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Summary: This program is a comprehensive, home-based, therapeutic intervention for high-risk families with children ages 6–36 months that seeks to decrease parents’ psychosocial stress and enhance their children’s social-emotional and cognitive development. The program is rated Promising for reducing children’s externalizing behavior problems, parental stress, and parental depression. (Review the full program description).
| Title | Rating | Details | Outcome Category | Study(ies) |
|---|---|---|---|---|
| Externalizing behavior (multisite) | None | One Study | Children in the Child First intervention group had fewer externalizing behavior problems (which included activity/impulsivity, aggression/defiance, and peer aggression) after 12 months, compared with children in the usual care control group. This difference was statistically significant. |
Mental Health/Behavioral Health ; Externalizing behavior | Lowell, Darcy I., Alice S. Carter, Leandra Godoy, Belinda Paulicin, and Margaret J. Briggs-Gowan. 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. See evaluation methods. |
| Parental stress (multisite) |
Promising | One Study |
Mothers in the Child First intervention group reported less clinical-level parenting stress after 12 months, compared with mothers in the usual care control group. This difference was statistically significant. |
Family functioning; Parenting skills; Parental stress | Lowell, Darcy I., Alice S. Carter, Leandra Godoy, Belinda Paulicin, and Margaret J. Briggs-Gowan. 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. See evaluation methods. |
| Depression (multisite) | None | One Study | Mothers in the Child First intervention group reported fewer clinical-level depressive symptoms after 12 months, compared with mothers in the usual care control group. This difference was statistically significant. |
Mental Health/Behavioral Health ; Internalizing behavior; Depression | Lowell, Darcy I., Alice S. Carter, Leandra Godoy, Belinda Paulicin, and Margaret J. Briggs-Gowan. 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. See evaluation methods. |
Program Goals
Child First (formerly referred to as Child FIRST [Child and Family Interagency, Resource, Support, and Training]) is a comprehensive, home-based, therapeutic intervention directed at high-risk families with children ages 6 months to 3 years. The goal of the program is to identify children in families that have high cumulative risk, as early as possible, to prevent or reduce the likelihood of serious emotional disturbance, developmental and learning disabilities, and abuse and neglect. The program takes place within a coordinated system of care that provides services and supports based on the strengths and needs of the family (Knitzer 2000; Stroul 2002).
Program Components/Key Personnel
The Child First model includes the following two complementary core components:
- Intensive care coordination: The model connects families with comprehensive, integrated, community-based services and supports through a system-of-care approach. These services are meant to stimulate growth and learning and decrease the stress experienced by the family.
- Parent–child psychotherapy: A team of mental health practitioners provides parents and caregivers relationship-based psychotherapy to strengthen the learning environment and boost development. Instead of using a fixed curriculum, parents/caregivers are given guidance and parenting strategies based on their needs.
Services are provided in the natural environment of the child’s home to improve the likelihood of engagement. The combination of these services is meant to increase adult self-regulation and executive functioning in a single model.
Each Child First family is connected to a clinical team, including a developmental/mental health clinician and a coordinator/case manager. The intervention focuses on engaging and building trust. This involves having staff treat families with kind, respectful, empathetic words and actions, and showing they are partners and advocates. Therefore, the team members begin by asking, “How would you like us to help you and your family?” In addition, all of the important members within the child’s life are included (grandparents; fathers, even if out of the home; siblings, etc.) in an effort to strengthen the parent–child relationships over the years. The clinician and care coordinator develop a family plan of broad, integrated supports and services for all family members based on family priorities, strengths, and needs. The care coordinator completes the therapeutic assessment and helps the family to become engaged in community services.
While no curriculum is used, easy-to-read child development materials are often shared with the families, in English and Spanish. The clinician and parent study the child’s behavior and attempt to interpret reasons (motivations and feelings) for the behavior and find ways parents might respond to their children. Play is used to promote parent–child interactions, handle challenges, and promote language development.
Program Theory
Child First is based on research showing that early trauma and problems of children lead to biological changes in the brain and body, which in turn lead to long-term problems in mental and physical health and learning (Streeck-Fischer and van der Kolk 2000). By repairing the impact of trauma on the child and strengthening the caregiving relationship, it is theorized that Child First can prevent or amend damage caused by stress.
The program is also based on the ecological framework, which addresses the child’s emotional well-being across a range of sectors, including mental health, health, early care, early intervention, education, child protection, and special and concrete services (Bronfenbrenner 1994).
Study Title: Randomized Controlled Trial of Child FIRST: Comprehensive Home-Based Intervention Translating Research Into Early Childhood Practice (which is associated with outcomes Externalizing behavior, Parental stress, and Depression)
Lowell and colleagues (2011) conducted a randomized controlled trial to examine the effect of the Child First intervention on children’s emotional-behavioral problems and on parental mental health after 12 months.
