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.
Model(s) Reviewed:
Child First
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not Applicable | None | None | Not assessed in manuscripts reviewed before 2021 |
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. |
| Intervention 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. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | Starting Early Starting Smart Prototype (Substance Abuse and Mental Health Services Administration, 9886); Robert Wood Johnson Foundation (60068) |
| Author affiliation | Darcy I. Lowell, a study author, is the founder and executive director of Child FIRST. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | ITSEA dysregulation | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 16.40 | Mean = 20.70 | Mean difference = -4.30 | HomVEE calculated = 0.36 | p > 0.05 | |
| High | ITSEA dysregulation | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 18.40 | Mean = 21.40 | Mean difference = -3.00 | HomVEE calculated = 0.22 | p > 0.05 | |
| High | ITSEA dysregulation (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 7.00 | Adjusted mean % = 15.90 | Difference = -8.90 | HomVEE calculated = -0.56 | p > 0.05 | |
| High | ITSEA dysregulation (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 11.30 | Adjusted mean % = 12.70 | Difference = -1.40 | HomVEE calculated = -0.08 | p > 0.05 | |
| High | ITSEA externalizing | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 13.80 | Mean = 18.40 | Mean difference = -4.60 | HomVEE calculated = 0.49 | p < 0.05 | |
| High | ITSEA externalizing | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 15.40 | Mean = 18.40 | Mean difference = -3.00 | HomVEE calculated = 0.30 | p > 0.05 | |
| High | ITSEA externalizing (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 22.80 | Adjusted mean % = 36.50 | Difference = -13.70 | HomVEE calculated = -0.40 | p > 0.05 | |
| High | ITSEA externalizing (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 17.00 | Adjusted mean % = 29.10 | Difference = 12.10 | HomVEE calculated = -0.42 | p < 0.05 | |
| High | ITSEA internalizing | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 13.10 | Mean = 14.60 | Mean difference = -1.50 | HomVEE calculated = 0.19 | p > 0.05 | |
| High | ITSEA internalizing | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 15.40 | Mean = 15.80 | Mean difference = -0.40 | HomVEE calculated = 0.13 | p > 0.05 | |
| High | ITSEA internalizing (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 3.50 | Adjusted mean % = 1.60 | Difference = 1.90 | HomVEE calculated = 0.49 | p > 0.05 | |
| High | ITSEA internalizing (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 1.90 | Adjusted mean % = 1.80 | Difference = 0.10 | HomVEE calculated = 0.03 | p > 0.05 | |
| High | Any ITSEA domain (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 26.40 | Adjusted mean % = 36.40 | Difference = -10.00 | HomVEE calculated = -0.28 | p < 0.05 | HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant. |
| High | Any ITSEA domain (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 26.30 | Adjusted mean % = 44.40 | Difference = -18.10 | HomVEE calculated = -0.49 | p > 0.05 | |
| High | Child language (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 10.50 | Adjusted mean % = 33.30 | OR = 4.40 | HomVEE calculated = -0.88 | p < 0.05 | |
| High | Child language (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 16.90 | Adjusted mean % = 30.30 | OR = 3.00 | HomVEE calculated = -0.46 | p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Percentage of desired services received that were received, child development | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 99.00 | % = 14.00 | Difference = 85.00 | HomVEE calculated = 3.89 | p < 0.001 | |
| High | Percentage of desired services that were received | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % = 88.10 | % = 31.80 | Difference = 56.30 | HomVEE calculated = 3.79 | p < 0.001 | |
| High | Percentage of desired services that were received | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 91.20 | % = 33.20 | Difference = 58.00 | HomVEE calculated = 3.93 | p < 0.001 | |
| High | Percentage of desired services that were received—child mental health | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 93.00 | % = 2.00 | Difference = 91.00 | HomVEE calculated = 3.93 | p < 0.001 | |
| High | Percentage of desired services that were received, early education | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 88.00 | % = 26.00 | Difference = 62.00 | HomVEE calculated = 1.84 | p < 0.001 | |
| High | Percentage of desired services that were received, adult education | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 62.00 | % = 9.00 | Difference = 53.00 | HomVEE calculated = 1.70 | p < 0.001 | |
| High | Percentage of desired services that were received, adult mental health | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 92.00 | % = 7.00 | Difference = 85.00 | HomVEE calculated = 3.05 | p < 0.001 | |
| High | Percentage of desired services that were received, concrete needs | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 89.00 | % = 16.00 | Difference = 73.00 | HomVEE calculated = 2.27 | p < 0.001 | |
