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Implementing Child First

Meets DHHS criteria for an evidenced based model

Prerequisites for Implementation

Last Updated

June 2016


Type of Implementing Agency

The Lead State Organization works with state and community stakeholders to select Child First affiliate agencies. Affiliate agencies must have the following qualifications:

  • Not-for-profit, 501(c)(3) status.
  • A relationship with the community, including (1) being known in the community as a reliable, trusted, collaborative partner and community leader; and (2) committed to a family-centered, system-of-care approach to providing comprehensive, coordinated services to children and families.
  • A Child First Advisory Board that includes the major community providers for young children and families. (Another existing early childhood collaborative can be designated for this purpose.)
  • Early childhood expertise, including experience serving children from infancy through age 5.
  • Provider of mental health services, including early childhood mental health and/or prevention services for low-income, high-risk families.
  • Experience providing home-based services.
  • Experience in, or willingness to apply for, Medicaid reimbursement for child mental health services.
  • A relationship with child welfare, including a willingness to meet with a child welfare liaison for monthly case reviews, if serving this population.
  • Willingness to participate in the accreditation process and dedicate staff time for weekly individual, clinical team, and group reflective supervision.


Staffing Requirements

A team consisting of a mental health/developmental clinician and care coordinator deliver the intervention. A clinical director or supervisor supervises the team.

A start-up Child First site must have two teams, a minimum of a half-time clinical director, and the following support staff roles: oversight of senior staff (approximately 0.1 full-time equivalent, or FTE); data entry/tracking (0.3 to 0.5 FTE); and administration (0.3 to 0.5 FTE).


Staff Education and Experience

Child First requires staff to have the following education and experience:

  • Mental health/developmental clinicians must have a master’s-level or higher degree, be licensed or license-eligible in a mental health specialty, and have three to five years of experience providing relationship-based psychotherapy with very young children.
  • Care coordinators must have a bachelor’s degree, knowledge about community resources, and experience working with ethnically diverse young children and families.
  • Clinical directors or supervisors must have (1) a master’s-level or higher degree in a mental health field; (2) training and experience in mental health and child development (prenatal through age 6), including at least five years of experience providing relationship-based psychotherapy for young children and their families; experience with dyadic, parent-child psychotherapy; and knowledge of adult psychopathology; (3) experience providing reflective, clinical supervision; and (4) experience working with ethnically diverse, low-income, high-risk families.

Child First teams must be culturally competent and able to meet the language needs of the communities served.


Supervision Requirements

Clinicians and care coordinators each receive a total of 3.5 hours of clinical, reflective supervision per week: one hour of individual supervision, one hour to meet as a clinical team, and 1.5 to 2.0 hours for all clinical teams to meet as a group. All staff receive programmatic or administrative supervision as a group for at least one hour per month. Supervision is provided by the Child First clinical director or supervisor (unless staff levels require an additional supervisor with Child First training). Supervisors must also maintain an open-door policy to respond to acute clinical needs. On average, a single, full-time clinical director or supervisor can supervise up to five clinical teams.

The clinical director/supervisor must participate in (1) biweekly, individual, clinical, reflective consultation with the Child First state clinical director or senior clinical Child First consultant from the Lead State Organization; and (2) weekly individual, clinical supervision from a senior clinician at the affiliate agency (or an outside consultant).


Staff Ratio Requirements

Each Child First team has a caseload of 12 to 16 families that is structured so they can complete 12 home visits per 40-hour work week. Caseloads vary based on service intensity; the success of planned visits (that is, no cancellation); and travel times.


Data Systems/Technology Requirements

All affiliate agencies are required to use the Child First web-based electronic health record (EHR) system or their own EHR system. These data systems are used for service delivery and to collect and analyze data on process and outcome measures (see the sections on fidelity for more information on the process and outcomes data). The Child First National Program Office (the Data and Quality Enhancement Team) provides training and ongoing technical assistance for these data requirements.

Child First’s EHR system consists of a Child First Comprehensive Record (CFCR), which contains all client information from referral to discharge, including assessments, formulation, treatment plan, progress notes, and billing. It was designed to facilitate efficient recording of client information and decrease data entry duplication. No other health record is necessary. For agencies that need to use their own electronic system, Child First is in the process of designing the Child First Abbreviated Record (CFAB). It will contain data elements that the National Program Office needs for assessing outcomes and fidelity.



The information contained on this page was last updated in June 2016. 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 executive director on May 12, 2016. HomVEE reserves the right to edit the profile for clarity and consistency.