Implementing Child First Meets HHS Criteria

Last updated: August 2011

This report summarizes information on how a given model was implemented in the studies reviewed. The report includes only information provided in (1) implementation studies and (2) effectiveness studies that rate moderate or high. These studies vary in the level of detail they provide about implementation features. Thus, the report does not provide an exhaustive picture of how the model was implemented across the programs studied. HomVEE notes, in the text or in parentheses, the number of studies that reported information on a given implementation feature.

Implementation experiences

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 Studies for Implementation Experiences for a list of the studies and to link to the characteristics of the samples examined in the effectiveness studies.)

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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.

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Location and setting

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

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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.

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Implementation experiences model components

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.
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Model adaptations or enhancements

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

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Dosage

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

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Lessons learned

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

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