Implementing Child First Meets HHS Criteria

Implementation last updated: 2020

The information in this profile reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the research reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Similarly, models described here may not all have impact studies, and those with impact studies may vary in their effectiveness. Please see the Effectiveness button on the left for more information about research on the effectiveness of the models discussed here.

Model overview

Theoretical approach

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.

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Implementation support

Child First, Inc. is a nonprofit organization based in Connecticut that supports model implementation throughout the Child First network, composed of local providers known as Child First affiliate agencies. The Child First National Program Office (NPO) provides these affiliate agencies with ongoing training, clinical consultation, and technical assistance. It also provides data support, analysis, 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 in which Child First is replicated has a state clinical director who (1) provides affiliate agencies in the state with clinical and administrative oversight, technical assistance, and biweekly clinical consultation; (2) coordinates monthly meetings with the Child First network and calls or meetings with senior leadership; and (3) supports integration of the Child First model into local and state early childhood systems of care.

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Intended population

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.

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Targeted outcomes

Child First works to heal and protect young children from trauma and adversity by supporting the development of a nurturing and responsive parent-child relationship. The targeted child outcomes include decreased child abuse and neglect and improved social-emotional development (mental and behavioral health), language and cognitive development, and executive functioning. Targeted parent outcomes include reduced depression, post-traumatic stress disorder, and other mental health problems; decreased parenting stress; improved executive functioning; and increased parental education and employment. The model also aims to decrease the family’s psychosocial and environmental stress (the social determinants of health) and increase their connection to comprehensive, growth-promoting, community-based services and supports.

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Model intensity and length

The intensity and length of Child First services vary based on the child’s and family’s 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, either together or separately.  
  • Intervention phase: Each family is visited weekly, at a minimum. Visits can be more frequent if there is high need, with their intensity determined by the unique needs and goals of the family.

The child’s and family’s needs determine the length of service, which is usually from 6 to 12 months. However, the intervention can be longer if significant challenges exist.

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The Child First model was originally implemented in greater Bridgeport, Connecticut. It has expanded to 15 affiliate 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 enhancements to the model. No information is available on the process, if any, for considering modifications to the model.

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Implementation notes

The information contained on this page was last updated in June 2020. 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 CEO on February 21, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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