Based on attachment theory, Promoting First Relationships® (PFR) is a brief, 10-week evidence-based, home-visiting intervention programme pioneered in the USA. It has been designed to support better infant mental health and aid brain development, giving parents the skills and knowledge to support their child’s emotional and social development. A central premise of attachment theory is that for optimal growth and development it is critical to feel safe and supported. Supporting families birth-five, PFR is unique because it trains providers to use unedited video recordings of the caregiver-child interaction to support caregivers in connecting to and understanding their child’s social and emotional needs through reflective observation. The results of PFR across multiple populations speak to its capacity to support caregivers as they learn to understand and support their child’s social and emotional needs.
PFR has been evaluated with a randomised control design in six different populations (one trial is still ongoing, Oxford et al., 2023); three in child welfare (Spieker et al., 2012; Oxford et al., 2016; Oxford et a., 2023), two within rural Native American communities (Booth La-Force et al., 2020; Booth La-Force 2022), and one with newborns in a perinatal mental health setting for both Spanish and English-speaking mothers (Oxford et al., 2021). In all five completed studies PFR improved observed caregiver sensitive and responsive care, caregiver knowledge of social and emotional development, and a range of child outcomes including behavioral problems (Paslish et al., 2016; Oxford et al., 2016; Oxford et al., 2021) and improved stress physiology (Nelson & Spieker, 2012; Hastings et a., 2018) as well as social attention in a study of children at risk for autism spectrum disorder (Jones et al., 2017). In the two completed child welfare studies, PFR prevented foster care placements for toddlers in the Child Protective Service population by 2.5 times (Oxford et al., 2016) and improved permanency outcomes for children in foster and kin care (Spieker et a., 2014).