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Implementing Child First

Meets DHHS criteria for an evidenced based model

Program Model Overview

Last Updated

June 2016

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The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.

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Implementation Support

Child First, Inc., the National Program Office, is a nonprofit organization based in Connecticut that supports program implementation. It accredits local providers, known as affiliate agencies, and provides them with training and technical assistance, and regular reports on process and outcome data to support quality improvement.

Each state or region designates a Lead State Organization, which functions as the Child First State Program Office. It houses the state clinical director, state program director, and, when needed, regional clinical directors. They provide affiliate agencies in the state with clinical and administrative oversight, technical assistance, clinical consultation, and support to integrate the Child First model into the state’s early childhood system of care.

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Theoretical Model

Child First intervenes with vulnerable young children and families at the earliest possible time to prevent and treat 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; and the presence of a nurturing, consistent, and responsive parent-child relationship buffers and protects the brain from these stressors.

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Target Population

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

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Targeted Outcomes

Child First is designed to promote a strong, nurturing parent-child relationship, decrease involvement with child protective services, and increase referrals and access to community-based services and supports for the child and family. Among children, Child First aims to improve social-emotional development, mental health, language and cognitive development, and executive functioning. Among parents, it aims to decrease depression, stress, and other mental health problems, and improve executive functioning.

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Program Model Components

Each family is assigned a Child First team consisting of a mental health/developmental clinician, who is responsible for assessment and a therapeutic intervention, and a care coordinator, who is knowledgeable about community services and supports. They provide the following services in the home or early care and education settings (the first month focuses on family engagement and assessment, followed by intervention):

  • Assessment of child and family needs. The clinician and care coordinator team uses an ecological approach to assess the child's health and development, important relationships, and family challenges. The home-based assessment includes a protocol of standardized and informal measures; discussions with parents and caregivers; observations in the home and the early care and education settings; 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. A mental health/developmental clinician gathers information within the early care and education or school setting through observation, a formal assessment of social-emotional development completed by the child’s teacher, and conversations with the teacher and school administration. The clinician works with the teacher to understand the meaning of the child’s behavior and to develop classroom strategies to decrease challenging behaviors and enhance the child’s social-emotional development.
  • A child and family plan of care. It outlines a plan for intervention, supports, and community-based services for the child, parents, and other family members. Child First staff develop the plan with the family during home visits; it reflects the parents’ goals, priorities, strengths, culture, and needs. The initial plan is revised as families accomplish goals and subsequent assessments reveal new challenges. The plan is reviewed at least every three months and serves as the Medicaid-compliant treatment plan.
  • Parent-child mental health intervention. The home-based intervention incorporates both trauma-informed child-parent psychotherapy (based on the work of Lieberman and Van Horn) and parent guidance. It is a two-generation approach, designed to strengthen the parent-child relationship and promote secure attachment so that the relationship serves both as a protective buffer to unavoidable stress and directly facilitates emotional, language, and cognitive growth. The model aims to promote parents/caregivers’ 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 of new strategies; and reflection on the psychodynamic relationship between parental feelings, history, and the parental response to the child.
  • Care coordination. The care coordinator provides intensive support during home visits to connect the family to comprehensive community-based services and supports and addresses barriers to access. The care coordinator aims to build parents’ capacity for executive functioning through planning, prioritizing, and connecting families to resources.

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Program Model Intensity and Length

The intensity and length of Child First services vary based on child and family 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 together or separately.
  • Intervention phase: Each family is visited weekly, at minimum. Visits can be more frequent if there is high need, or less frequent as the family nears program completion.

Child and family needs determine the length of service, which is usually from 6 to 12 months. The intervention can be longer if there are significant challenges.

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Location

The Child First model was originally implemented in greater Bridgeport, Connecticut. It has expanded to 15 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

There have been no adaptations or enhancements to Child First.

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Notes

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.

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