Promoting First Relationships (PFR)

Placement on the Continuum of Evidence Promising Download icon Download PDF
Target Population: 
Emotional Competency, Parenting, Relationships
Target Audience 

This program is delivered to parents and caregivers of young children who are birth to 3 years old and intends to impact parents, caregivers, and young children.


Promoting First Relationships (PFR), a community-based program, is delivered by trained professionals and is designed to foster the growth of healthy, secure relationships between parents or caregivers and young children.  The program is based on the premise that steady and safe relationships can promote self-confidence and social well-being.


Results from one randomized trial of PFR indicated improvements in parental sensitivity and understanding and child competence at post-test.  These results were not maintained at the 6-month follow-up.  However, it was demonstrated that more children in PFR had an increasing cortisol pattern at post-test, which is indicative of a positive coping response, and less separation distress at the 6-month follow-up compared to children in the control group.  At a 2-year follow-up, it was shown that more foster parents in PFR provided stable, uninterrupted care and eventually adopted or became legal guardians of toddlers compared to foster parents in the control group.


This program focuses on the creation and maintenance of nurturing and stable caregiver-child relationships, which can positively impact the social and emotional development of a young child.  Sessions are held in the caregiver's home and include the following features:

  • Record caregiver-child interactions and review these videos with caregivers.  Discuss parenting strengths and interpretations of children's cues and signals;
  • Provide encouraging, positive feedback to caregivers to develop and promote their abilities and their commitment to their children;
  • Explore the emotions and needs that lie beneath caregivers' and children's concerns or worries and behaviors; and
  • Encourage the practice of contemplation and thoughtfulness for caregivers.
Previous Use 

PFR was developed in the late 1990s at the University of Washington.  Since that time, professionals have been trained in the PFR program across the United States.  


Training is required for professionals who work with caregivers/parents and young children.  There are two levels of training - Knowledge Building and Skill Building. A 2-day Learner's Workshop for Level 1 Knowledge Building, delivered in Seattle, Washington, or as an on-site workshop, costs $395 per person and is required before participating in the 16-week Mentored Distance Learning Level 2 Skill Building training.  The cost for individual mentoring is $2,800 per person.  The cost of paired mentoring is $1,900 each or $3,800 per pair.  Please contact Jennifer Rees using the email address listed in Contact for more information.


Considerations for implementing this program include ensuring facilitators obtain training, acquiring buy-in from parents and caregivers, ensuring that parents and caregivers have access to necessary equipment to view videos during sessions, and making time for program sessions.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email


If you are interested in implementing PFR, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email


The program is delivered in 10, weekly, 60- to 75-minute sessions.


The PFR curriculum, which is necessary for implementation, includes a book, handouts, and a DVD and costs $125.  Please visit for cost information on additional materials.  Free resources for providers and parents are available at

Evaluation Plan 

To move PFR to the Effective category on the Clearinghouse Continuum of Evidence at least one external evaluation must be conducted that demonstrates sustained, positive outcomes.  This study must be conducted independently of the program developer.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals.  Please call 1-877-382-9185 or email


Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email:

You may also contact PFR by mail University of Washington, CHDD South Building Room 212, Box 327920, Seattle, WA 98195 or contact Jennifer Rees, the Program and Training Manager, by phone 1-206-616-5380 or email or visit

Source and Spieker, Oxford, Kelly, Nelson, and Fleming (2012).

*Resources and associated costs reflect those identified at the time of fact sheet publication.