Model effectiveness research report last updated: 2011
Child First intervenes with vulnerable young children and families at the earliest possible time to prevent and heal 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. Child First aims to build a nurturing, consistent, and responsive parent-child relationship, which buffers and protects the child’s brain from these stressors. In addition, the model is designed to stabilize and decrease the multiple concrete challenges in the family’s life.
Child First affiliate sites assign each family a team consisting of a licensed master’s-level mental health/developmental clinician responsible for assessment and therapeutic intervention and a care coordinator responsible for connecting families to community services and supports. The Child First model involves the following:
- Engagement and assessment of child and family needs. The clinician and care coordinator work as a team to engage and build a trusting relationship with the family. To understand the family’s strengths and challenges, the team, in collaboration with the family, uses an ecological approach to assess the child’s health and development, important relationships, and the family’s culture and priorities. The assessment includes a protocol of standardized and informal measures; discussions with parents; observations in the home and early care and education settings (see details below); 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. The mental health/developmental clinician gathers information within any early care setting attended by the child receiving home visiting services. These settings may include family, friend, and neighbor care; early care and education programs; and schools. The clinician gathers information through observations; conversations with the teacher and school administration; and review of any records. The clinician works with the teacher to understand the meaning of the child’s behavior, develop classroom strategies to decrease challenging behaviors and enhance the child’s social-emotional development, and coordinate efforts between the child’s early care and education setting and the home.
- Development of a child and family plan of care. The plan of care outlines the therapeutic intervention; parenting supports; and community-based services for the child, parents, and other family members. The Child First team develops the plan with the family during home visits; it reflects the parents’ goals, priorities, strengths, culture, and needs. The initial plan is revised as the family accomplishes goals and subsequently focuses on new challenges. The plan is reviewed at least every three months.
- Parent-child mental health intervention. The home-based intervention incorporates both Child-Parent Psychotherapy (CPP) and parenting support and guidance. It is a two-generation approach, designed to strengthen the parent-child relationship and promote secure attachment so the relationship both serves as a protective buffer from unavoidable stress and directly facilitates emotional, language, and cognitive growth. It addresses the experience of trauma and adversity in the child’s life, with the goal of helping the child heal and resolving behavioral problems. The model aims to promote parents’ 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 and the development of new strategies; and reflection on the psychodynamic relationship between parental history, feelings, and the parental response to the child.
- Promotion of executive functioning. The clinician works with the parent on emotional regulation. The care coordinator scaffolds and supports the parent in the development of other executive functioning capacities, such as goal planning. The care coordinator works with the parent to develop individual and family goals, prioritize those goals, create plans to accomplish them, monitor progress, and revise those plans. In addition, the care coordinator provides the parent with relationship-based activities and routines, based on the Abecedarian Approach, that help the parent scaffold executive functioning skills with the child.
- Care coordination. The care coordinator’s priority is to help stabilize the family, especially in the face of acute challenges, such as threats to the child’s safety, possible eviction, or lack of adequate food. To help decrease stress and enhance the child’s and family’s development, the care coordinator helps connect the family to comprehensive community-based services and supports, and directly addresses barriers to service access.
Child First serves pregnant women and families with children from birth through age 5 years in which (1) children have emotional, behavioral, or developmental difficulties; or (2) the family faces multiple environmental and psychosocial challenges (which Child First views as social determinants of health) that may lead to negative parent and child outcomes, such as maternal depression, domestic violence, substance abuse, homelessness, or abuse and neglect. Families are served without regard for their legal status or the number of children in the family.