Lessons from Implementing the Promoting First Relationships Program with Early Head Start Home Visiting Staff

Evidence-based programs are of high interest to researchers and policymakers and are now frequently required when conducting federally-funded research in areas including education and home visiting. However, there have been growing concerns about scaling evidence-based interventions in community settings. In order to achieve successful implementation, it is critical to understand context, and the conditions of adaptation. 

This research was conducted in an Early Head Start (EHS) program that integrated the Promoting First Relationships (PFR; Kelly, Zuckerman, Sandoval, & Buehlman, 2008) parent-child interaction intervention into existing services.  PFR is a 10-week intervention to support parents/caregivers in meeting social-emotional needs of infants and toddlers by building nurturing, responsive relationships. PFR is based on video reflection between caregivers and service providers, focusing on positive feedback and attachment topics.

This study is part of a larger project examining the effectiveness of the PFR intervention when implemented by current EHS home visitors. For this component of the project, our research questions were threefold: 1) How is the overall adaptation process perceived by home visitors?; 2) What challenges and issues are identified during implementation?; and 3) What supportive systems and recommendations can be made to promote sustainability of the intervention in the context of EHS? 

The PFR training process included a 3-day group session followed by a 20-week mentoring process involving delivery of PFR to 2 families and demonstration of fidelity. Data were collected via open-ended individual interviews with a diverse group of 8 home visitors, after the intervention was completed with an initial family. Interviews were transcribed for analysis and supplemented with questionnaires about home visitor demographic characteristics, level of education, and employment history.

Qualitative data analysis was conducted, based on grounded theory and the constant-comparative method.  An initial coding scheme was developed, based on interview questions and themes, and codes were identified by reviewing all transcripts. Codes were then entered using NVivo 10 analysis software. 

Preliminary findings indicate that overall there were positive feelings about the philosophy and content of PFR, although the training process was perceived to be intensive.  Challenges identified by the EHS home visitors involved the use of technology, scheduling, and family household issues (e.g., siblings or multiple families present).  Overall, initial implementation of the intervention was successful.  A major goal of the EHS program is to continue using PFR after this research is complete.  Thus, recommendations and suggestions for sustainability of the intervention within EHS will be made.