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Promoting First Relationships®

Blueprints Program Rating: Promising

A training program for service providers in the use of effective strategies for promoting secure and healthy relationships between caregivers and young children birth to three years of age.

Program Outcomes

  • Reciprocal Parent-Child Warmth

Program Type

  • Foster Care and Family Prevention
  • Home Visitation
  • Parent Training

Program Setting

  • Home
  • Mental Health/Treatment Center

Continuum of Intervention

  • Selective Prevention (Elevated Risk)
  • Indicated Prevention (Early Symptoms of Problem)


  • Infant (0-2)


  • Male and Female


  • All Race/Ethnicity


  • Blueprints: Promising

Program Information Contact

Jennifer Rees, Program and Training Manager
University of Washington
CHDD South Building Room 212
Box 357920
Seattle, WA 98195

Program Developer/Owner

  • Monica Oxford, MSW, Ph.D.
  • University of Washington

Brief Description of the Program

Promoting First Relationship® trains workers in early intervention, community mental health, home visiting and early care and education settings to deliver a home visiting program based on infant mental health principles. Promoting First Relationships® is strengths based. It uses joint observation and reflection on videotaped caregiver-child interactions to increase caregivers’ confidence and competence. Providers support caregivers’ ability to read their child’s nonverbal cues, empathize with and provide comfort when their child is distressed, and understand that their child’s difficult behavior may reflect underlying social and emotional needs. The program is delivered in the home to caregivers and children (birth to 3 years of age) in 10 weekly sessions of 60-75 minutes. The program model requires that providers receive regular reflective consultation.

See: Full Description


A randomized control trial conducted by the developer (Spieker et al., 2012) showed significant improvement among children in the treatment group as compared to the control group at posttest in:

  • Caregiver perception of competence, though this effect was no longer present at a 6-month follow-up assessment.
  • Parent sensitivity, a measure of reciprocal parent-child warmth (though this effect was not sustained 6 months later)
  • Parent understanding of toddler social emotional needs and developmental expectations (which also was not sustained 6 months later)

Oxford, Spieker et al. (2016) found significant improvement in the treatment group, as compared to the control group for:

  • Child atypical affective communication (a risk factor)
  • Parent understanding of toddlers (only at posttest and 6-month follow-up)
  • Parent sensitivity, also a measure of reciprocal parent-child warmth (only at 6-month follow up)
  • Chances of removal from the birth parent home within one-year post intervention.

Race/Ethnicity/Gender Details

The study did not provide differential analysis by race/ethnicity or gender.

Risk and Protective Factors

Risk Factors
  • Family: Parent stress

Training and Technical Assistance

Promoting First Relationships® (PFR) includes 2 levels of training. Level 1 is a prerequisite for Level 2. The studies certified by Blueprints included service providers with Level 2 training.

Level 1-- Knowledge Building:

This two-day workshop is designed to give service providers knowledge about using Promoting First Relationships® within one's own practice. The workshop is taught by PFR Master Trainers and includes the curriculum, parent handouts, and training in the following:

  • Elements of a Healthy Relationship
  • Attachment Theory and Secure Relationships
  • Reflective Capacity Building
  • Development of Self for Infants and Toddlers
  • PFR Consultation Strategies
  • Challenging Behaviors
  • Intervention Planning Development

Level 2 -- Skill Building (Provider Level):

In the mentored distance learning, participants work individually or in pairs with a PFR Master Trainer.

  • First 5 weeks: Trainees view professionally filmed PFR intervention sessions with caregivers (parents and child care providers) and young children (infant, toddler, special needs). The videos were developed and narrated by Dr. Jean Kelly, PFR founder. After viewing two videos at a time, trainees and their PFR Master Trainer will meet every week online to reflect on the filmed sessions and the PFR infant mental health essentials.
  • Next 10 weeks: Trainees are mentored weekly online as they intervene with caregiver/child dyads at their own sites. Sessions include reflection on videos of the dyadic interactions that trainees upload to a secure website, and discussion about how to implement PFR concepts and consultation strategies.

Training Certification Process

Level 3 -- Agency Trainer Level Training (by invitation only):

Individuals who have successfully completed the Level 2 training, may participate in an Agency Trainer Level Training (Level 3), by invitation only. This training certifies individuals to provide Level 2 trainings to service providers within their own agencies per the Agency Trainer Guidelines.

  • First 3 weeks: Participants view parent-child observation videos to hone observation skills and practice applying PFR concepts. Additional readings cover topics in attachment, understanding children's behavior through a social-emotional lens, and providing reflective consultation. Trainees meet weekly with their PFR Master Trainer to discuss this content.
  • Next 10 weeks: Trainees are mentored weekly as they intervene with a second caregiver/child dyad at their own site. Trainees will increase skills in providing the PFR intervention as they gain experience with an additional dyad.
  • Agency Trainers receive 2 sessions after completing their second family to prepare them to train others within their agency.

Brief Evaluation Methodology

Spieker et al. (2012) randomly assigned infant-caregiver dyads to either the Promoting First Relationships treatment program or a control group receiving another home visitation program. All participating infants had experienced a court-ordered change in caregiver and were referred by a state agency. The study assessed child behaviors and security and caregiver sensitivity and support at baseline, posttest, and 6 months after completion of the program. Using the same sample, Spieker et al. (2014) analyzed caregiver stability and permanency outcomes of children 2 years after they had enrolled in the study, and Pasalich et al. (2016) conducted additional moderation analyses. Meanwhile, two studies (Nelson & Spieker, 2013; Oxford et al., 2013) used a subsample of the dyads randomized in the Spieker et al. (2012) study to examine additional outcomes, including infant/toddler stress and sleep problems.

Oxford, Spieker et al. (2016) randomly assigned infant-caregiver dyads to either the Promoting First Relationships treatment program or to a control group receiving phone consultations and information on resources. All participating parents had been reported to child protective services for child maltreatment. The study assessed child and caregiver behaviors at baseline, posttest, 3-month follow-up, and 6-month follow-up.