Study
Booth?LaForce and colleagues (2023a) conducted a randomized controlled trial to examine the effect of Promoting First Relationships for Native families on the quality of caregiver?child interactions, caregivers? knowledge of their children?s needs, caregiver depression, and child externalizing behaviors after three months.
The study took place on a rural reservation in the Northern Plains area of the United States. Potential participants were recruited at community events; from the Special Supplemental Nutrition Program for Women, Infants and Children; and through flyers/brochures, word of mouth, and Facebook. Further, community programs and providers (including the Birth-to-Three program, health care providers, Head Start, Department of Social Services, and childcare providers) also recommended the study to their patients or clients. Interested individuals were contacted by a Native Research Visitor, who provided detailed information on the study, determined eligibility, and then scheduled a home visit to obtain informed consent and collect baseline data. To be eligible for the study, families were required to have at least one parent or guardian who 1) was at least 18 years old and lived on or near the reservation; 2) spoke English; 3) was the primary caregiver for a child ages 10?31 months and reported to be Native by their caregiver; 4) had telephone access; 5) was not living in a treatment facility or shelter, hospitalized, or imprisoned; and 6) was willing to have study staff come to their home. After baseline data collection, an algorithm was used to randomize the 162 total participants, blocking on caregiver sex, in equal numbers to the treatment group (Promoting First Relationships, n = 81) and control group (Resource and Referral, n = 81).
Individuals in the Promoting First Relationships treatment group received the intervention as described in the program description above. Those in the Resource and Referral control group received three phone calls from a local Native staff member and answered questions about health care, financial needs, and personal or family struggles. These participants were sent information on more than 75 local services and recommendations tailored to their needs and received two follow-up calls two weeks and then three months after the initial call.
At baseline, children in the treatment group were on average 19.9 months old and 49.4 percent female. Of the caregivers in the treatment group, 93.8 percent were female, 96.3 percent were American Indian or Alaska Native, 80.2 percent were birth parents to the child, and 16 percent were relatives. Of these caregivers, 59.3 percent were married or partnered, 37 percent had some college education or more, and 24.7 percent had less than a high school education. Children in the control group were on average 20.3 months old and 50.6 percent female. Of caregivers in the control group, 91.4 percent were female, 95.1 were American Indian or Alaska Native, 84 percent were the birth parents to the child, and 14.8 percent were relatives. Of these caregivers, 64.2 percent were married or partnered, 38.3 percent had some college education or more, and 28.4 percent had less than a high school education. At baseline, there were no statistically significant differences between the treatment and control groups on any demographic variables.
To measure the quality of caregiver?child interactions, video recordings of these interactions were assessed using the Nursing Child Assessment Teaching Scale, which contains 73 ?yes or no? items that evaluated the caregiver?s sensitivity, stimulation of the child, and emotional responsiveness; and the child?s clarity of cues and responsiveness to the caregiver. The ?Raising a Baby? questionnaire was used to assess caregiver knowledge of the social?emotional needs of infants and toddlers. Caregivers rated 16 items on a 4-point scale (from ?strongly agree? to ?strongly disagree?), with higher scores indicating a higher level of caregiver knowledge. The 20-item Center for Epidemiological Studies-Depression Scale was used to assess caregivers? depressive symptoms. Caregivers rated how often over the past week they experienced symptoms associated with depression, such as restless sleep, poor appetite, and feeling lonely. Response options were 0 (?rarely or none of the time?), 1 (?some or little of the time?), 2 (?moderately or much of the time?) or 3 (?most or almost all the time?). The 125-item Infant?Toddler Social Emotional Assessment, a comprehensive caregiver-report measure, was used to assess the children?s social?emotional competencies and behavior problems. The mean summary score for the externalizing domain was used. Caregivers rated each item on a 3-point scale (0 = ?not true/rarely,? 1 = ?somewhat true/sometimes,? 2 = ?very true/often?).
The treatment and control groups were compared on immediate post-intervention outcomes (Time 2) and outcomes three months later (Time 3), controlling for baseline (Time 1) values. The CrimeSolutions review of this study focused on the outcomes at Time 3. A series of repeated-measures multivariate analyses of covariance were used to assess the effect of the intervention on the outcomes. No subgroup analysis was conducted.
