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Implementing Promoting First Relationships®

Model Overview

Last Updated

June 2015


The information in this profile reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness.


Implementation Support

Promoting First Relationships (PFR) is a caregiver-child relationship-building program that can be used one-on-one with parents, in the clinic or in home, and with child care providers and early childhood teachers responsible for group care. The HomVEE review is based on PFR used with parents in the home.

The Barnard Center for Infant Mental Health and Development at the University of Washington developed PFR. The center provides training on the model.


Theoretical Model

The model, based on attachment theory, posits that developing strong early relationships with caregivers is the key to healthy social, emotional, behavioral, language, and cognitive development in children. The program aims to foster parent- and caregiver-child relationships by helping parents and caregivers read and understand child cues and the unmet need behind challenging behaviors, and supporting parents’ use of sensitive and responsive caregiving behaviors.


Target Population

PFR targets parents and caregivers of children ages birth to 3 years.


Targeted Outcomes

The program seeks to promote children’s social-emotional development by fostering secure and healthy parent- and caregiver-child relationships.


Model Components

PFR can be implemented with parents in the home or in other settings, and with early childhood teachers and providers. Regardless of setting or type of caregiver, PFR involves providing feedback based on video recordings of parent/caregiver interactions with children.

When PFR is implemented with parents in the home, the home visitor makes video recordings of the parent interacting with their child at home, and the home visitor and parent view and reflect on the recordings. The home visitor highlights positive interactions observed and offers instructive comments to enhance caregiving. The home visitor also helps the parent reflect on both their and their child’s behavior, feelings, and needs during the interaction. In addition, PFR provides parents with information, including handouts, on the social and emotional needs of infants and toddlers, and strategies to meet these needs. The home visitor and the parent discuss ways to handle challenging behaviors and explore the parent’s own social-emotional development and how that influences their caregiving.


Model Intensity and Length

The PFR home visiting program is designed to provide weekly hour-long home visits for 10 to 14 weeks. The program can be extended based on a family’s needs.



PFR-trained agencies are delivering the model in eight states: Delaware, Florida, Idaho, Montana, North Carolina, Oregon, Rhode Island, and Washington. Practitioners in an additional 20 states have attended the initial PFR workshop and may be using the PFR curriculum and handouts.


Adaptations and Enhancements

The model has been adapted for use in pediatric primary care.



The information contained on this page was last updated in June 2015. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Barnard Center on April 22, 2015. HomVEE reserves the right to edit the profile for clarity and consistency.