 parent/child dyads	Unadjusted mean = 52.09	Unadjusted mean = 50.04	Mean difference = 2.05	Study reported = 0.42	Statistically significant, p < 0.01	HomVEE calculated significance Submitted by nwu on Fri, 04/12/2019 - 18:31 Statistical significance is based on HomVEE calculations.

Reductions in child maltreatment
Rating	Outcome measure	Effect	Sample	Timing of follow-up	Sample size	Intervention group	Comparison group	Group difference	Effect size	Statistical significance	Notes
High	CPS-initiated child removals from birth parent	FavorableUnfavorable or ambiguousNo Effect	PFR vs. R&R, Washington state 2011-2014	15 months post-intervention	211 parent/child dyads	Unadjusted proportion = 0.06	Unadjusted proportion = 0.13	Incidence rate ratio = 2.50	HomVEE = -0.56	Statistically significant, p= 0.04	Negative effect is favorable Submitted by user on Fri, 03/15/2019 - 14:29 Negative effect is favorable to the intervention.