Randomized Trial of Promoting First Relationships: Effects on Maltreated Toddlers’ Separation Distress and Sleep Regulation After Reunification




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

Brief Type

Journal Publication


  • Other Models


This study investigates the impact of an attachment focused intervention, Promoting First Relationships (PFR), on sleep problems among toddlers in child welfare recently reunified with their birth parent. Recently reunified parent–toddler dyads (n=43) were drawn from a larger random control trial. Toddlers (11–36 months) and their parents were assessed in two-hour research home visits at enrollment (baseline), and a 6-month post-intervention follow-up. Measures included parental report of sleep problems and research visitor observation of separation distress (using the Toddler Attachment Sort-45). The PFR intervention predicted fewer sleep problems, adjusting for a baseline measure of sleep problems and other covariates. A path model showed evidence of an indirect effect of PFR on sleep problems through declines in separation distress. An attachment focused intervention like PFR that reduces infant separation distress can lead to reductions in sleep problems. (author abstract)

Data Collection Methods

  • Program administrative record reviews
  • Standardized assessment tools



For More Information

Oxford, M. L., Fleming, C. B., Nelson, E. M., Kelly, J. F., & Spieker, S. J. (2013). Randomized trial of Promoting First Relationships: Effects on maltreated toddlers' separation distress and sleep regulation after reunification. Children and Youth Services Review, 35, 1988–1992. http://dx.doi.org/10.1016/j.childyouth.2013.09.021
Author Contact Information:
Monica L. Oxford


  • Participant, Family, and Program Outcomes