Child First
Category
Family Support
Child's Age
0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years
Participant
Children, Parents/Guardian
Languages
English, Spanish
Brief Description
Intensive, home-based early childhood model that supports young children and their families as they heal from the damaging effects of stress and trauma. Two-generation approach builds strong, nurturing, caregiver-child relationships, promotes adult capacity, and connects families with services to increase emotional health, promote learning success, and prevent child abuse and neglect.
Expected Impact
- Decrease in parental stress
- Reduction in early childhood exposure to neglect, abuse, and violence
- Less likely to experience language problems
- Less likely to have aggressive or defiant behaviors
- Lower levels of maternal mental health problems
- Less likely to be involved with CPS
- Increase in access to community supports and services
- Decrease in post-intervention exposure to violence and abuse
- Improvements in Child First outcome domains: child communication, child behavior, child social skills, caregiver-child interaction, caregiver depression, caregiver PTSD and caregiver stress
Core Components for Model Fidelity
- Intended Audience: Children are eligible for referrals if they display emotional/behavioral or developmental/learning difficulties, have been exposed to or impacted by trauma, or are from a family facing multiple challenges (such as substance use, homelessness, or parental mental illness). No formal screening is required.
- Psychotherapeutic, Two-Generation Home Visits: Helps build a nurturing, responsive, parent-child relationship to protect the child’s developing brain from the damage of chronic stress, heals the effects of trauma and adversity for both child and parent/caregiver, and promotes strong emotional health and cognitive growth.
- Care Coordination: Provides hands-on connection to broad community-based services and supports for all family members, partnering with the family to work through immediate, severe challenges, decrease stress, and utilize growth-enhancing community resources.
- Infant and Early Childhood Community Collaborative: Implementers must participate in an Infant and Early Childhood Community Collaborative (IECCC) to enhance and integrate services for infants, young children, and their families, along a continuum from promotion to prevention to intervention.
Languages Materials are Available in
English, Spanish
Delivery Mode
In-person home visits.
Dosage
During the first month (assessment period), families are visited twice per week. After the first month, visits are conducted at least once per week (more frequent visits as needed). On average, visits last 60 minutes. Services continue for 6-12 months on average.
Infrastructure for Implementation
Materials: Necessary materials include laptops; Wi-Fi for remote work; toys for sessions (lists of recommended toys for clinicians and FRPs are provided by Child First); and portable video cameras, tripods and other accessories for video intervention. Additionally, some standardized assessments will need to be purchased ongoingly.
Space: The supervisor and team must have access to an office space to conduct individual, team, and group supervision.
Other: A group of community stakeholders identify a lead organization and affiliated agencies to provide community support.
Staffing Requirements
Typically, affiliate sites implement a minimum of 4 Child First teams. For every 4 Child First teams (each with 1 Clinician and 1 Care Coordinator), there must be 1 Child First Clinical Supervisor. Each Child First team serves approximately 8-16 families and conducts roughly 8-10 visits per week. Clinical Supervisors, Care Coordinators, and Clinicians must be full-time, in-house members of the Child First program and employed by the contracted Child First provider.
- The Clinician must be a Master’s level or higher mental health clinician and hold a license or be associate licensed as an LCSW, LPC, or LMFT.
- The Care Coordinator must hold a Bachelor’s degree or higher. The Care Coordinator supports families in meeting their immediate needs, connects families with resources in the community and supports caregiver executive functioning.
- The Clinical Supervisor must be a licensed mental health clinician with a master’s or doctoral degree in social work, psychology, APRN-child psychiatry, marriage and family therapy, or a related field. They must have a minimum of 5 years’ experience working psychotherapeutically with young children (0-5) and their families using a relationally based model; specific experience with dyadic parent-child psychotherapy, preferred. Preferably, supervisors will have a minimum of 3 years’ experience conducting reflective supervision with licensed mental health clinicians.
