Supporting Parents Program (SPP)

This study is enrolling participants by invitation only.
Information provided by (Responsible Party):
Monica Oxford, University of Washington Identifier:
First received: April 7, 2011
Last updated: May 21, 2013
Last verified: May 2013

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 CPS for maltreatment. In addition, it evaluates the effectiveness of training community social service workers in providing the intervention.

Condition Intervention
Child Abuse
Child Neglect
Behavioral: Promoting First Relationships (PFR)
Behavioral: Resource and Referral

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Training Social Work Providers: Intervention for Maltreating Families of Infants

Resource links provided by NLM:

Further study details as provided by University of Washington:

Primary Outcome Measures:
  • Child welfare outcomes [ Time Frame: 1 year post intervention ] [ Designated as safety issue: Yes ]
    Intake, maltreatment, and placement history

Secondary Outcome Measures:
  • Child Social Emotional Development [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Infant-Toddler Social Emotional Assessment (ITSEA; Carter, Little, Briggs Gowan, & Kogan, 1999) parent report of selected domains: externalizing, internalizing, dysregulation, competence, maladaptive, social relatedness, atypical, and items of clinical significance.

  • Attachment [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Toddler Attachment Scale-45 Item Trilemma (TAS-45) adapted from the Attachment Q-Set (AQS; Waters & Deane, 1985) by Kirkland, Bimler, Drawneek, McKim, and Scholmerich (2004). Observational measure coded by research visitor; includes ratings of security, avoidance, dependence, and disorganized/disoriented behavior.

  • Child Behavior [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Bayley Behavior Ratings (Bayley, 1993) to assess emotion regulation

  • Parent-Child Interaction [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Coding Interactive Behavior-Child & Parent Outcomes (CIB; Feldman, 1998). Parent-child 10-minute free play interaction coded for child social engagement, child negative affect, and dyadic reciprocity; parental sensitivity and reciprocity, parental intrusiveness, and parental withdrawal.

  • Parental Sensitivity [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Social-Emotional Growth Fostering NCAST Scales: Coded from observation of caregiver interacting with child on teaching task.

  • Parental Mindfulness [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    "About My Baby": three open-ended questions; coded to assess "mindfulness" representations of the child's mental life.

  • Maternal unrealistic expectations [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Parent Opinion Questionnaire (POQ; Azar et al., 1984): questionnaire to assess unrealistic parental expectations of child behavior in the areas of self-care, help and affection to parents, leaving children alone, proper feelings and behavior punishment, and family responsibility.

  • Parental confidence [ Time Frame: pretest, posttest, 3 month follow up, 6 month follow up ] [ Designated as safety issue: No ]
    Caregiving Helplessness Questionnaire (CHQ; George, Coulson, Majany, & Soloman, 1995) subscales: parent-child frightened and parent helplessness.

Estimated Enrollment: 254
Study Start Date: January 2011
Estimated Study Completion Date: November 2014
Estimated Primary Completion Date: November 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Promoting First Relationships (PFR)
PFR is based on attachment theory and is strengths based. The 10 week intervention is delivered in the home of the family. Each week has a theme for discussion, an activity which includes videotaping or viewing and reflecting on a videotaped session, and time for "joining" - checking in with the parent, listening to their concerns and establishing a positive, supportive relationship. The sessions include handouts, one with the content area covered that day and one applying a topic to their relationship with their child. The provider also videotapes playtime between parent and child and alternates every other week with watching the video with the parent. When the parent and provider watch the video of the previous session, they reflect about what the needs are of both the parent and the child. 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)
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.
Active Comparator: Resource & Referral
This condition will consist of 1) Resource and Referral Personal Assistance provided over the phone, and 2) Local Services Resource Packet. The participant in this arm of the intervention trial will receive a phone call from a Resource and Referral Specialist hired by the project. The service will consist of 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 (such as a phone number to a housing assistance program, location of local food bank). In addition, families in this condition will have the Research and Referral Specialist's phone number they can call if an additional need arises. The resource packet will include information organized by type of need or resource. These packets will be updated regularly as services change over time.
Behavioral: Resource and Referral
Needs assessment, followed with a resource packet sent by mail

Detailed Description:

Child maltreatment has well-established, wide-ranging, and long-term negative effects on children. Most children who have experienced maltreatment and are receiving services through the Child Welfare System (CWS) remain in their homes with their caregivers. While the need for parenting services is extensive, few intervention programs have proven to be efficacious in reducing child abuse and neglect within the CWS population, especially for infants and toddlers. It is essential that social service practitioners within the CWS delivery system are equipped to provide brief interventions to maltreating parents. This grant, "Training Social Work Providers: Intervention for Maltreating Families of Infants and Toddlers," is an evaluation of a training program for social welfare providers to implement a brief attachment theory-based intervention to families who have been investigated for child abuse and neglect by Child Protective Services. The program (Promoting First Relationships [PFR]; Kelly, Buehlman, & Caldwell, 2000) will be tested at two levels: through social welfare practice and at the level of outcomes for children and families.

Social service providers will be trained to deliver PFR to families under investigation for maltreatment by the Department of Social and Health Services, in two counties in Washington State. Subsequently, families under investigation by CPS will be recruited into the study and randomly assigned to the experimental group (receiving the PFR intervention) or to the comparison group (receiving resources and referrals).

The specific aims of this study are to (1) Test the effectiveness of training community social welfare service providers in the use of attachment-based interventions by measuring their pre-training and post-training service provision strategies and interactions with maltreating families; (2) To test the effects of a relationship and attachment-based intervention with infants/toddlers of parents identified as maltreating by comparing them to a control group on rates of re-referral to CPS, severity of referral, and foster care placement; and (3) To conduct a test of the effectiveness of an attachment-based intervention on child well-being by comparing experimental and comparison groups on important outcomes (attachment security, emotional regulation, behavior, and developmental functioning).

RELEVANCE Child maltreatment is a serious public health issue, affecting close to a million children nationally every year. The establishment of effective evidence-based interventions for high-risk families is essential to curtail the devastating long-term effects of maltreatment. The proposed study tests the feasibility and effectiveness of a well-documented relationship-based intervention (Promoting First Relationships) in improving outcomes for families referred to CPS for maltreatment.


Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 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

Exclusion Criteria:

  • 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
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Please refer to this study by its identifier: NCT01332851

United States, Washington
University of Washington, Family & Child Nursing
Seattle, Washington, United States, 98105
Sponsors and Collaborators
University of Washington
  More Information

Additional Information:
No publications provided

Responsible Party: Monica Oxford, Research Associate Professor, University of Washington Identifier: NCT01332851     History of Changes
Other Study ID Numbers: D-103010-S, 1R01HD061362-01A2
Study First Received: April 7, 2011
Last Updated: May 21, 2013
Health Authority: United States: Federal Government
United States: Institutional Review Board

Keywords provided by University of Washington:
child welfare
child protective services
child abuse
child neglect
parenting processed this record on April 26, 2015