Child First

Mental Health In-home Parent Skill-Based Supported

Child First, formerly known as Child and Family Interagency Resource, Support, and Training (Child FIRST), is a home-based intervention that aims to promote healthy child and family development through a combination of psychotherapy and care coordination. Child First is provided by a clinical team that includes a mental health clinician and a care coordinator. There are seven major program components: (1) The clinical team starts by engaging and building trust with the family. (2) The clinical team then conducts a comprehensive assessment through clinical history, assessment measures, and observations in the home and other primary environments for the child (e.g., early care and education). The purpose of this component is to help the clinical team understand the child’s health and development, the child’s important relationships, and the challenges that interfere with the caregivers’ ability to support their child’s development. (3) The clinical team and family co-develop a plan of care that is informed by the assessment and used to guide program components 4 through 7. (4) The mental health clinician delivers a trauma-informed treatment, Child-Parent Psychotherapy, to the caregiver(s) and child to strengthen the parent-child relationship and increase the social-emotional well-being of both child and caregiver. (5) The clinical team promotes self-regulation and executive functioning capacity by mentoring caregiver(s) on how to focus their attention, plan, organize, and problem-solve. (6) If children are in early care and education environments, the mental health clinician consults with their teachers and caregiver(s) to enhance their understandings of the child’s behavior and to coordinate efforts with the home intervention. (7) The care coordinator works to immediately stabilize the family and connects family members to community-based services to decrease stressors and promote healthy development, as identified in the plan of care.


Child First is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.


Date Research Evidence Last Reviewed: May 2021


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: the program or service manual, the program or service developer’s website, the California Evidence Based Clearinghouse for Child Welfare, and the studies reviewed.


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

Child First is provided to families with young children (prenatal through age 5 at entry). The program targets children with social-emotional, behavioral, developmental, or learning problems. These children usually come from families experiencing trauma and adversity. Many of these families also experience multiple social, economic, or psychological challenges (e.g., depression, substance misuse, intimate partner violence, abuse and neglect, homelessness).

Dosage

Child First is typically delivered over the course of 6 to 12 months. During the “assessment period” (first month), sessions occur twice weekly with both the mental health clinician and care coordinator. These sessions last about 90 minutes. After the assessment period, sessions occur at least once a week with each staff member. Sessions may occur with staff members together or separately depending on the unique family circumstances. These sessions last about 60 to 75 minutes. Sessions may be more frequent or extend beyond 12 months based on need.

Location/Delivery Setting
Recommended Locations/Delivery Settings

Child First is typically delivered in participants’ homes.

Location/Delivery Settings Observed in the Research

  • Home

Education, Certifications and Training

The clinical team consists of a mental health clinician and care coordinator that jointly deliver the intervention to the family. Licensed mental health clinicians must have at least a master’s degree and be knowledgeable in early childhood development and relationship-based psychodynamic interventions. The care coordinator must have at least a bachelor’s degree and 3 years’ experience working in the home and community. The clinical supervisor must be a licensed mental health clinician with 5 years of psychotherapeutic experience. Staff must be multi-lingual and reflect the ethnic composition of the community. They must also have substantial experience working with young children and with ethnically diverse, multi-challenged families.

 

Both clinicians and care coordinators must complete the Learning Collaborative training provided by Child First within a 6- to 8-month period. The training is comprised of four in-person Learning Sessions lasting 2 to 4 days each when offered in-person (expanded over a longer period when offered virtually). Child First also provides Distance Learning, which consists of five online training modules before and interspersed between the Learning Sessions.

 

Additional training is provided by role. Care coordinators complete training on the Abecedarian Approach. Clinical supervisors complete training on reflective clinical supervision and skills for leading program sites. Clinicians and clinical supervisors must also complete a three-session training in Child-Parent Psychotherapy over a period of 12 months. The first session lasts 4 days and the remaining two sessions last 2 days. New staff at established agencies may complete Staff Accelerated Training (STAT) covering the Learning Collaborative content in four 1- to 2-day sessions over a period of 4 months.

 

The Child First State Clinical Lead provides reflective clinical consultation for all affiliate sites (in-person or virtually) weekly during the 6- to 8-month training period and biweekly after training ends. The Child First State Clinical Lead also leads a Supervisors’ Network meeting monthly.

 

Agencies participate in an accreditation process after operating for at least 1 to 2 years to certify the agency is implementing the program with fidelity to the model.

Program or Service Documentation
Book/Manual/Available documentation used for review

The Child First Training Manual is implemented in conjunction with the Child First Toolkit.

