History and Results of Promoting First Relationships Training Efforts with Various Early Childhood Populations
Promoting First Relationships began in 1998 with a grant from the Royalty Research Fund to provide early intervention to homeless families. Kelly and colleagues trained service providers (parent-child advocates) working with homeless families in King County, WA. In 1999, this work continued in a collaboration between Health Care for the Homeless Network and the Department of Family and Child Nursing at the University of Washington. The results from this initial project were quite significant and are reported in Topics in Early Childhood Special Education, Vol 20, Issue 3, Fall of 2000: Training Personnel to Promote Quality Parent-Child Interaction in Families Who Are Homeless. The article reports the significant change in provider behavior as a result of training. Providers became more positive, contingent and instructive to parents about their interactions with their young children. Mothers became more contingent, social and emotionally growth fostering, and stimulating in their interactions with their children.
As a result of these successful efforts, in the year 2000, PFR partnered with the Washington State Department of Health and Healthy Child Care Washington to enhance relationship quality between childcare providers and young children. In this on-going partnership, nurse consultants are trained to support childcare providers in their efforts to promote young children's social-emotional health and early development within the childcare setting. PFR staff have trained nurse consultants and childcare providers in every health jurisdiction in the state of Washington . Trained nurses are expected to continue to train childcare providers within their jurisdiction. Results from qualitative evaluations revealed that the unique on-site videotaping method and positive feedback approach are important elements of the training model. Providers expressed how they changed their perspective on children’s emotional needs, learned to be more empathetic, learned new strategies for dealing with behavioral issues, and came to better appreciate the important role they play in the child’s social and emotional development.
In 2002-2003, Promoting First Relationships was funded by the Washington State Department of Social and Health Services Infant-Toddler Early Education Program to train service providers in Washington State who work with young children (birth to three) with disabilities and their families, and to evaluate the results of training. Data analyses showed that as a result of training, service providers concentrated a significantly greater amount of their intervention on enhancing the parent-child relationship. Providers used more positive, instructive, and reflective behavior to coach mothers during dyadic interaction. As a result, parents scored significantly higher on the NCAST Teaching Scale from before to after the 8 weekly intervention visits. Mothers became more growth fostering in their interactions with their young children, more contingent, and showed more overall responsiveness and sensitivity with their children. Additionally, children became more responsive and contingent with their mothers. Partial results were presented at the Zero To Three National Training Institute (December, 2003). Dr. Kelly presented full results at the Society for Research in Child Development (SRCD) in Atlanta, GA (April, 2005),and a manuscript reporting full results is currently in press for publication in Infants and Young Children.
From 2001-2002, PFR, funded by the Administration for Children and Families trained Early Head Start providers in western Washington (Region X). This project combined expertise in working with both child care providers and parent-child advocates, offering training to Early Head Start center-based providers as well as home visitors who work and intervene with the parent-child relationship. Trainees reported that videotaping is a powerful learning tool for both providers and families, and that caregivers value the attachment-based approach. Providers further reported that the training helped them understand the family’s and child’s world, and to help parents feel and become more successful in their parenting roles. This training project showed that PFR training is successful and valued in both home and center-based settings.
In 2003, we again worked with Early Head Start, as part of our Healthy Child Care Washington contract with the Department of Health. We partnered with a combination home- and center-based program to train the agency’s 25-member staff in Promoting First Relationships, and to evaluate the results of training on provider behavior in both home and center-based settings. Data collection ended in June, 2004. Results showed significant changes from pre-training to post-training. On the “Ways of Being” measure (Kelly, Buehlman, & Korfmacher, 2003) center-based providers showed significant change from before to after PFR training. Specifically, they more often used interactive behaviors that promoted mutuality and stimulated learning. These results were presented at the Zero to Three National Training Institute in Orlando Florida (Oxford , M. & Kelly, J.F., 2007) click here for a copy.
From 2005-2007, the Promoting First Relationships program received funding from the Bill and Melinda Gates Foundation, to reach the goal of family stabilization for families with young children transitioning from homelessness to living in a home with a functional and satisfying family life. The plan for the program, as informed by needs assessments gathered from families and transitional housing staff, was to increase family stabilization by providing training to program staff working with families with young children (birth through 6 years), and to evaluate the effects of training on staff skills and knowledge, and parent and child functioning. For evaluation purposes, we examined the skills and knowledge of both the PHN staff members and families from before to after training.
Participating in PFR training improved staff attitudes toward children and parents, expanded staff knowledge of relationship-focused content, and changed actual observed staff behavior with families such that it became less directive, more positive, and more supportive of the parent-child relationship from before to after training. Observed staff/parent interactions showed that interactions became more focused on the parent-child relationship instead of focused solely on the parent. In our model of change, PHN staff members began to engage in supportive relationships with the parents so that, in turn, the parents could better support their children.
The training also resulted in very encouraging results for families. The pattern of results for parent and child outcomes strongly supports the conclusion that the 10-session PFR individual and group training for parents is an effective intervention for families in the transition from homelessness. Specifically, participating in the PFR training had positive effects on parent attitudes, parent perceived stress, and their observed social and emotional growth fostering of their children. As a result of changes in parenting attitudes and interactional behavior, the children (observed interacting with their parents) began to interact more with their parents, became more securely attached, and parents rated their children more socially competent then before the training, with fewer behavior problems. (unpublished report)
In early 2006, Promoting First Relationships began a 5-year project funded by the National Institute of Mental Health to acquire crucially needed evidence to support interventions promoting infants’ mental health in foster care. This project is also designed to build community capacity to deliver infant mental health interventions and services to foster families. This research project is a longitudinal, randomized controlled trial, and will involve over 200 foster families in Western Washington . The Promoting First Relationships staff will collaborate with community partners to conduct the research and assist in modifying the existing interventions for implementation with infants in foster care and their caregivers. A process evaluation of the collaborative partnership will be conducted, as will a test of the effectiveness of the interventions on the following outcomes: foster caregiver sensitivity, infant attachment security and emotional, behavioral, and developmental functioning, and placement stability.
In 2007, Promoting First Relationships began another 5- year randomized trial funded by National Institute of Child Health and Development to study the effects of early detection and intervention for infants at risk for autism.
In summary, Promoting First Relationships training has proved effective for promoting secure and nurturing parent-child relationships and child care provider-child relationships and is currently being used in a variety of early childhood settings.
Emde, R. N., & Sameroff, A. J. (1989). Understanding early relationship disturbances. In A. J. Sameroff & R. N. Emde (Eds.), Relationship disturbances in early childhood: A developmental approach. New York : Basic Books.
Kelly, J. F., Buehlman, K., & Caldwell, K. (2000). Training personnel to promote quality parent-child interaction in families who are homeless. Topics in Early Childhood Special Education, 20, 174-185.
Kelly, J.F., Zuckerman, T., & Rosenblatt, S. (in press). Promoting First Relationships: A
Relationship-Focused Early Intervention Approach. Infants and Young Children.
Shonkoff, J. & Phillips, D. (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington , DC : National Academies Press.
