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Promising Program Seal

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.

Promoting First Relationships® (PFR) is a home visiting program that offers early intervention services to promote healthy attachment and development for infants who have had a change in their primary caregiver. Federal funding streams aimed at promoting healthy development of young children and preventing child abuse, including Medicaid, Title V, IDEA Part C, and Title IV-B Child Welfare Services, can support Promoting First Relationships®. State funds allocated for child welfare services can also support Promoting First Relationships. Finally, the Affordable Care Act made an historic investment in home visiting, allocating $1.5 billion to support states in implementing evidence-based home visiting programs through the Maternal, infant and Early Childhood Home Visiting Program.

Allocating State or Local General Funds

In addition to commitments of state general fund dollars for Medicaid match, many states allocate state and county funds to support preventive child welfare services. These dollars are an important source of support for Promoting First Relationships®.

Maximizing Federal Funds


Medicaid: If the intervention is delivered by Medicaid-eligible providers, the program can potentially be billed as a Medicaid therapeutic service, or through targeted case management services under Medicaid. Whether Medicaid billing is an option depends on the state Medicaid plan.

Formula Funds:

  • Maternal, Infant, and Early Childhood Home Visiting Grants – The Affordable Care Act created a dedicated funding stream to support evidence-based home visiting programs. Funds flow to a state agency designated by the governor to administer the program, which then assesses needs and administers funds to local communities.
  • Title V Maternal and Child Health Block Grant, which funds public health activities aimed at supporting healthy pregnancy and early childhood.
  • Title IV-B Child Welfare Services grant which can be used to fund child abuse prevention activities and family preservation services.
  • IDEA Part C: Early Intervention Services for Infants and Toddlers with Disabilities that supports early intervention services for children 0 - 3 with developmental delays or disabilities. Staff implementing EI services can be trained to deliver the PFR model.
  • Temporary Assistance for Needy Families which is the core funding stream dedicated to providing income support for low income families and can also be used fairly flexibly by states to support four key goals, including assisting needy families so children can be cared for in their own homes.

Discretionary Grants: There are many federal discretionary grants supporting child welfare and early care and education that can potentially support PFR, including programs within SAMHSA, the Department of Education and the Children’s Bureau within DHHS.

Foundation Grants and Public-Private Partnerships

Foundations that prioritize investments in child welfare services and healthy early childhood development are good targets for investing in PFR. Local United Ways that invest in home visiting programs and child welfare have also supported PFR.

Generating New Revenue

Many states have Children’s Trust Funds that are supported with dedicated revenue streams from license plates, commemorative documents and tax form check-offs. Children’s Trust Funds support child abuse prevention services and are a potential source of support for PFR.