It is recommended that the Child First team members be representative of the diverse community populations they serve in terms of ethnicity and language.
Each affiliate site must participate in an Infant and Early Childhood Community Collaborative (IECCC). The goal of the collaborative is to determine how best to enhance and integrate services for infants, young children, and their families, along a continuum from promotion to prevention to intervention. This group should represent a wide array of providers, community members, stakeholders, and caregivers in the catchment area of the affiliate site.
NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Prevent Child Abuse North Carolina | PCANC (preventchildabusenc.org) or National Family Support Network for more information, training and certification.
Training for Model Fidelity
Training is available for staff both in-person and through live virtual sessions. A Learning Collaborative is used during initial start-up and provided by existing members of Child First’s National Program Office Clinical Training Team. This program lasts 6-8 months. Child-Parent Psychotherapy (CPP) is taught by a certified CPP trainer during the Learning Collaborative. Child First offers a Staff Accelerated Training program for new staff members at an existing Child First agency. In addition, all staff engage in a series of online, self-paced training courses.
Contact Information
Serena Curry: Manager of National Program Development; scurry@childfirst.org, 860-841-8318
Cost Estimates
NOTE: Smart Start funds cannot be used to duplicate services, such as those reimbursed by Medicaid. Based on the NC Affiliate Medicaid Model Sample Agency spreadsheet shared by the purveyor, there is a potential year one funding gap for “early operations.”
During this period, affiliate agencies are hiring, training, and gradually building up to serve a full caseload. With the current EPSDT service definition, affiliates should expect to receive sufficient Medicaid reimbursement to cover the cost of programming once they receive prior authorization to provide services to children and reach a full caseload. Early operation expenses that are not reimbursed through Medicaid and subsequently eligible to receive Smart Start funding may exceed $250,000.
Child First is free to families and the National Service Office works with affiliates to secure start-up and sustainable funding that is sufficient to cover the full cost of programming.
The primary costs associated with Child First are staffing-related. Child First affiliates have an annual operating budget of at least $800,000 to support a minimum of four Child First teams, including annual fees.
The treatment plan established by the Child First team is designed to be Medicaid-compliant.
Purpose Service Code (PSC)
5525 – Intensive Home Visiting
Program Identifier (PID)
Child First
Minimal Outputs for NCPC Reporting
FY 23-24:
- Number of parents/guardians participating†
FY 24-25:
- Number of parents/guardians participating†
†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.
Minimal Outcomes for NCPC Reporting
FY 23-24:
- Increase in parent use of services
FY 24-25:
- Increase in parent use of services
Minimal Measures for NCPC Reporting
FY 23-24:
- Child First Quarterly Assessment Completion and Outcomes Report
FY 24-25:
- TBD
NCPC Evidence Categorization
Evidence Informed- 2 publications. The founder and CEO is a co-author of both, although independent evaluators managed the research. One used a randomized sample and comparison group.
Research Summary
The most recent publications on Child First include a randomized control trial1 and a study utilizing a one group pretest-posttest design2. Sample populations included families with a child aged 0-6 years who screened positive for early childhood exposure to violence or social-emotional/behavioral problems and/or whose parents screened high for psychosocial risk. Participants were demographically diverse in traits such as ethnicity, marital status, education, and employment. Results from these studies indicated improvements in the child’s language and behavioral problems, as well as improvements in parent stress levels and mental health. Families receiving treatment from Child First were less likely to be involved with CPS after treatment.
- ^ See Lowell et al. (2011). This study is a randomized, controlled trial to test the effectiveness of Child First. The sample population included 157 families with a child age 6 to 36 months who screened positive for social-emotional/behavioral problems and/or whose parents screened high for psychosocial risk. The sample was from an urban area and demographically diverse on traits such as ethnicity, marital status, education, and employment. Families were screened and completed baseline surveys, then randomly assigned to a control group or the Child First treatment group. Families completed self-report questionnaires and interviews at the 6-month and 12-month mark. Child First families were more likely to be receiving the services they desired, and their children’s language and behavioral problems were ameliorated. Parenting stress levels and psychological/depressive symptoms were significantly lower in the treatment group. These families were also significantly less likely to be involved with CPS 3 years after treatment.
