Promoting First Relationships: Randomized Trial of a Relationship-Based Intervention for Toddlers in Child Welfare




Susan J. Spieker, Monica L. Oxford, Jean F. Kelly, Elizabeth M. Nelson, and Charles B. Fleming

Brief Type

Journal Publication


  • Other Models


We conducted a community-based, randomized control trial with intent-to-treat analyses of Promoting First Relationships (PFR) to improve parenting and toddler outcomes for toddlers in state dependency. Toddlers (10–24 months; N ¼ 210) with a recent placement disruption were randomized to 10-week PFR or a comparison condition. Community agency providers were trained to use PFR in the intervention for caregivers. From baseline to postintervention, observational ratings of caregiver sensitivity improved more in the PFR condition than in the comparison condition, with an effect size for the difference in adjusted means postintervention of d ¼ .41. Caregiver understanding of toddlers’ social emotional needs and caregiver reports of child competence also differed by intervention condition postintervention (d ¼ .36 and d ¼ .42) with caregivers in the PFR condition reporting more understanding of toddlers and child competence. Models of PFR effects on within-individual change were significant for caregiver sensitivity and understanding of toddlers. At the 6-month follow-up, only 61% of original sample dyads were still intact and there were no significant differences on caregiver or child outcomes. (author abstract)

Data Collection Methods

  • Home Visit Observations
  • Standardized assessment tools



For More Information

Spieker, S. J., Oxford, M. L., Kelly, J. F., Nelson, E. M., & Fleming, C. B. (2012). Promoting first relationships: Randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment, 17(4) 271-286. DOI: 10.1177/1077559512458176
Author Contact Information:
Susan J. Spieker


  • Participant, Family, and Program Outcomes