Implementing Child First Meets HHS Criteria

Model implementation summary last updated: 2020

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

Child First intervenes with vulnerable young children and families at the earliest possible time to prevent and heal the effects of trauma and adversity. The goal is to decrease the incidence of emotional and behavioral disturbance, developmental and learning problems, and abuse and neglect among high-risk young children and their families. The Child First model is based on brain development research, which shows that extremely high-stress environments (including poverty, maternal depression, domestic violence, abuse and neglect, substance abuse, and homelessness) are toxic to the developing brain of the young child. Child First aims to build a nurturing, consistent, and responsive parent-child relationship, which buffers and protects the child’s brain from these stressors. In addition, the model is designed to stabilize and decrease the multiple concrete challenges in the family’s life.

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Implementation support

Child First, Inc. is a nonprofit organization based in Connecticut that supports model implementation throughout the Child First network, composed of local providers known as Child First affiliate agencies. The Child First National Program Office (NPO) provides these affiliate agencies with ongoing training, clinical consultation, and technical assistance. It also provides data support, analysis, and access to reports on process and outcome data to support implementation fidelity and quality improvement. The NPO is responsible for accreditation of all Child First affiliates.

Each state in which Child First is replicated has a state clinical director who (1) provides affiliate agencies in the state with clinical and administrative oversight, technical assistance, and biweekly clinical consultation; (2) coordinates monthly meetings with the Child First network and calls or meetings with senior leadership; and (3) supports integration of the Child First model into local and state early childhood systems of care.

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Intended population

Child First serves pregnant women and families with children from birth through age 5 years in which (1) children have emotional, behavioral, or developmental difficulties; or (2) the family faces multiple environmental and psychosocial challenges (which Child First views as social determinants of health) that may lead to negative parent and child outcomes, such as maternal depression, domestic violence, substance abuse, homelessness, or abuse and neglect. Families are served without regard for their legal status or the number of children in the family.

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Targeted outcomes

Child First works to heal and protect young children from trauma and adversity by supporting the development of a nurturing and responsive parent-child relationship. The targeted child outcomes include decreased child abuse and neglect and improved social-emotional development (mental and behavioral health), language and cognitive development, and executive functioning. Targeted parent outcomes include reduced depression, post-traumatic stress disorder, and other mental health problems; decreased parenting stress; improved executive functioning; and increased parental education and employment. The model also aims to decrease the family’s psychosocial and environmental stress (the social determinants of health) and increase their connection to comprehensive, growth-promoting, community-based services and supports.

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Model services

Child First affiliate sites assign each family a team consisting of a licensed master’s-level mental health/developmental clinician responsible for assessment and therapeutic intervention and a care coordinator responsible for connecting families to community services and supports. The Child First model involves the following:

  • Engagement and assessment of child and family needs. The clinician and care coordinator work as a team to engage and build a trusting relationship with the family. To understand the family’s strengths and challenges, the team, in collaboration with the family, uses an ecological approach to assess the child’s health and development, important relationships, and the family’s culture and priorities. The assessment includes a protocol of standardized and informal measures; discussions with parents; observations in the home and early care and education settings (see details below); information from the child’s health provider, teacher, and others who regularly interact with the child and family; and reviews of records.  
  • Observation and consultation in early care and education setting. The mental health/developmental clinician gathers information within any early care setting attended by the child receiving home visiting services. These settings may include family, friend, and neighbor care; early care and education programs; and schools. The clinician gathers information through observations; conversations with the teacher and school administration; and review of any records. The clinician works with the teacher to understand the meaning of the child’s behavior, develop classroom strategies to decrease challenging behaviors and enhance the child’s social-emotional development, and coordinate efforts between the child’s early care and education setting and the home.  
  • Development of a child and family plan of care. The plan of care outlines the therapeutic intervention; parenting supports; and community-based services for the child, parents, and other family members. The Child First team develops the plan with the family during home visits; it reflects the parents’ goals, priorities, strengths, culture, and needs. The initial plan is revised as the family accomplishes goals and subsequently focuses on new challenges. The plan is reviewed at least every three months.  
  • Parent-child mental health intervention. The home-based intervention incorporates both Child-Parent Psychotherapy (CPP) and parenting support and guidance. It is a two-generation approach, designed to strengthen the parent-child relationship and promote secure attachment so the relationship both serves as a protective buffer from unavoidable stress and directly facilitates emotional, language, and cognitive growth. It addresses the experience of trauma and adversity in the child’s life, with the goal of helping the child heal and resolving behavioral problems. The model aims to promote parents’ understanding of normal and atypical developmental challenges and expectations; safety and joy in the relationship; parental reflection on the meaning and feelings motivating a child’s behavior; problem solving and the development of new strategies; and reflection on the psychodynamic relationship between parental history, feelings, and the parental response to the child.  
  • Promotion of executive functioning. The clinician works with the parent on emotional regulation. The care coordinator scaffolds and supports the parent in the development of other executive functioning capacities, such as goal planning. The care coordinator works with the parent to develop individual and family goals, prioritize those goals, create plans to accomplish them, monitor progress, and revise those plans. In addition, the care coordinator provides the parent with relationship-based activities and routines, based on the Abecedarian Approach, that help the parent scaffold executive functioning skills with the child.  
  • Care coordination. The care coordinator’s priority is to help stabilize the family, especially in the face of acute challenges, such as threats to the child’s safety, possible eviction, or lack of adequate food. To help decrease stress and enhance the child’s and family’s development, the care coordinator helps connect the family to comprehensive community-based services and supports, and directly addresses barriers to service access.
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Model intensity and length

The intensity and length of Child First services vary based on the child’s and family’s needs.

  • Engagement/assessment phase (first month): Home visits are scheduled twice per week for 60 to 90 minutes, and clinicians and care coordinators visit families together. Thereafter, the individual needs of the child and family determine when visits are made, either together or separately.  
  • Intervention phase: Each family is visited weekly, at a minimum. Visits can be more frequent if there is high need, with their intensity determined by the unique needs and goals of the family.

The child’s and family’s needs determine the length of service, which is usually from 6 to 12 months. However, the intervention can be longer if significant challenges exist.

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The Child First model was originally implemented in greater Bridgeport, Connecticut. It has expanded to 15 affiliate sites across Connecticut; Palm Beach County, Florida; and 25 counties in eastern North Carolina. Affiliate agencies serve one or more specific geographic areas.

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Adaptations and enhancements

The NPO has not approved any adaptations or enhancements to the model. No information is available on the process, if any, for considering modifications to the model.

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Implementation notes

The information contained on this page was last updated in June 2020. Recommended further reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the Child First CEO in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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