Supporting Parents Program: Intervention for Families in CPS

NCT01332851 | Completed Results

• 2 other identifiers: D-103010-S1R01HD061362-01A2
• Study Type: interventional
• Target: 270
• Locations: 1 country
• Sites: 1

Brief Summary

The study evaluates the feasibility and effectiveness of a well-documented relationship-based intervention (Promoting First Relationships), compared to a resource and referral condition, in improving outcomes for families of infants and toddlers referred to Child Protective Services (CPS) for maltreatment. In addition, it evaluates the effectiveness of training community social service workers in providing the intervention.

Conditions

Child Abuse; Child Neglect

Keywords

child welfare; child protective services; child abuse; child neglect; infant; parenting

Outcome Measures

Primary Outcomes (3)

• Child Welfare Outcomes: CWS Removal From Birth Parent Home

  Official child welfare administrative records indicating whether child was removed from the birth parent home within one year of parent completing intervention (or one year after estimated date intervention would have been completed, for parents who did not complete). Data were analyzed with a survival model that predicted hazard of being removed from the birth parent home.

  1 year post intervention

• Parental Sensitivity (Video Recorded Observation Coded by Blind Coders)

  Parent sensitivity was measured at all four time points by a modified total score of the Nursing Child Assessment Teaching Scale (NCATS; Barnard, 1994), a videotaped interaction to assess caregiver sensitivity, stimulation of the child, and emotional responsiveness during interaction were scored. The scale was modified to exclude some items from the original measure that demonstrated low variability in other studies. A total score was based on 45 items, possible range 0 - 45. Items covered mutuality (e.g. contingency, gaze, and positive affect), caregiver verbal and nonverbal support of child, and sensitive instruction during the teaching task. Items were scored yes (1) or no (0), and yes scores were summed. Cronbach's alpha for the sensitivity scale ranged from .68 to .72. A single, blinded coder was trained to reliability by a certified NCATS instructor and passed regular reliability checks. Higher scores indicate greater parental sensitivity.

  Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)

• Secure Base Behavior (Observation During Research Visit; Higher Score Indicates Greater Security)

  Secure base behavior was measured with the Toddler Attachment Sort-45 (TAS-45; Kirkland, Bimler, Drawneek, McKim, \& Schölmerich, 2004). The TAS-45 is based on 39 items from the Attachment Q-Sort (AQS; Waters, 1987), an attachment measure that has been extensively validated (van IJzendoorn, Vereijken, Bakermans-Kranenburg, \& Riksen-Walraven, 2004), plus six items tapping atypical affective communication. After home visits, research visitors sorted cards for 45 descriptive statements of child attachment behavior into five piles representing "most like" to "least like" the child. Item scores were standardized within individuals and then compared to a security profile to arrive at an security score. Higher value indicates greater secure base behavior. Because scores are based standardized item scores weighted by proximity to the secure profile, the possible range is large, difficult to determine, and not reported in the instrument manual. The observed range was from -.62 to +1.00.

  Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)

Secondary Outcomes (11)

• Parenting Stress: Dysfunctional Interaction

  Baseline, post intervention (approximately 4 months from baseline, 3 month follow up from post intervention (~7 months from baseline), 6 month follow up (~ 10 months from baseline)

• Parent Stress: Competence (Higher Score Means More Stress)

  Baseline 3-month post-intervention (~7 months post baseline), 6-month follow up (~ ten months post baseline)

• Child Social Emotional Development (Higher Scores Indicate More Competence)

  Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)

• Child Behavior Problems

  Baseline, post intervention (approximately 4 months from baseline, 3 month follow up (~7 months from baseline), 6 month follow up (~ 10 months from baseline)

• Child Emotion Regulation

  Baseline and at the 3 month follow up (~ 7 months post baseline)

Study Arms (2)

Promoting First Relationships (PFR)

EXPERIMENTAL

PFR is a strengths-based 10 week in-home parenting intervention based on attachment theory. Each week has a theme for discussion, an activity, and time for "joining" - checking in with the parent, listening to their concerns and establishing a positive, supportive relationship. The sessions include handouts which focus on the content area covered that day and applying a topic to their relationship with their child. The provider also videotapes playtime between parent and child. On alternate weeks, the provider watches the video with the parent, reflecting on both the parent's and the child's needs. The provider helps the parent develop greater empathy and understanding of the child's needs and feelings, and helps the parent identify her own feelings and needs around parenting.