The sample included 157 families with multiple risks identified at two sites that served families living in poverty in urban areas. To be eligible, the child had to: 1) be ages 6–36 months and have screened positive on the Brief Infant-Toddler Social and Emotional Assessment (a 42-item, parent-report, standardized screener for children ages 12–36 months) and/or have a parent who scored high for psychosocial risk on a risk screen (Parent Risk Questionnaire) developed for the study; 2) live in the city of Bridgeport, Connecticut; and be in a permanent caregiving environment. After the initial eligibility screening, parents were given baseline screening measures and questionnaires (or interviews, for those with difficulty reading) during two sessions in the family home and a third session in the hospital office.
Following screening, families were randomized by coin toss into the Child First intervention group (n = 78) or usual care control group (n = 79). Randomization was stratified by the child’s age (6–20 months and 21–36 months), socioemotional/behavior problems (low, moderate, or high), and family psychosocial risk (moderate or high).
Several measures were used to assess the outcomes of interest at baseline and at 6- and 12-month follow-ups. Child social-emotional/behavioral problems were assessed with the internalizing domain (comprised of depression/withdrawal, general anxiety, separation distress, and inhibition to novelty subscales) and externalizing domain (comprised of activity/impulsivity, aggression/defiance, and peer aggression subscales) of the Infant-Toddler Social and Emotional Assessment. Parental stress was measured by the Parenting Stress Index Short Form, which provided an overall score in three domains: Parent Distress, Difficult Child, and Parent-Child Dysfunctional Interaction. Parental depressive symptoms were assessed with self-reports on the Center for Epidemiological Studies Depression Scale.
At baseline, the children were 5.4 to 35.9 months of age and their mothers ranged in age from 17 to 47 years. Of the Child First group, 57.7 percent of the children were girls; in the usual care group, 54.4 percent were girls. Regarding race/ethnicity, 60.3 percent of the mothers in the Child First group were Latino/Hispanic, 26.9 percent were Black, 6.4 percent were white, and 6.4 percent reported another ethnicity. In the usual care group, 57 percent of the mothers were Latino/Hispanic, 32.9 percent were Black, 8.9 percent were white, and 1.3 percent reported another ethnicity. There were no statistically significant differences between the Child First and usual care control groups on baseline measures of age, sex, sociodemographic and psychosocial risk, or the child or parent outcomes of interest.
An intention-to-treat analysis was conducted. Repeated measures analysis of covariance models were used to assess the effect of the intervention on child internalizing and externalizing behavior problems and parental stress and depression at the 12 month follow up, while controlling for baseline scores on the outcome variables and with maternal education as a covariate. No subgroup analysis was conducted.
Citation:
Lowell, Darcy I., Alice S. Carter, Leandra Godoy, Belinda Paulicin, and Margaret J. Briggs-Gowan. 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.
The child internalizing behavior outcome (Lowell et al. 2011) was reviewed and expert Study Reviewers determined that the available evidence was insufficient for a rating to be assigned. In accordance with CrimeSolutions policy, this outcome is not included in the profile.
The Child First Assessment and Intervention Manual is used to teach and guide the intervention. Following each weekly visit to families, clinicians complete the Assessment and Intervention Fidelity Checklist, which is reviewed in clinical supervision to maintain intervention fidelity (Lowell et al. 2011).
These sources were used in the development of the program profile:
Carter, Alice S. 2013. “Infant-Toddler Social and Emotional Assessment (ITSEA).” In: Volkmar, F.R. (eds.). Encyclopedia of Autism Spectrum Disorders. New York: Springer.
Bronfenbrenner, Urie. 1994. “Ecological Models of Human Development.” In International Encyclopedia of Education, Vol. 3, 2nd Edition. Oxford: Elsevier. [Reprinted in Gauvain, M., and Cole, M. (eds.). Readings on the Development of Children, 2nd Edition. 1993. New York: Freeman, 37–43.]
Crusto, Cindy A., Melissa L. Whitson, Richard Feinn, Jo-Ann Gargiulo, Cyndy Holt, Belinda Paulicin, Wendy Simmons, and Darcy I. Lowell. 2013. “Evaluation of a Mental Health Consultation Intervention in Preschool Settings.” Best Practices in Mental Health 2:1–21.
Knitzer, J. 2000. “Early Childhood Mental Health Services: A Policy and Systems Development Perspective.” In J. P. Shonkoff and S. J. Meisels (eds.). Handbook of Early Childhood Intervention, Second Edition. New York: Cambridge University Press, 416–38.
Streeck-Fischer, Annette, and Bessel A. van der Kolk. 2000. “Down Will Come Baby, Cradle and All: Diagnostic and Therapeutic Implications of Chronic Trauma on Child Development.” Australian and New Zealand Journal of Psychiatry 34:903–18.
Stroul, B. 2002. System of Care: A Framework for System Reform in Children’s Mental Health. Washington, D.C.: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.
This program was originally rated Ineffective. It has been re-reviewed based on the change in the program rating instrument. Under the new instrument, CrimeSolutions ow now rates individual program outcomes and no longer assigns an overall rating.
Rating Process
Program Status
This program is Active.