Core Components

Target population for Promoting First Relationships (PFR) is 0-3 years old (with materials extending to 5 years). The programme describes itself as a universal preventative programme, relevant for all parents of children 0-3 years old. Evidence suggests it is most beneficial for those families at high risk of attachment disruption and with parents who have themselves experienced physical abuse.

The programme is delivered as an individual home-visiting programme, comprising of 10 weekly home visits of 60-75 minutes each. The programme is clearly operationalised with the curriculum described for all 10 core visits.

Topics covered include:

• strategies for calming ourselves and our children
• how to meet the socioemotional needs of young children
• understanding and responding to challenging behaviour
• recognising the need for young children to feel safe and secure in their relationships with their caregivers

PFR delivery centres on video review of caregiver-child interactions which takes place on every other visit, interspersed with reflective observation and discussion regarding the parent-child relationship and understanding the toddler’s cues in terms of social and emotional underpinnings.

Fidelity

Fidelity assessment is mandatory and is assessed through PFR Master Trainer review of videotaped sessions, with core facets of delivery, as well as potential pitfalls, rated on scaled scoring sheets. Practitioners are provided with a detailed description of characteristics necessary to demonstrate fidelity to allow appropriate preparation.

Practitioners are only classified as a ‘Certified Provider’ once fidelity has been achieved. Fidelity is reassessed annually, and high fidelity is required for progression to Agency Trainer Training.

Modifiable Components

PFR has been adapted for use with a wide range of populations, maintaining the core components of programme content. Developers emphasise flexibility to attune to families’ needs with potential to extend the programme from the core 10 sessions for up to 14 sessions.

When home visits are not possible, the intervention can be delivered remotely using an online platform to conduct sessions and to record and review caregiver-child interactions. 

Promoting First Relationships (PFR) offers 3 levels of training. Level 1, Learner’s Workshop can be accessed onsite, in Seattle or online. Levels 2 & 3 are provided by distance learning.

Support for Organisation / Practice

Implementation Support

PFR provides a ‘Readiness Assessment’ checklist which supports agencies to select appropriate staff to undergo training and ensure systems are in place for successful implementation.

There is no compulsory routine data collection associated with the programme, however PFR can provide curricular checklists to support agencies with their own data collection where requested. Expert support throughout implementation process is available, if sites wish to access it, from the PFR Programme Director.

Licence Requirements

There are no licence requirements for providing the programme, however it is only recognised as the evidence-based intervention if providers have undertaken Level 2 training and successfully demonstrated fidelity.

Start-up Costs

Cost of programme delivery for one family is approx. $1,800 (2016). This includes training, weekly reflective practice, fidelity support, travel expenses and equipment including toys and camera.

Specific training costs are as follows:

• Level 1 - $585 per participant in-house Seattle or $11,000 for cohort up to 25 participants on-site with agency or delivered online via Zoom. 
• Level 2 - $2,500 per person if two or more individuals per agency are trained or $3,300 if only one person is trained
• Level 3 - $2,500 per person

Fidelity is reassessed annually at $150 per fidelity assessment.

Online coaching (optional for Level 2, compulsory for Level 3) is $500/year for 10 group sessions).

Building Staff Competency

Qualifications Required

PFR providers come from a range of professional backgrounds and there are no specific stipulations regarding qualifications, although Bachelor’s degree or more is recommended, experience with infants and children 0-3 years of age is expected.

It is recommended for a sustainable model that a minimum of two staff members from an agency are trained to at least Level 2 ‘Certified Provider’, with additional benefit if their organisational supervisor or manager also attends at least Level 1 training to ensure they are familiar with the programme content and implementation.

Training Requirements

Training is readily available through in-person (Level 1) and distance learning (Levels 2&3), provided by the PFR core team.

• Level 1 – 2 days of overview of programme principles and familiarisation with programme materials including curriculum and parent handouts. Level 1 training is now available virtually via Zoom and takes place over four 3.5 hour sessions
• Level 2 (to deliver the programme as a Certified Provider) – 15 weeks with PFR Master Trainer
o Initial 5 weeks – learners view caregiver-child intervention sessions
o Following 10 weeks – learners are mentored weekly online in interventions with caregiver/child dyads
• Level 3 – 15 weeks
o Initial 3 weeks – view caregiver-child observation videos to hone skills
o Following 10 weeks – weekly online mentoring in intervention with dyad
o Additional reading and training preparation for 2 follow-up weeks

Supervision Requirements

Coaching/Reflective Practice is provided by PFR programme and recommended for all Level 2 Certified Providers. Monthly coaching is essential for all Level 3 Agency Trainers.

