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Attachment‐based home visiting programs that serve new mothers experiencing psychological distress may advance health equity by helping families systemically exposed to adversity. This study examined whether one such program (Promoting First Relationships/PFR) had particularly beneficial effects on maternal and child relationship outcomes for mothers reporting the greatest psychological distress. A randomized controlled trial of the PFR program included a low‐income sample of 252 Spanish‐ and English‐speaking mother‐child dyads referred prenatally for mental health concerns. The sample of mothers was 65.5% White, 17.5% Black, and 17.1% multiracial or other racial groups; 47.2% reported Hispanic ethnicity. The moderating variable of psychological distress was measured using maternal‐reported screening tools for symptoms of depression, anxiety, anger, post‐traumatic stress, and interpersonal sensitivity. Outcomes included observed parenting sensitivity and self‐reported understanding of infants/toddlers, caregiving confidence, and child externalizing behavior. Results showed a significant treatment condition by baseline psychological distress interaction for observed parenting sensitivity such that differences in outcomes favoring the PFR condition were greatest among those with high baseline psychological distress (baseline child age 6–12 weeks). In a low‐income sample of new mothers, those with the greatest need, as indicated by high psychological distress, showed greater improvements in their sensitive and responsive caregiving if they were randomized to the PFR treatment condition.

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