Implementing Child First Meets HHS Criteria

Last updated: May 2018

Model Overview

Implementation Support

Child First, Inc., the National Program Office (NPO), is a nonprofit organization based in Connecticut that supports model implementation throughout the Child First network, which is composed of local providers, known as Child First affiliate agencies. The NPO provides affiliate agencies with ongoing training, clinical consultation, and technical assistance. It also provides data support and access to reports on process and outcome data to support implementation fidelity and quality improvement. The NPO is responsible for accreditation of all Child First affiliates.

Each state or region has a clinical director who (1) provides affiliate agencies in the state or region with clinical and administrative oversight, technical assistance, and biweekly clinical consultation; (2) coordinates meetings with the Child First network and senior leadership; and (3) supports integration of the Child First model into local and state early childhood systems 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 environmental and psychosocial 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 works to heal and protect young children from trauma and adversity. The targeted child outcomes include improved social-emotional development, mental health, language and cognitive development, and executive functioning. Targeted parent outcomes include reduced depression and other mental health problems, decreased parenting stress, and improved executive functioning.

The goals of Child First are to decrease psychosocial and environmental stress and promote healthy child and family development by fostering a strong, nurturing parent-child relationship, decreasing involvement with child protective services, and increasing connections to community-based services and supports for the child and other family members.

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Model Components

Each family is assigned a Child First team consisting of a licensed, master’s-level mental health/developmental clinician, who is responsible for assessment and therapeutic intervention, and a care coordinator, who is responsible for connecting families to 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.
  • Development of 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. 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 families accomplish goals and subsequent assessments reveal new challenges. The plan is reviewed at least every three months.
  • Parent-child mental health intervention. The home-based intervention incorporates both trauma-informed Child-Parent Psychotherapy (CPP; 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 and the development 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 goal setting, planning, prioritizing, and revising; and by connecting families to resources.
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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 a minimum. Visits can be more frequent if there is high need, with intensity of the visits determined by the unique goals of the family.

Child and family needs determine the length of service, which is usually from 6 to 12 months. However, 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

The NPO has not approved any adaptations or enhancement to the model.

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Implementation Notes

The information contained on this page was last updated in May 2018. 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 January 17, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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