Behavioral: Promoting First Relationships (PFR)

Resource & Referral

ACTIVE COMPARATOR

This condition consists of 1) Resource and Referral assistance provided over the phone, and 2) Local Services Resource Packet. The participant receives a phone call from a Resource and Referral Specialist to conduct a needs assessment to identify the particular needs or concerns of the family (such as housing needs, mental health, tangible goods). If a need is identified, the Referral and Referral Specialist will provide the family with local information regarding the stated need. The R\&R provider makes two follow-up check in calls with the families. In addition, families can call the Research and Referral Specialist if additional needs arise. The resource packet includes information organized by type of need or resource. These packets are updated regularly as services change over time.

Behavioral: Resource and Referral

Interventions

Promoting First Relationships (PFR) BEHAVIORAL

PFR is a parenting intervention based on attachment theory and is strengths based. It is a 10 week intervention that is delivered in the home of the family.

Promoting First Relationships (PFR)

Resource and Referral BEHAVIORAL

Needs assessment, followed with a resource packet sent by mail

Resource & Referral

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Biological parents and their child aged 10-24 months, who is an identified victim for referral to CPS, and who are parenting their child a majority of the time
• Families served by CPS offices in Snohomish and Skagit counties, in the state of Washington
• Families at moderate to high risk for maltreatment (physical abuse, neglect, or emotional maltreatment) and under investigation by Child Protective Services
• English speaking primary caregiver
• Telephone access
• Current housing

You may not qualify if:

• Experiencing an acute crisis (homelessness, hospitalization, imprisonment)
• Identified child (in a risk only CPS intake) or identified victim (in CPS intakes with allegations) has a voluntary services agreement within 2 weeks of a newly opened investigation
• Identified child (in a risk only CPS intake) or identified victim (in CPS intakes with allegations) has a dependency filing within 2 weeks of a newly opened investigation
• Previously received the Promoting First Relationships intervention

Sponsors & Collaborators

• University of Washington: lead
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

University of Washington, Family & Child Nursing

Seattle, Washington, 98105, United States

Location

Related Publications (2)

• Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Promoting First Relationships(R): Randomized Trial of a 10-Week Home Visiting Program With Families Referred to Child Protective Services. Child Maltreat. 2016 Nov;21(4):267-277. doi: 10.1177/1077559516668274. Epub 2016 Sep 21.

  PMID: 27646148 RESULT

• Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev. 2023 May 4;5(5):CD014874. doi: 10.1002/14651858.CD014874.pub2.

  PMID: 37146219 DERIVED

Related Links

• Promoting First Relationships (PFR)

MeSH Terms

Interventions

Health Resources; Referral and Consultation

Intervention Hierarchy (Ancestors)

Health Planning; Health Care Economics and Organizations; Delivery of Health Care; Health Care Quality, Access, and Evaluation; Professional Practice; Organization and Administration; Health Services Administration

Limitations and Caveats

Generalizability limited by sample selection criteria. Follow-up was only 6-months post-intervention for most outcomes although child welfare records covered 1 year post-intervention. Parent report was used for some key outcomes.

Results Point of Contact

• Title: Dr. Monica Oxford
• Organization: Family and Child Nursing, University of Washington

mloxford@uw.edu

206-685-6107

Study Officials

• Monica L Oxford, PhD

  University of Washington

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Professor

Study Record Dates

• First Submitted: April 7, 2011
• First Posted: April 11, 2011
• Study Start: January 1, 2011
• Primary Completion: June 1, 2015
• Study Completion: October 1, 2015
• Last Updated: June 7, 2018
• Results First Posted: June 7, 2018

Record last verified: 2018-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)