- ^ See Crusto et al. (2008). This evaluation of Child First studied the impact of the program on high-risk, urban families who were referred to Child First and screened positive for early childhood exposure to violence. The population was ethnically diverse (55% Latino/Hispanic and 27% Black/non-Hispanic) and children ranged in age from birth to 6 years. 87% of children had witnessed family violence. Participating families completed the Child First referral form to provide demographic information. They were then surveyed on exposure to violence and family service needs. The Child First team documented the family’s service utilization. Parents completed the Traumatic Events Screening Inventory- Parent Report Revised semi-structured interview, the Trauma Symptom Checklist for Young Children, the Parenting Stress Index- Short Form, and the Patient Satisfaction Questionnaire. Results indicate that children experienced fewer traumatic events and parents reported significantly less parenting stress upon exiting the program.
Researched Population
- Families with a child ages 0 to 6 years
- Child screened positive for early childhood exposure to violence or social-emotional/behavioral problems
- Child’s parents screened high for psychosocial risk (including trauma, poverty, intimate partner violence, homelessness, caregiver depression, and other factors)
- Demographically diverse families regarding race/ethnicity, marital status, education, and employment
Clearinghouse and Compendium References
California Evidence-Based Clearinghouse for Child Welfare- 2-3 Supported by Research Evidence/Promising Research Evidence
Title IV-E Prevention Services Clearinghouse- rated Supported
Home Visiting Evidence of Effectiveness- rated “meets criteria for an ‘evidence-based early childhood home visiting service delivery model’ for the general population, but does not meet criteria for tribal populations”
Bright Start Tennessee Clearinghouse
Blueprint Programs- rated Promising
National Home Visiting Resource Center- rated Evidence-Based
Crusto, C.A. Lowell, D.I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S. R., & Kaufman, J. S. (2008). Evaluation of a Wraparound Process for Children Exposed to Family Violence. Best Practices in Mental Health: An International Journal, 4(1), 1-18. https://www.ingentaconnect.com/content/follmer/bpmh/2008/00000004/00000001/art00002
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 Development, 82(1), 193-208. https://srcd.onlinelibrary.wiley.com/doi/10.1111/j.1467-8624.2010.01550.x
- Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant and Early Childhood Mental Health® (Endorsement or IECMH-E®)
- Highly recommended by NCPC
- NCIMHA Endorsement Overview
- Two Endorsement categories depending on scope of practice
- Infant Mental Health Endorsement®: For professionals working with or on behalf of children birth to 3.
- Early Childhood Mental Health Endorsement®: For professionals working with or on behalf of children 3 to 6.
- Supports professionals in identifying and developing the knowledge and skills necessary to provide services that are high quality, culturally informed, reflective, and relationship based.
- Endorsement offers career paths that focus on principles, best practice skills, and reflective work experiences that lead to increased confidence and credibility.
- No additional training is required for Endorsement.
- Many applicants may find that many of their onboarding, in service, conference, discipline specific certification, and NCIMHA sponsored trainings can be utilized to complete an Endorsement application.
- NCIMHA Competency Guidelines® & Crosswalks: NCIMHA provides multiple crosswalks connecting the Competency Guidelines to well-recognized training curricula for professionals seeking Endorsement. Below are a few of these crosswalks that are particularly salient to the Smart Start Network as the curricula are included in Smart Solutions. Please view the associated Smart Solutions entries as well as NCIMHA's website for additional information about these curricula and other opportunities.
Local Partnerships Currently Implementing
Local Partnerships in purple have adopted Child First. Local Partnership contact information can be found here.