research

Quasi-Experimental Research

Results of Promoting First Relationships Research and Training Efforts with Various Early Childhood Populations

In 1998, Dr. Kelly received a grant from the Royalty Research Fund to provide Promoting First Relationships to homeless families. Dr. Kelly and her colleague, Kim Buehlman, 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 partnership, nurse consultants were 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 trained nurse consultants and childcare providers in every health jurisdiction in the state of Washington. Trained nurses continued 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 full results are reported in Infants andYoung Children, Vol 21, No. 4, pp. 285-295.

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). See poster.

With funding from the Annie E. Casey Foundation, beginning in 2004, the Promoting First Relationships program partnered with the Human Services Policy Center in the Evans School of Public Affairs. This partnership was devised to address the limitation on improving the quality of care provided by “family, friends, and neighbors,” as these populations comprise a significant percentage of all non-parental care, especially for very young children. We implemented the Promoting First Relationships program with low-income grandmothers, who provided care to their grandchildren, in different racial and ethnic communities, through both home visits and small-group classes. This project showed feasibility in offering PFR to grandmothers in both group and home-visiting models. As a result of the intervention, quantitative results showed improved caregiving skills and decreased grandmother depression. Qualitative analyses of post-intervention interviews showed perceived change in grandmother’s caregiving behaviors, children’s behaviors, and the grandmother-daughter relationship. These results are reported in Maher, E., Kelly, J.F., Scarpa, J. (2008). A Qualitative Evaluation of a Program to Support Family, Friend, and Neighbor Caregivers. The NHSA Dialog: A Research-to-Practice Journal for the Early Intervention Field, Volume 11, Issue 2, April. We also, as part of this grant, conducted a workshop on the cultural appropriateness of the PFR curriculum, involving participants from different cultural and ethnic groups, which led to several changes in the Promoting First Relationships Curriculum.

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. Presented by Kelly and Spieker (2008). Promoting First Relationships: Results of a Training Program with Providers Serving Homeless Families. Zero to Three National Training Institute, Los Angeles, November 2008. See poster.

From 2007-2011, Promoting First Relationships had a contract (Promoting First Relationships Training for Children’s Administration Service Providers) with the Washington State’s Children’s Administration to conduct state-wide training with family support home visitors, as well as staff members from therapeutic childcares. These services are provided by Children’s Administration and contracted through community providers offering services to families that have received a Child Protective Services (CPS) referral. Services are also provided to foster care parents caring for children who are born drug-affected. After intensive on-site training with a Promoting First Relationships Master Trainer, the home visitors and child care consultants have the ability to use their newly acquired skills with the families and children whom they serve and to mentor others in their agencies.

In 2007 to Present (on-going), Promoting First Relationships also started a program of training (Promoting First Relationships in King County) funded through the King County Children and Family Commission to train local agencies in infant mental health practices. The participating agencies include mental health agencies, birth-to-three developmental centers, therapeutic child cares and the King County Health Department. After intensive on-site training with a Promoting First Relationships Master Trainer, the trained providers have the ability to use their newly acquired skills with the families and children whom they serve and to mentor others in their agencies to infuse infant mental health practices into their work. This is currently an on-going contract, now funded through the King County Health Department, with additional agencies applying for training each year.
Over the course of this contract, fifteen providers were trained at the Trainer level and were certified to train other colleagues within their agency to use PFR, as well as to use the intervention themselves.  In 2012, the training model changed to a shorter, learner-level model, which allowed more providers to be trained to use the PFR intervention with families on their caseloads. Sixteen providers were successfully trained at the learner level in 2012, and twelve additional learners have been selected to start their training in 2013.

From 2009 to 2010, Promoting First Relationships engaged in a one-year contract (Promoting First Relationships: Supporting the Social/Emotional Development of Young Children in Child Care) with the Boeing Foundation to provide training to Pierce and Snohomish County child care consultants in infant mental health. After intensive on-site training with a Promoting First Relationships Master Trainer, the child care consultants gained the ability to use their newly acquired skills with the families and children whom they serve and to mentor others in their agencies to infuse infant mental health practices into their work.

Beginning in Fall 2011, the Promoting First Relationships program introduced their newly developed distance learning training in order to reach providers across the United States and abroad.  Families First of Palm Beach County in Florida was the first group of sixteen providers to engage in this new method of training.  PFR Master Trainers use a video series that covers the core program principles followed by weekly on-line mentoring sessions to train providers in how to implement the PFR program with families on their caseloads.