Manuscript Details

Source

Lowell, D. I., Carter, A. S., Godoy, L., Paulicin, B., & Briggs‐Gowan, M. J. (2011). A randomized controlled trial of Child FIRST: A comprehensive home‐based intervention translating research into early childhood practice. Child development, 82(1), 193-208.

High rating
Model(s) Reviewed
Child First
Author Affiliation

Darcy I. Lowell, a study author, is the founder and executive director of Child FIRST.

Funding Sources

Starting Early Starting Smart Prototype (Substance Abuse and Mental Health Services Administration, 9886); Robert Wood Johnson Foundation (60068)

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low Not Applicable None
Notes

In 2020, HomVEE updated this review to remove family involvement with CPS findings from the Reductions in Child Maltreatment domain because some cases in the abuse complaint may be unsubstantiated. In this domain HomVEE reviews only outcomes focused on substantiated cases of abuse and neglect.

Study Participants

Children were eligible if they were between 6 and 36 months of age; had a positive screening for social-emotional/behavioral problems on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and/or the parent screened high for psychosocial risk; and lived in a permanent caregiving environment in Bridgeport, Connecticut. Of 642 families completing screens, 464 passed the screening, 254 consented to the study, and 157 were randomized (stratified by age, BITSEA score, and family psychosocial risk). There were 78 children in the Child FIRST intervention group and 79 in the usual care comparison group at baseline, 64 (intervention) and 67 (comparison) at the six-month follow-up, and 58 (intervention) and 59 (comparison) at the 12-month follow-up. Fifty-nine percent of mothers in the study were Hispanic, 30 percent were African American, 8 percent were Caucasian, and 4 percent were of another race/ethnicity.

Setting

This study took place in Bridgeport, Connecticut.

Home Visiting Services

The Child FIRST model has two core components. The first is a connection to a “system of care,” a community-based, comprehensive, coordinated set of services, including early education, health care, and other social services. Second, the program offers a psychotherapeutic approach to promote nurturing caregiving. Services were offered in the home. Two staff members, a clinician and care coordinator, were assigned to each family. The clinician was responsible for therapeutic assessment and intervention with the child and parent and the care coordinator facilitated family engagement in community services. Weekly visits lasting 45 to 90 minutes were made jointly or individually, as needed by the family.

Comparison Conditions

Comparison families (the usual-care group) continued to receive usual care from the study’s recruitment sites: the Bridgeport Hospital Pediatric Primary Care Center and the Supplementary Nutrition Program for Women, Infants, and Children.

Study Participants

Children were eligible if they were between 6 and 36 months of age; had a positive screening for social-emotional/behavioral problems on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and/or the parent screened high for psychosocial risk; and lived in a permanent caregiving environment in Bridgeport, Connecticut. Of 642 families completing screens, 464 passed the screening, 254 consented to the study, and 157 were randomized (stratified by age, BITSEA score, and family psychosocial risk). There were 78 children in the Child FIRST intervention group and 79 in the usual care comparison group at baseline, 64 (intervention) and 67 (comparison) at the six-month follow-up, and 58 (intervention) and 59 (comparison) at the 12-month follow-up. Fifty-nine percent of mothers in the study were Hispanic, 30 percent were African American, 8 percent were Caucasian, and 4 percent were of another race/ethnicity.

Setting

This study took place in Bridgeport, Connecticut.

Home Visiting Services

The Child FIRST model has two core components. The first is a connection to a “system of care,” a community-based, comprehensive, coordinated set of services, including early education, health care, and other social services. Second, the program offers a psychotherapeutic approach to promote nurturing caregiving. Services were offered in the home. Two staff members, a clinician and care coordinator, were assigned to each family. The clinician was responsible for therapeutic assessment and intervention with the child and parent and the care coordinator facilitated family engagement in community services. Weekly visits lasting 45 to 90 minutes were made jointly or individually, as needed by the family.

Comparison Conditions

Comparison families (the usual-care group) continued to receive usual care from the study’s recruitment sites: the Bridgeport Hospital Pediatric Primary Care Center and the Supplementary Nutrition Program for Women, Infants, and Children.

