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Implementing Child First

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

August 2011


Summary of Sources

Information in this section is based on one study included in the Home Visiting Evidence of Effectiveness (HomVEE) review. For Child First, we reviewed one randomized controlled trial (RCT) study (Please see study database list).


Characteristics of Model Participants

All parents involved in the program were female. About 6 percent of program participants were white, 27 percent were African American, 60 percent were Hispanic, and 6 percent were of other racial or ethnic backgrounds. About 58 percent of children were female; 42 percent were male.

At the time of program entry, most mothers and families faced multiple socioeconomic barriers. Three out of five mothers had attained less than a high school diploma and two-thirds of mothers were unemployed. Approximately 92 percent of families were receiving public assistance and one in four were homeless. Just under half of participating families had a history of substance abuse and about 28 percent had a history of Child Protective Services involvement.

Participation in Child First was voluntary.


Location and Setting

The study was implemented in the greater Bridgeport, Connecticut area.


Staffing and Supervision

Each family was assigned a clinical team that consisted of a master’s level developmental and mental health clinician and an associate’s or bachelor’s level care coordinator and case manager. These practitioners typically were from the same racial/ethnic groups as the families and spoke the families’ preferred language. The team was supervised by a clinical supervisor.

The study reviewed did not include information about staff caseloads or staff training.


Model Components

Child First included two core components: (1) connecting families to comprehensive, integrated services and supports through a ‘‘system of care’’ approach and (2) promotion of responsive, nurturing caregiving through a relationship-based psychotherapeutic approach. Program content was individualized and guided by the family’s strengths, needs, and psychological availability.


Model Adaptations or Enhancements

The study reviewed did not include information on adaptations or enhancements.



Participating families received weekly visits lasting approximately 45 to 60 minutes, although the study notes that there were many missed and cancelled appointments.


Fidelity Measurement

After each visit, the clinician completed the Assessment and Intervention Fidelity Checklist that focused on core elements of the intervention: observation of the child’s emotional, cognitive, and physical development; observation of parent–child interaction and play; psychoeducational assessment including developmental stages, expectations, and meaning of typical behaviors; reflective functioning to understand the child’s feelings and meaning of child’s unique and challenging behaviors; psychodynamic understanding of mother’s history, feelings, and experience of the child; alternate perspectives of child behavior and new parental responses; and positive reinforcement of both parents’ and child’s strengths to promote parental self-esteem. The clinical supervisor reviewed the fidelity checklist to ensure fidelity.



The study estimated that the cost of the psychotherapeutic and care coordination components of the intervention was about $4,000 per family. No information was provided about the specific components used to estimate the costs.


Lessons Learned

The study did not include any lessons learned about implementing Child First.