RCT evidence has demonstrated that PFR participation improves child emotional regulation and increases toddlers’ secure base behaviours through positive change in the parent-child relationship as a result of enhanced parental sensitivity.

Theory of Change

Promoting First Relationships (PFR) supports parents to recognise toddler behaviour in terms of the child’s social and emotional needs. This improved parental sensitivity facilitates more appropriate, attuned parental responses and in turn enhances the parent-child relationship.

Values

Promoting First Relationships centres on improving the parent-child relationship through improving parental to their child’s cues. One of the core elements of programme delivery involves video recording interactions between parent and child within their home.

• Is the delivery of early-intervention home visiting services to improve attachment relationships aligned with the key values of your organisation?
• As a service, do you accept the essential role of capturing and reviewing video footage of parent-child interactions?

Priorities

PFR can be applied as a universal preventative programme however particular benefit has been evidenced with families of infants 0-3years old at risk of or experiencing difficulties in the child-caregiver relationship.

• Is the delivery of targeted services to families of babies and young children at risk of disrupted attachment relationships aligned with the priorities of your organisation?

Existing Initiatives 

• Does your service already provide early intervention programmes aiming to improve child development and mental health outcomes?

Workforce

Promoting First Relationships implementation requires at least 2 practitioners per site to deliver the home-visiting programme individually, weekly over ten weeks, with 8-12 families on each practitioners’ caseload. In addition to delivery, practitioners must have protected time of approximately 2-3 hours per week (overall i.e. not per family) to support their training and ongoing coaching of PFR skills. Practitioners must have experience in working with caregivers of infants and children 0-3 years old and be able to work with a strength-based, reflective approach. 

• Do you have practitioners within your service who embody these characteristics?
• Will your service be able to protect the time needed for practitioners to undertake the training, coaching and effective delivery of this programme?

PFR recommend that a manager or supervisor overseeing the PFR practitioners commits to attending at least Level 1 PFR training to ensure a familiarity with the programme and be best equipped to support practitioners effectively.

• Are you able to identify a supervisor or manager for these PFR practitioners who can attend Level 1 PFR training?

Technology Support

PFR delivery requires practitioners to be able to capture and review caregiver-child dyads, as well as to access Zoom technology to facilitate training and reflective practice sessions.

• Does your service have the technology and supports to allow these integral processes to take place?

Administrative Support

PFR requires some administrative support in ensuring handouts and materials are prepared for each session. PFR also requires the administrative management of video footage consent and storage.

• Do your current administrative procedures support your practitioners to implement a programme like this?
• Do you have policies in place which will allow for the safe storage and review of video footage?

Financial Support

Cost of programme delivery for one family is approx. $1,800 (2016). This includes training, weekly reflective practice, fidelity support, travel expenses  and equipment including toys and camera. In addition, annual fidelity review is $150 per fidelity assessment and online coaching (if required) is $500/year for 10 group sessions. 

• Do you have the finances to pay for practitioners to attend the training?
• Do you have the finances to pay for the printing of handouts, videotape recording of sessions and ongoing running costs for the delivery of the programme?
• Do you have the finances to pay for monthly reflective practice supervision and the annual fidelity assessment for each practitioner?

Comparable Population 

PFR is primarily targeted at families with children 0-3 years of age, with significant risk of disrupted caregiver-child attachment relationships. Mediation studies have shown that PFR has stronger effects on improving sensitivity when the caregiver reports a history of physical abuse when they were a child as well as stronger improvements on attachment security when the child has experienced multiple child welfare placements.

• Are families with children 0-3 years of age, with significant risk of disrupted caregiver-child attachment relationships, an identified population of particular concern to your organisation?

Desired Outcome

RCT evidence has demonstrated that PFR participation improves child emotional regulation and increases toddlers’ secure base behaviours through positive change in the parent-child relationship as a result of enhanced parental sensitivity. 

• Are the improvements of children’s social and emotional development and the quality of the caregiver-child relationship priority outcomes for your organisation?
• Do you have other existing initiatives that would be supportive of addressing this need and achieving these outcomes?