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Promoting First Relationships® for Primary Caregivers and Toddlers in a Native Community: a Randomized Controlled Trial

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Abstract

This study tested the effectiveness of Promoting First Relationships® (PFR), a preventive intervention program aimed at fostering positive caregiver-child relationships in Native families living on a rural reservation. Participants were 162 primary caregivers (96% Native; 93% female) and their Native toddlers (10–31 months old; 50% female). Families were randomized to a PFR group (n = 81) or Resource and Referral (RR) control group (n = 81), after baseline data collection (Time 1) to assess the quality of caregiver-child interaction, caregiver knowledge about children’s social-emotional needs, caregiver depressive symptoms, and child externalizing behavior. After delivery of the PFR intervention or the RR service, follow-up assessments were repeated immediately post-intervention (Time 2) and 3 months later (Time 3). After controlling for baseline assessments, multivariate analyses of covariance revealed that caregivers in the PFR group had significantly higher scores on knowledge about children’s social-emotional needs at Time 2 (p < .01, η2 = .06) and Time 3 (p < .05, η2 = .04) and less severe depressive symptoms at Times 2 and 3 (both p < .05, η2 = .04). At Time 3, the quality of caregiver-child interaction was better in the PFR group (p < .01, η2 = .06), an effect that was moderated by severity of depressive symptoms (p = .05, η2 = .06), with PFR having the greatest impact at low levels of initial symptoms (p = .02). Results support the positive impact of PFR in a Native community and suggest conditions under which the intervention may be most effective.

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Notes

  1. We use “Native” rather than American Indian, Native American, or Indigenous because of the Tribe’s preference.

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Acknowledgements

We acknowledge, in alphabetical order, the contributions of Tara Ducheneaux, Corrine Huber, Odile Madesclaire, Katie Nelson, Marcia O’Leary, Ellie OneFeather, Jamie Pesicka, Anthippy Petras, and Jennifer Rees. We are grateful to our Tribal partner for collaborating with us on this research and allowing us to work with their community, and to the families who participated in the project.

Funding

Funding for this research was provided by the National Institute of Nursing Research, NIH, R01 NR014153 (Principal Investigators: C. Booth-LaForce, M. Oxford, D. Buchwald).

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Authors and Affiliations

  1. Department of Child, Family, and Population Health Nursing, Barnard Center for Infant Mental Health and Development, University of Washington, Box 357231, Seattle, WA, 98195-7231, USA

    Cathryn Booth-LaForce & Monica L. Oxford

  2. Missouri Breaks Industries Research Inc, Eagle Butte, SD, 57625, USA

    Rae O’Leary

  3. Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA

    Dedra S. Buchwald

Authors
  1. Cathryn Booth-LaForce
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Corresponding author

Correspondence to Cathryn Booth-LaForce.

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Ethics Approval

All research reported herein received Tribal approval, Indian Health Service Institutional Review Board approval, and university Institutional Review Board approval. 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.

Consent to Participate

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

Conflict of Interest

The second author 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.

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Booth-LaForce, C., Oxford, M.L., O’Leary, R. et al. Promoting First Relationships® for Primary Caregivers and Toddlers in a Native Community: a Randomized Controlled Trial. Prev Sci 24, 39–49 (2023). https://doi.org/10.1007/s11121-022-01415-y

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