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.

Prerequisites for implementation

Type of implementing program

The NPO works with state and community stakeholders to select Child First affiliate agencies in a region. Affiliate agencies must be or have the following qualifications:

  • Not-for-profit, 501(c)(3) status or public agency;
  • A respected relationship within the community, including being (1) known as a reliable, trusted, collaborative partner and community leader; and (2) committed to a family-centered system-of-care approach to providing comprehensive, coordinated services to children and families;
  • A Child First Advisory Board that includes the major community providers for young children and families. (Another existing early childhood collaborative may be designated for this purpose.)
  • A social justice commitment, including hiring staff who represent the diverse languages and culture of the communities being served;
  • Early childhood expertise, including experience in serving children from infancy through age 5 years;
  • A provider of mental health services, including early childhood mental health and/or prevention services for low-income, high-risk families;
  • Experience in providing home-based services;
  • Experience in or willingness to apply for Medicaid reimbursement for child mental health services, or have another consistent public funding stream to sustain services;
  • Experience in serving the child welfare population and willingness to work closely with the child welfare agency to serve the most vulnerable families;
  • Staff that meet Child First education, standards, and licensing requirements, including master’s-level, licensed, mental health clinicians and supervisors; and bachelor’s-level care coordinators;
  • Willingness to commit to all Child First fidelity requirements, including comprehensive training, implementation standards, benchmarks, assessment protocols, continuous quality improvement, and evaluation of model effectiveness;
  • Willingness to dedicate staff time for weekly individual, clinical team, and group reflective supervision, and have the clinical director/supervisor participate in reflective, clinical consultation; and
  • Willingness to participate in the Child First accreditation process.
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Staffing requirements

A team consisting of a mental health/developmental clinician and a care coordinator working together deliver the intervention. A Child First trained clinical director or supervisor provides reflective clinical and administrative supervision for the team.

A new Child First affiliate site optimally should have at least four home visiting teams with a full-time clinical director/supervisor. (An affiliate site with six teams or more must have additional supervisors.) An affiliate agency must have a senior clinician to provide reflective, clinical supervision and implementation support to the affiliate site Child First clinical director/supervisor.

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Staff education and experience

Child First requires staff to have the following education and experience:

  • Mental health/developmental clinicians must have a master’s-level or higher degree, be licensed or license-eligible (with approval) in a mental health specialty, and have three to five years of experience in providing relationship-based psychotherapy with very young children.
  • Care coordinators must have a bachelor’s degree, knowledge about community resources, and experience in working with ethnically diverse young children and families.
  • Clinical directors/supervisors must have (1) a master’s-level or higher degree in a mental health field; (2) training and experience in mental health and child development (prenatal through age 5 years), including at least five years of experience in providing relationship-based psychotherapy for young children and their families; experience with dyadic, parent-child psychotherapy and knowledge of adult psychopathology; (3) experience in providing reflective, clinical supervision; and (4) experience in working with ethnically diverse, low-income, high-risk families.

Child First teams must be culturally informed and sensitive, and meet the language needs of the communities served.

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Supervision requirements

The Child First clinical director/supervisor provides each clinician and care coordinator with a total of 3.5 hours of clinical, reflective supervision per week: one hour of individual supervision, one hour of clinical team (clinician and care coordinator together) supervision, and 1.5 to 2.0 hours of group supervision with all clinical teams together. All staff receive programmatic or administrative supervision as a group for at least one hour per month. Clinical directors/supervisors must also maintain an open-door policy to respond to acute clinical needs. A single, full-time clinical director/supervisor can supervise four clinical teams. Additional teams require additional supervisory support.

The clinical director/supervisor must participate in (1) biweekly, individual, clinical, and reflective consultation with the Child First state clinical director and (2) weekly individual clinical supervision from a senior clinician at the affiliate agency with experience in psychodynamic work with young children.

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Staff ratio requirements

Each Child First team has a caseload of 12 to 16 families, usually structured so the team can complete 12 home visits per 40-hour work week. However, caseloads and the number of completed weekly visits may vary based on intensity of service need and travel times. For example, a team working with a family with major challenges or a child in foster care with therapeutic intervention with both the foster and birth parents may visit the family multiple times per week. Thus, that team would have a lower caseload. Likewise, a team working with families living in a rural area with longer travel times may have a lower caseload.

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Data systems/technology requirements

All affiliate agencies are required to use the Child First web-based electronic health record—the Child First Comprehensive Clinical Record (CFCR)—which contains all client information from referral to discharge, including intake, assessments, treatment plan, progress notes, scheduling, and billing (optional). It was designed to facilitate efficient recording of client information and decrease data entry duplication. No other health record is needed.

Both process and outcome measures are analyzed, and reports are available to all affiliate agency clinical directors for program management and quality enhancement. The NPO uses the reports to assess model fidelity. The NPO's Data and Quality Enhancement Team provides intensive training and ongoing technical assistance for these data requirements.

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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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