Booth-LaForce C, Oxford ML, O’Leary R, Rees J, Petras A, Buchwald DS. Implementation fidelity of the Promoting First Relationships intervention program in a Native community. Transl Behav Med. 2023 Jan 20;13(1):34-41. doi: 10.1093/tbm/ibac060. PMID: 36227860; PMCID: PMC9853091.

An evidence-based parenting intervention called Promoting First Relationship (PFR) was evaluated for implementation fidelity in a Northern Plains Native community. PFR is a preventive program for primary caregivers and their young children based on attachment theory. Ten sessions are delivered weekly for an hour through home visits conducted by trained providers who are tribal members living on the reservation with at least a relevant bachelor’s degree. Each week has a specific theme and includes a check-in, reflection time, observation of video recordings, and handouts on the child’s behaviors, feelings, and needs. This study analyzed data from a randomized controlled trial of 162 primary caregivers and their children (10-30 months old) who were assigned to the PFR intervention or the control condition (referral to local resources). PFR providers were trained in a two-day in-person workshop and then, online intensive training and pilot sessions. All trainees were required to pass fidelity checks with three families to be certified. Researchers measured implementation fidelity using a checklist on adherence to content, scoring quality of delivery in video-recorded sessions, number of PFR sessions completed, and participant satisfaction. On average, adherence to PFR content was very high (mean=0.99 out of 1.00; SD=0.02) and quality of delivery exceeded established criteria. Despite high attrition which occurred before intervention delivery (28.40%, N=23), the remaining participants completed all 10 intervention sessions. Additionally, participants reported high satisfaction with the program (mean=3.90 out of 4, SD=0.19). Overall, high implementation fidelity of the PFR intervention was achieved in a Native community using in-person and remote online training and video feedback.