Home-based intervention lowers risk of foster-care separations

UW Nursing-developed program teaches caregivers to respond better to children’s emotional needs

Families being investigated for child maltreatment who received a 10-week home visiting program were less likely to have their children placed in foster care than families who received phone-based interventions, according to a new study by UW School of Nursing researchers. The study appears in the November edition of the journal Child Maltreatment.

The home visiting program, Promoting First Relationships^®, prepares social service providers to use practical, in-depth, effective strategies for promoting secure and healthy relationships between caregivers and young children, birth to age 3. Caregivers of young children learn to recognize, understand and respond to children’s social emotional needs.

“This study demonstrates that promoting infant mental health-focused services to vulnerable families in the child welfare system can have a lasting impact on parent and child wellbeing and the child welfare system as a whole,” said Dr. Monica Oxford, the study’s principal investigator and interim director of the Barnard Center for Infant Mental Health and Development.

“It was exciting to see that families were able to remain intact and become stronger as a result of this program,” she said.

The study included 247 families with 10- to 24-month-old children living in Snohomish, southern Skagit, or northern King Counties who had a recent open child protective services investigation of child maltreatment. Families were randomly assigned to either the Promoting First Relationships^® program in which they received one-hour home visits over 10 weeks, or the telephone-based resource and referral service in which they received a needs assessment, service referrals and mailed information packets. Therapists from the YWCA of Snohomish County were trained and delivered PFR.

“Promoting First Relationships^® had a strong, positive effect on these families,” said Oxford, a UW professor of Family and Child Nursing. “Not only did far fewer children end up in foster care, we observed that parents became more sensitive and responsive to their children’s cues and needs, and they showed a better understanding of their child’s emotional needs.”

This study has long-term implications for the health of our community, Oxford said.

Previous studies have connected early life adversities, including maltreatment, with an increased risk of a host of chronic conditions in adulthood, including Chronic Obstructive Pulmonary Disease, arthritis, asthma and heart disease. Adults who experienced adverse events in childhood, such as maltreatment, also have a greater incidence of mental health disorders, homelessness, experience more lost time from work and have lower academic achievement.

This study builds on a previous study by Dr. Susan Spieker, Kathryn Barnard Endowed Professor for Infant Mental Health at the UW School of Nursing. That study found that Promoting First Relationships^® improved caregiver sensitivity and knowledge of children’s developmental needs, which helped children improve their social competence. Spieker’s work also showed improved permanency outcomes for children whose foster or kin caregivers received Promoting First Relationships^®.

“The combined outcomes of these studies are so exciting,” Oxford said. “They demonstrate that Promoting First Relationships^® is an evidence-based program that has the power to make an immediate and lasting impact on the health of vulnerable children and families. This program will improve the health of our community for years to come.”

Promoting First Relationships^® was developed in 1998 by Dr. Jean Kelly, UW professor emeritus, and her colleagues and is currently disseminated across Washington State and the United States.

This study was funded (awards R01HD061362 and U54HD083091) by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health, and conducted in partnership with Washington’s Children’s Administration and the YWCA in Everett.

In addition to Oxford, Spieker and Mary Jane Lohr of the UW School of Nursing, and Charles Fleming of the UW School of Social Work were also involved in the study.