| High | Percentage of desired services that were received, family support | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 83.00 | % = 9.00 | Difference = 74.00 | HomVEE calculated = 2.36 | p < 0.001 | |
| High | Percentage of desired services that were received, medical services | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 98.00 | % = 78.00 | Difference = 20.00 | HomVEE calculated = 1.59 | p < 0.001 | |
| High | Percentage of desired services that were received, social services | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % = 93.00 | % = 56.00 | Difference = 37.00 | HomVEE calculated = 1.42 | p < 0.001 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | BSI | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 21.00 | Mean = 35.10 | Mean difference = -14.10 | HomVEE calculated = 0.56 | p < 0.01 | |
| High | BSI | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 32.70 | Mean = 33.00 | Mean difference = -0.30 | HomVEE calculated = 0.00 | p > 0.05 | |
| High | BSI (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 25.80 | Adjusted mean % = 31.80 | Difference = -6.00 | HomVEE calculated = -0.18 | p > 0.05 | |
| High | BSI (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 14.00 | Adjusted mean % = 39.00 | Difference = -25.00 | HomVEE calculated = -0.83 | p < 0.05 | |
| High | CES-D | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 13.50 | Mean = 17.40 | Mean difference = -3.90 | HomVEE calculated = 0.45 | p < 0.05 | |
| High | CES-D | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 16.90 | Mean = 18.50 | Mean difference = -1.60 | HomVEE calculated = 0.20 | p > 0.05 | |
| High | CES-D (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 33.30 | Adjusted mean % = 37.90 | Difference = -4.60 | HomVEE calculated = -0.12 | p > 0.05 | |
| High | CES-D (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 46.00 | Adjusted mean % = 40.80 | Difference = 5.20 | HomVEE calculated = 0.13 | p > 0.05 | |
| High | PSI difficult child | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 23.50 | Mean = 26.50 | Mean difference = -3.00 | HomVEE calculated = 0.47 | p < 0.05 | |
| High | PSI difficult child | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 24.90 | Mean = 25.90 | Mean difference = -1.00 | HomVEE calculated = 0.28 | p > 0.05 | |
| High | PSI difficult child (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 7.10 | Adjusted mean % = 11.90 | Difference = -4.80 | HomVEE calculated = -0.35 | p > 0.05 | |
| High | PSI difficult child (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 4.80 | Adjusted mean % = 19.70 | Difference = -14.90 | HomVEE calculated = -0.96 | p < 0.05 | |
| High | PSI parent distress | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 29.70 | Mean = 30.40 | Mean difference = -0.70 | HomVEE calculated = 0.23 | p > 0.05 | |
| High | PSI parent distress | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 30.30 | Mean = 33.60 | Mean difference = -3.30 | HomVEE calculated = 0.47 | p < 0.05 | |
| High | PSI parent distress (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 31.80 | Adjusted mean % = 45.50 | Difference = -13.70 | HomVEE calculated = -0.35 | p < 0.05 | HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant. |
| High | PSI parent distress (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 21.40 | Adjusted mean % = 28.80 | Difference = -7.40 | HomVEE calculated = -0.24 | p > 0.05 | |
| High | PSI parent-child dysfunction | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 21.60 | Mean = 20.60 | Mean difference = 1.00 | HomVEE calculated = 0.00 | p > 0.05 | |
| High | PSI parent-child dysfunction | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 20.40 | Mean = 21.90 | Mean difference = -1.50 | HomVEE calculated = 0.27 | p > 0.05 | |
| High | PSI parent-child dysfunction (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 19.10 | Adjusted mean % = 22.70 | Difference = -3.60 | HomVEE calculated = -0.13 | p > 0.05 | |
| High | PSI parent-child dysfunction (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 21.40 | Adjusted mean % = 17.40 | Difference = 4.40 | HomVEE calculated = 0.17 | p > 0.05 | |
| High | PSI total score | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | Mean = 74.20 | Mean = 81.90 | Mean difference = -7.70 | HomVEE calculated = 0.49 | p < 0.05 | |
| High | PSI total score | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | Mean = 76.30 | Mean = 76.90 | Mean difference = -0.60 | HomVEE calculated = 0.20 | p > 0.05 | |
| High | PSI total score (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 19.60 | Adjusted mean % = 22.00 | Difference = -2.40 | HomVEE calculated = -0.09 | p > 0.05 | |
| High | PSI total score (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 20.60 | Adjusted mean % = 34.90 | Difference = -14.30 | HomVEE calculated = -0.44 | p < 0.05 | |
| High | Any PSI scale (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 12 months | 117 families | % (adjusted) = 32.70 | Adjusted mean % = 44.10 | Difference = -11.40 | HomVEE calculated = -0.29 | p < 0.05 | HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant. |
| High | Any PSI scale (proportion with clinically concerning problems) | FavorableUnfavorable or ambiguousNo Effect |
Bridgeport, CT | 6 months | 117 families | % (adjusted) = 38.10 | Adjusted mean % = 57.60 | Difference = -19.50 | HomVEE calculated = -0.48 | p < 0.05 |