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Lowell, D. I., Carter, A. S., Godoy, L., Paulicin, B., & Briggs‐Gowan, M. J. (2011). A randomized controlled trial of Child FIRST: A comprehensive home‐based intervention translating research into early childhood practice. Child development82(1), 193-208.

Model(s) Reviewed: Child First
Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Not Applicable None None Not assessed in manuscripts reviewed before 2021
Notes:

In 2020, HomVEE updated this review to remove family involvement with CPS findings from the Reductions in Child Maltreatment domain because some cases in the abuse complaint may be unsubstantiated. In this domain HomVEE reviews only outcomes focused on substantiated cases of abuse and neglect.

Study characteristics
Study participants Children were eligible if they were between 6 and 36 months of age; had a positive screening for social-emotional/behavioral problems on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) and/or the parent screened high for psychosocial risk; and lived in a permanent caregiving environment in Bridgeport, Connecticut. Of 642 families completing screens, 464 passed the screening, 254 consented to the study, and 157 were randomized (stratified by age, BITSEA score, and family psychosocial risk). There were 78 children in the Child FIRST intervention group and 79 in the usual care comparison group at baseline, 64 (intervention) and 67 (comparison) at the six-month follow-up, and 58 (intervention) and 59 (comparison) at the 12-month follow-up. Fifty-nine percent of mothers in the study were Hispanic, 30 percent were African American, 8 percent were Caucasian, and 4 percent were of another race/ethnicity.
Setting This study took place in Bridgeport, Connecticut.
Intervention services The Child FIRST model has two core components. The first is a connection to a “system of care,” a community-based, comprehensive, coordinated set of services, including early education, health care, and other social services. Second, the program offers a psychotherapeutic approach to promote nurturing caregiving. Services were offered in the home. Two staff members, a clinician and care coordinator, were assigned to each family. The clinician was responsible for therapeutic assessment and intervention with the child and parent and the care coordinator facilitated family engagement in community services. Weekly visits lasting 45 to 90 minutes were made jointly or individually, as needed by the family.
Comparison conditions Comparison families (the usual-care group) continued to receive usual care from the study’s recruitment sites: the Bridgeport Hospital Pediatric Primary Care Center and the Supplementary Nutrition Program for Women, Infants, and Children.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).
Subgroups are not listed for manuscripts reviewed before 2021.
Funding sources Starting Early Starting Smart Prototype (Substance Abuse and Mental Health Services Administration, 9886); Robert Wood Johnson Foundation (60068)
Author affiliation Darcy I. Lowell, a study author, is the founder and executive director of Child FIRST.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings that rate moderate or high

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High ITSEA dysregulation
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 16.40 Mean = 20.70 Mean difference = -4.30 HomVEE calculated = 0.36 p > 0.05
High ITSEA dysregulation
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 18.40 Mean = 21.40 Mean difference = -3.00 HomVEE calculated = 0.22 p > 0.05
High ITSEA dysregulation (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 7.00 Adjusted mean % = 15.90 Difference = -8.90 HomVEE calculated = -0.56 p > 0.05
High ITSEA dysregulation (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 11.30 Adjusted mean % = 12.70 Difference = -1.40 HomVEE calculated = -0.08 p > 0.05
High ITSEA externalizing
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 15.40 Mean = 18.40 Mean difference = -3.00 HomVEE calculated = 0.30 p > 0.05
High ITSEA externalizing
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 13.80 Mean = 18.40 Mean difference = -4.60 HomVEE calculated = 0.49 p < 0.05
High ITSEA externalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 22.80 Adjusted mean % = 36.50 Difference = -13.70 HomVEE calculated = -0.40 p > 0.05
High ITSEA externalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 17.00 Adjusted mean % = 29.10 Difference = 12.10 HomVEE calculated = -0.42 p < 0.05
High ITSEA internalizing
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 15.40 Mean = 15.80 Mean difference = -0.40 HomVEE calculated = 0.13 p > 0.05
High ITSEA internalizing
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 13.10 Mean = 14.60 Mean difference = -1.50 HomVEE calculated = 0.19 p > 0.05
High ITSEA internalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 3.50 Adjusted mean % = 1.60 Difference = 1.90 HomVEE calculated = 0.49 p > 0.05
High ITSEA internalizing (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 1.90 Adjusted mean % = 1.80 Difference = 0.10 HomVEE calculated = 0.03 p > 0.05
High Any ITSEA domain (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 26.30 Adjusted mean % = 44.40 Difference = -18.10 HomVEE calculated = -0.49 p > 0.05
High Any ITSEA domain (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 26.40 Adjusted mean % = 36.40 Difference = -10.00 HomVEE calculated = -0.28 p < 0.05

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HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

