Randomized Controlled Trials

Several Randomized Clinical Trial (RCT) studies have been conducted using the Promoting First Relationships program across a broad range of populations:

Four Randomized Clinical Trials (RCT) have been completed with PFR: two in child welfare populations Fostering Families Project (FFP [1]: N = 210) and Supporting Parents Program (SPP [7]: N = 247); one within an American Indian tribe, Beginning Relationships, (N = 34) [18]; and one with a perinatal population with Spanish and English-speaking mothers who have a mental health diagnosis, Mom and Baby Program (N = 254) [19].

PFR significantly improved:

  • Observed parental sensitivity in all four studies [1,7,18,19], Effect size Cohen’s d = .21 – 1.21
  • Parent knowledge of child social and emotional needs [1,5,7,18,19], Cohen’s d = .20 – .58
  • Child behavior, security [1,5,7,8,19] and sleep [3,12], Cohen’s d = .19 – 1.18
  • Prevented foster care placement by 2.5 times [7]
  • Improved permanency for children in foster care [2]
  • Improved stress physiology [4,9] and improved social attention in children at risk for Autism Spectrum Disorders [16].

Two other RCT’s are current in field with diverse populations including American Indians and reunified birth families.

Reference list for publications regarding Promoting First Relationships:

Email rees@uw.edu to receive a copy of any of the below papers free of charge.


Fostering Families Project 2005-2010

  1. Spieker, S., Oxford, M., Kelly, J., Nelson, E., & Fleming, C. (2012). Promoting First Relationships randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment, 17(4), 271-286.
  2. Spieker, S.J., Oxford, M.L., & Fleming, C.B. (2014). Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention. Children and Youth Services Review44, 201-206.
  3. Oxford, M., Fleming, C., Nelson, E., Kelly, J., & Spieker, S. (2013). Randomized trial of Promoting First Relationships: Effects on maltreated toddlers’ separation distress and sleep regulation after reunification. Children and Youth Services Review, 35(12), 1988-1992.
  4. Nelson, E.M., & Spieker, S.J. (2013). Intervention effects on morning and stimulated cortisol responses among toddlers in foster care. Infant Mental Health Journal, 34(3), 211-221.
  5. Pasalich, D.S., Fleming, C.B., Oxford, M.L., Zheng, Y., & Spieker, S.J. (2016). Can parenting intervention prevent cascading effects from placement instability to insecure attachment to externalizing problems in maltreated toddlers? Child Maltreatment, 21(1), 175-185.
  6. Oxford, M.L., Marcenko, M., Fleming, C.B., Lohr, M.J., & Spieker, S.J. (2016). Promoting birth parents’ relationships with their toddlers upon reunification: Results from Promoting First Relationships® home visiting program. Children and Youth Services Review, 61,109-116.

Supporting Parents Program 2010-2015

  1. 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.
  2. Pasalich, D.S., Fleming, C.B., Spieker, S.J., Lohr, M.J., & Oxford, M.L. (2018) Does parents’ own history of child abuse moderate the effectiveness of the Promoting First Relationships® intervention in Child Welfare? Child Maltreatment, 21(1), 175-185
  3. Hastings, P.D., Kahle, S., Fleming, C., Lohr, M.J., Katz, L.F., & Oxford, M.L. (2019). An intervention that increases parental sensitivity in families referred to Child Protective Services also changes toddlers’ parasympathetic regulation. Developmental Science, 22 (1).
  4. Kuklinski, M.R., Oxford, M.L., Spieker, S.J., Lohr, M.J., & Fleming, C.B. (2020). Benefit-cost analysis of Promoting First Relationships®: Implications of victim benefits assumptions for return on investment. Child Abuse & Neglect106, 104515.
  5. Hash, J.B., Oxford, M.L., Fleming, C.B., Ward, T.M., & Spieker, S.J. (2019). Sleep problems, daily napping behavior, and social-emotional functioning among young children from families referred to Child Protective Services. Behavioral Sleep Medicine, 18(4), 447-459.
  6. Hash, J.B., Oxford, M.L., Fleming, C.B., Ward, T.M., Spieker, S.J., & Lohr, M.J. (2019). Impact of a home visiting program on sleep problems among young children experiencing adversity. Child Abuse & Neglect89, 143-154.
  7. Oxford, M.L., Spieker, S.J., Lohr, M.J., Fleming, C.B., Dillon, C., & Rees, J. (2018). Ensuring implementation fidelity of a 10-week home visiting program in two randomized clinical trials. Maternal and Child Health Journal, 22(3), 376-383.
  8. Spieker, S.J., Oxford, M.L., Fleming, C.B., & Lohr, M.J. (2018). Parental childhood adversity, Depressive symptoms, and parenting quality: Effects on toddler self-regulation in child welfare services involved families. Infant Mental Health Journal,39(1), 5-16.
  9. Hash, J.B., Oxford, M.L., Fleming, C.B., Ward, T.M., Spieker, S.J., & Lohr, M.J. (2019). Impact of a home visiting program on sleep problems among young children experiencing adversity. Child Abuse & Neglect, 89, 143-154.

Sibling Study

  1. Jones, E.J., Dawson, G., Kelly, J., Estes, A., & Webb, S.J. (2017). Parent‐delivered early intervention in infants at risk for ASD: Effects on electrophysiological and habituation measures of social attention. Autism Research10(5), 961-972.

Beginning Relationships 2012-2017

  1. Oxford, M., Booth-LaForce, C., Echo-Hawk, A., Madesclaire, O., Parrish, L., Widner, M., … & CATCH Project Team. (2020). Promoting First Relationships®: Implementing a home visiting research program in two American Indian communities. Canadian Journal of Nursing Research, 52(2), 149-156.
  2. Booth-LaForce, C., Oxford, M., Barbosa-Leiker, C., Burduli, D., and Buchwald, D., (2020). Randomized controlled trial of the Promoting First Relationships®preventive intervention for primary caregivers and toddlers in an American Indian community. Prevention Science21(1), 98-108.

Mom and Baby Study 2015-2020

  1. Spieker, S.J., Oxford, M.L., Hash, J.B., Lohr, M.J., & Fleming, C.B., (2020). Randomized trial of Promoting First Relationships® for new mothers who received prenatal community mental health services. Manuscript under review.