Lowell, D., Parilla, R., Soliman, S., & DiBella-Farber, K. (2019). Child First training manual. Child First, Inc.

Lowell, D., Parilla, R., Quieroga, S., Theriault, A., & Davino, A. (2020). Child First toolkit. Child First, Inc.

Available languages

Materials for Child First are available in English and Spanish.

Other supporting materials

Training & Consultation

Accreditation Process

Home-Based Intervention Components

Contact Information for Developers

Website: https://www.childfirst.org/

Phone: (203) 538-5222

Email: info@childfirst.org

Results of Search and Review Number of Studies Identified and Reviewed for Child First
Identified in Search 2
Eligible for Review 1
Rated High 1
Rated Moderate 0
Rated Low 0
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child safety: Child welfare administrative reports 0.37
14
1 (4) 157 Favorable: 1
No Effect: 3
Unfavorable: 0
Child well-being: Behavioral and emotional functioning 0.27
10
1 (6) 117 Favorable: 1
No Effect: 5
Unfavorable: 0
Child well-being: Cognitive functions and abilities 0.78
28
1 (2) 117 Favorable: 2
No Effect: 0
Unfavorable: 0
Adult well-being: Parent/caregiver mental or emotional health 0.33
12
1 (4) 117 Favorable: 2
No Effect: 2
Unfavorable: 0
Adult well-being: Family functioning 0.38
14
1 (8) 117 Favorable: 4
No Effect: 4
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child safety: Child welfare administrative reports 0.37
14
1 (4) 157 Favorable: 1
No Effect: 3
Unfavorable: 0
-
Lowell, 2011
Involvement with Child Protective Services 0.32
12
- 157 - 1
Involvement with Child Protective Services 0.32
12
- 157 - 7
Involvement with Child Protective Services 0.39
15
- 157 - 19
Involvement with Child Protective Services 0.45 *
17
- 157 - 31
Child well-being: Behavioral and emotional functioning 0.27
10
1 (6) 117 Favorable: 1
No Effect: 5
Unfavorable: 0
-
Lowell, 2011
Infant-Toddler Social and Emotional Assessment: Externalizing Behaviors 0.54 *
20
- 117 - 7
Infant-Toddler Social and Emotional Assessment: Internalizing Behaviors 0.24
9
- 117 - 7
Infant-Toddler Social and Emotional Assessment: Dysregulation 0.28
10
- 117 - 7
Infant-Toddler Social and Emotional Assessment: Externalizing Behaviors 0.36
14
- 117 - 1
Infant-Toddler Social and Emotional Assessment: Internalizing Behaviors 0.07
2
- 117 - 1
Infant-Toddler Social and Emotional Assessment: Dysregulation 0.11
4
- 117 - 1
Child well-being: Cognitive functions and abilities 0.78
28
1 (2) 117 Favorable: 2
No Effect: 0
Unfavorable: 0
-
Lowell, 2011
Infant-Toddler Developmental Assessment: Child Language Status 0.89 *
31
- 117 - 7
Infant-Toddler Developmental Assessment: Child Language Status 0.66 *
24
- 117 - 1
Adult well-being: Parent/caregiver mental or emotional health 0.33
12
1 (4) 117 Favorable: 2
No Effect: 2
Unfavorable: 0
-
Lowell, 2011
Brief Symptom Inventory 0.50 *
19
- 117 - 7
Center for Epidemiological Studies: Depression Scale 0.50 *
19
- 117 - 7
Brief Symptom Inventory 0.01
0
- 117 - 1
Center for Epidemiological Studies: Depression Scale 0.29
11
- 117 - 1
Adult well-being: Family functioning 0.38
14
1 (8) 117 Favorable: 4
No Effect: 4
Unfavorable: 0
-
Lowell, 2011
Parenting Stress Index: Total Score 0.28
10
- 117 - 7
Parenting Stress Index: Difficult Child 0.29
11
- 117 - 7
Parenting Stress Index: Parent-Child Dysfunction 0.12
4
- 117 - 7
Parenting Stress Index: Parent Distress 0.25
9
- 117 - 7
Parenting Stress Index: Total Score 0.62 *
23
- 117 - 1
Parenting Stress Index: Difficult Child 0.52 *
19
- 117 - 1
Parenting Stress Index: Parent-Child Dysfunction 0.45 *
17
- 117 - 1
Parenting Stress Index: Parent Distress 0.52 *
20
- 117 - 1

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers.

Studies Rated High

Study 11295

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://doi.org/10.1111/j.1467-8624.2010.01550.x





Studies Not Eligible for Review

Study 11296

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, 4(1), 1-18. 

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4)