High Child language (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 10.50 Adjusted mean % = 33.30 OR = 4.40 HomVEE calculated = -0.88 p < 0.05
High Child language (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 16.90 Adjusted mean % = 30.30 OR = 3.00 HomVEE calculated = -0.46 p < 0.05
Linkages and referrals
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Percentage of desired services received that were received, child development
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 99.00 % = 14.00 Difference = 85.00 HomVEE calculated = 3.89 p < 0.001
High Percentage of desired services that were received
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % = 88.10 % = 31.80 Difference = 56.30 HomVEE calculated = 3.79 p < 0.001
High Percentage of desired services that were received
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 91.20 % = 33.20 Difference = 58.00 HomVEE calculated = 3.93 p < 0.001
High Percentage of desired services that were received—child mental health
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 93.00 % = 2.00 Difference = 91.00 HomVEE calculated = 3.93 p < 0.001
High Percentage of desired services that were received, early education
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 88.00 % = 26.00 Difference = 62.00 HomVEE calculated = 1.84 p < 0.001
High Percentage of desired services that were received, adult education
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 62.00 % = 9.00 Difference = 53.00 HomVEE calculated = 1.70 p < 0.001
High Percentage of desired services that were received, adult mental health
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 92.00 % = 7.00 Difference = 85.00 HomVEE calculated = 3.05 p < 0.001
High Percentage of desired services that were received, concrete needs
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 89.00 % = 16.00 Difference = 73.00 HomVEE calculated = 2.27 p < 0.001
High Percentage of desired services that were received, family support
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 83.00 % = 9.00 Difference = 74.00 HomVEE calculated = 2.36 p < 0.001
High Percentage of desired services that were received, medical services
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 98.00 % = 78.00 Difference = 20.00 HomVEE calculated = 1.59 p < 0.001
High Percentage of desired services that were received, social services
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % = 93.00 % = 56.00 Difference = 37.00 HomVEE calculated = 1.42 p < 0.001
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High BSI
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 21.00 Mean = 35.10 Mean difference = -14.10 HomVEE calculated = 0.56 p < 0.01
High BSI
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 32.70 Mean = 33.00 Mean difference = -0.30 HomVEE calculated = 0.00 p > 0.05
High BSI (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 25.80 Adjusted mean % = 31.80 Difference = -6.00 HomVEE calculated = -0.18 p > 0.05
High BSI (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 14.00 Adjusted mean % = 39.00 Difference = -25.00 HomVEE calculated = -0.83 p < 0.05
High CES-D
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 13.50 Mean = 17.40 Mean difference = -3.90 HomVEE calculated = 0.45 p < 0.05
High CES-D
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 16.90 Mean = 18.50 Mean difference = -1.60 HomVEE calculated = 0.20 p > 0.05
High CES-D (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 46.00 Adjusted mean % = 40.80 Difference = 5.20 HomVEE calculated = 0.13 p > 0.05
High CES-D (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 33.30 Adjusted mean % = 37.90 Difference = -4.60 HomVEE calculated = -0.12 p > 0.05
High PSI difficult child
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 24.90 Mean = 25.90 Mean difference = -1.00 HomVEE calculated = 0.28 p > 0.05
High PSI difficult child
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 23.50 Mean = 26.50 Mean difference = -3.00 HomVEE calculated = 0.47 p < 0.05
High PSI difficult child (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 4.80 Adjusted mean % = 19.70 Difference = -14.90 HomVEE calculated = -0.96 p < 0.05
High PSI difficult child (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 7.10 Adjusted mean % = 11.90 Difference = -4.80 HomVEE calculated = -0.35 p > 0.05
High PSI parent distress
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 29.70 Mean = 30.40 Mean difference = -0.70 HomVEE calculated = 0.23 p > 0.05
High PSI parent distress
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 30.30 Mean = 33.60 Mean difference = -3.30 HomVEE calculated = 0.47 p < 0.05
High PSI parent distress (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 21.40 Adjusted mean % = 28.80 Difference = -7.40 HomVEE calculated = -0.24 p > 0.05
High PSI parent distress (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 31.80 Adjusted mean % = 45.50 Difference = -13.70 HomVEE calculated = -0.35 p < 0.05

footnote124

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HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

High PSI parent-child dysfunction
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 20.40 Mean = 21.90 Mean difference = -1.50 HomVEE calculated = 0.27 p > 0.05
High PSI parent-child dysfunction
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 21.60 Mean = 20.60 Mean difference = 1.00 HomVEE calculated = 0.00 p > 0.05
High PSI parent-child dysfunction (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 21.40 Adjusted mean % = 17.40 Difference = 4.40 HomVEE calculated = 0.17 p > 0.05
High PSI parent-child dysfunction (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 19.10 Adjusted mean % = 22.70 Difference = -3.60 HomVEE calculated = -0.13 p > 0.05
High PSI total score
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families Mean = 74.20 Mean = 81.90 Mean difference = -7.70 HomVEE calculated = 0.49 p < 0.05
High PSI total score
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families Mean = 76.30 Mean = 76.90 Mean difference = -0.60 HomVEE calculated = 0.20 p > 0.05
High PSI total score (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 19.60 Adjusted mean % = 22.00 Difference = -2.40 HomVEE calculated = -0.09 p > 0.05
High PSI total score (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 20.60 Adjusted mean % = 34.90 Difference = -14.30 HomVEE calculated = -0.44 p < 0.05
High Any PSI scale (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 12 months 117 families % (adjusted) = 32.70 Adjusted mean % = 44.10 Difference = -11.40 HomVEE calculated = -0.29 p < 0.05

footnote124

Submitted by user on

HomVEE-calculated p-value is greater than 0.05, indicating that this result is not significant.

High Any PSI scale (proportion with clinically concerning problems)
FavorableUnfavorable or ambiguousNo Effect
Bridgeport, CT 6 months 117 families % (adjusted) = 38.10 Adjusted mean % = 57.60 Difference = -19.50 HomVEE calculated = -0.48 p < 0.05