Findings that rate moderate or high in this manuscript

Child development and school readiness
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Child language (proportion with clinically concerning problems) 6 months High
0.46 p < 0.05 117 families Bridgeport, CT
Any ITSEA domain (proportion with clinically concerning problems) 6 months High
0.49 p > 0.05 117 families Bridgeport, CT
ITSEA externalizing (proportion with clinically concerning problems) 6 months High
0.40 p > 0.05 117 families Bridgeport, CT
ITSEA dysregulation (proportion with clinically concerning problems) 6 months High
0.56 p > 0.05 117 families Bridgeport, CT
ITSEA internalizing (proportion with clinically concerning problems) 6 months High
0.49 p > 0.05 117 families Bridgeport, CT
ITSEA externalizing 6 months High
0.30 p > 0.05 117 families Bridgeport, CT
ITSEA internalizing 6 months High
0.13 p > 0.05 117 families Bridgeport, CT
ITSEA dysregulation 6 months High
0.22 p > 0.05 117 families Bridgeport, CT
Child language (proportion with clinically concerning problems) 12 months High
0.88 p < 0.05 117 families Bridgeport, CT
Any ITSEA domain (proportion with clinically concerning problems) 12 months High
0.28 p < 0.05 117 families Bridgeport, CT
ITSEA externalizing (proportion with clinically concerning problems) 12 months High
0.42 p < 0.05 117 families Bridgeport, CT
ITSEA dysregulation (proportion with clinically concerning problems) 12 months High
0.08 p > 0.05 117 families Bridgeport, CT
ITSEA internalizing (proportion with clinically concerning problems) 12 months High
0.03 p > 0.05 117 families Bridgeport, CT
ITSEA externalizing 12 months High
0.49 p < 0.05 117 families Bridgeport, CT
ITSEA internalizing 12 months High
0.19 p > 0.05 117 families Bridgeport, CT
ITSEA dysregulation 12 months High
0.36 p > 0.05 117 families Bridgeport, CT
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Linkages and referrals
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Percentage of desired services that were received 6 months High
3.79 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received 12 months High
3.93 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received—child mental health 12 months High
3.93 p < 0.001 117 families Bridgeport, CT
Percentage of desired services received that were received, child development 12 months High
3.89 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, early education 12 months High
1.84 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, family support 12 months High
2.36 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, adult mental health 12 months High
3.05 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, social services 12 months High
1.42 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, medical services 12 months High
1.59 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, adult education 12 months High
1.70 p < 0.001 117 families Bridgeport, CT
Percentage of desired services that were received, concrete needs 12 months High
2.27 p < 0.001 117 families Bridgeport, CT
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
BSI (proportion with clinically concerning problems) 6 months High
0.18 p > 0.05 117 families Bridgeport, CT
Any PSI scale (proportion with clinically concerning problems) 6 months High
0.48 p < 0.05 117 families Bridgeport, CT
PSI total score (proportion with clinically concerning problems) 6 months High
0.44 p < 0.05 117 families Bridgeport, CT
PSI difficult child (proportion with clinically concerning problems) 6 months High
0.96 p < 0.05 117 families Bridgeport, CT
PSI parent distress (proportion with clinically concerning problems) 6 months High
0.35 p < 0.05 117 families Bridgeport, CT
PSI parent-child dysfunction (proportion with clinically concerning problems) 6 months High
0.13 p > 0.05 117 families Bridgeport, CT
CES-D (proportion with clinically concerning problems) 6 months High
0.13 p > 0.05 117 families Bridgeport, CT
BSI 6 months High
0.00 p > 0.05 117 families Bridgeport, CT
CES-D 6 months High
0.20 p > 0.05 117 families Bridgeport, CT
PSI total score 6 months High
0.49 p < 0.05 117 families Bridgeport, CT
PSI difficult child 6 months High
0.47 p < 0.05 117 families Bridgeport, CT
PSI parent-child dysfunction 6 months High
0.27 p > 0.05 117 families Bridgeport, CT
PSI parent distress 6 months High
0.47 p < 0.05 117 families Bridgeport, CT
BSI (proportion with clinically concerning problems) 12 months High
0.83 p < 0.05 117 families Bridgeport, CT
Any PSI scale (proportion with clinically concerning problems) 12 months High
0.29 p < 0.05 117 families Bridgeport, CT
PSI total score (proportion with clinically concerning problems) 12 months High
0.09 p > 0.05 117 families Bridgeport, CT
PSI difficult child (proportion with clinically concerning problems) 12 months High
0.35 p > 0.05 117 families Bridgeport, CT
PSI parent distress (proportion with clinically concerning problems) 12 months High
0.24 p > 0.05 117 families Bridgeport, CT
PSI parent-child dysfunction (proportion with clinically concerning problems) 12 months High
0.17 p > 0.05 117 families Bridgeport, CT
CES-D (proportion with clinically concerning problems) 12 months High
0.12 p > 0.05 117 families Bridgeport, CT
BSI 12 months High
0.56 p < 0.01 117 families Bridgeport, CT
CES-D 12 months High
0.45 p < 0.05 117 families Bridgeport, CT
PSI total score 12 months High
0.20 p > 0.05 117 families Bridgeport, CT
PSI difficult child 12 months High
0.28 p > 0.05 117 families Bridgeport, CT
PSI parent-child dysfunction 12 months High
0.00 p > 0.05 117 families Bridgeport, CT
PSI parent distress 12 months High
0.23 p > 0.05 117 families Bridgeport, CT
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American
30%
Hispanic or Latino
59%
White
8%
Some other race
4%

Maternal Education

Less than a high school diploma
53%
High school diploma or GED
25%
Some college or Associate's degree
19%
Bachelor's degree or higher
2%
Unknown
1%

Other Characteristics

Enrollment in means-tested programs
93%

This study included participants from the following locations:

  • Connecticut