Randomized Controlled Trial of the Promoting First Relationships® Preventive Intervention for Primary Caregivers and Toddlers in an American Indian Community

  • Cathryn Booth-LaForceEmail author
  • Monica L. Oxford
  • Celestina Barbosa-Leiker
  • Ekaterina Burduli
  • Dedra S. Buchwald


Preventive intervention programs that address parenting practices and children’s developmental needs early in life have led to positive changes in caregiving behavior and children’s developmental outcomes. However, little is known about the efficacy of such programs among American Indian families. This study tested the efficacy of the strengths-based Promoting First Relationships® (PFR) program in American Indian families living on a rural reservation. Participants were 34 toddlers (10–30 months old) and their primary caregivers. Families were randomized to an Immediate (n = 17) or Waitlist (n = 17) group after a home visit for baseline data collection, which included assessment of observed caregiver-child interactions, caregiver perceptions, and child behavior. After randomization, we delivered the PFR intervention in 10 visits to the Immediate group, with some adaptations based on focus groups with community members and staff input. We analyzed follow-up assessments by implementing multiple regression analyses, controlling for baseline scores and using multiple imputation to handle missing data. Results supported our primary hypotheses: the Immediate group, compared with Waitlist, had significantly higher scores on the quality (p = .011, d = 1.02) and contingent responsiveness (p = .013, d = 1.21) of caregiver-child interactions, as well as on caregiver knowledge of toddlers’ social and emotional needs and level of developmentally appropriate expectations (p = .000, d = 0.58). Caregiver stress and caregivers’ reports of child behavior did not differ significantly. Our results hold promise for additional PFR research in other Native communities.


American Indians Home visiting Promoting First Relationships Caregiver-child interaction Randomized controlled trial 



We acknowledge, in alphabetical order, the contributions of Colleen Dillon, Abigail Echo-Hawk, Raymond M. Harris, Janet Katz, Odile Lallemand, Sterling McPherson, Katie Nelson, Michael Orr, Anthippy Petras, Jennifer Rees, and John Roll; and the dedicated on-site staff who provided the intervention and collected research data. We are grateful to our tribal partner for collaborating with us on this research and allowing us access to their community and to the families who participated in the project.

Funding Information

Funding for this research was provided by the National Institute on Minority Health and Health Disparities, P20 MD006871 (Principal Investigators: D.S. Buchwald and J. Roll).

Compliance with Ethical Standards

Conflict of Interest

Monica L. Oxford is the Director of the University of Washington Parent-Child Relationship Programs at the Barnard Center, which provides materials and training for Promoting First Relationships® on a fee basis. The other authors declare that they have no conflict of interest.

Ethical Approval

All research reported herein received both tribal approvals and university Institutional Review Board approvals. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study upon which this manuscript is based.


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Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.Department of Child, Family, & Population Health NursingUniversity of WashingtonSeattleUSA
  2. 2.College of NursingWashington State UniversitySpokaneUSA
  3. 3.Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community HealthWashington State UniversitySeattleUSA

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