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

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.