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Center on Human Development and Disability
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Promoting Infant Mental Health in Foster Care

Contact: Susan Spieker, 206-543-8453

Core Function: Research and Evaluation

This research project is a community-based longitudinal comparative effectiveness study focused on infants in foster care, a very vulnerable and under-studied population. The objectives of this study are to acquire crucially needed evidence to support interventions promoting infants' social emotional health in foster care, while building community capacity to deliver infant mental health interventions and services to foster families.

Nationally, approximately 50,000 infants under 12 months enter foster care every year. Infants enter foster care with multiple risks that are exacerbated by the loss of their first attachment relationship, even if the quality of care they received was poor prior to removal. Their reactions to this loss, combined with their other vulnerabilities, make them difficult for foster caregivers to care for in ways that help them self-regulate and develop a secure new attachment. Currently, there are virtually no prevention and intervention efforts that have a very early, preventive focus on children in the child welfare system. Consequently, as these children age their needs and vulnerabilities intensify, decreasing the probability of reunification, escalating difficulties in attachment with related problems of emotional disturbance, and eventually leading to more costly care in increasingly restrictive settings.

This study enrolled 210 infants under state supervision when they were approximately 11-24 months old, and within a month of transitioning to a new home. The infants were randomly assigned to experimental and comparison conditions involving two different prevention programs. The experimental group received an attachment theory based program, Promoting First Relationships (PFR), and the comparison group received Early Education Support (EES). PFR and EES interventionists work with foster, kin, and birth care providers. PFR focuses on understanding child's cues, attachment needs, and developmental level, with the goal of minimizing the impact that the experience of separations and caregiver transitions will have on developing attachment strategies and emotional regulation. EES provides caregiver resource and referral, education and support, but does not have an attachment focus.

The PFR intervention was developed at the CHDD by Dr. Jean Kelly and is widely recognized throughout the state as a successful program that promotes the ability of parents to provide nurturing care to their infants and young children.


University of Washington • Center on Human Development and Disability Box 357920 • Seattle WA 98195-7920 USA • 206-543-7701 • chdd@uw.edu

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