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Child First

Blueprints Program Rating: Promising

A two-generation home visitation program which works to heal and protect young children and their families from the devastating effects of chronic stress and trauma. It provides psychotherapeutic services and intensive care coordination, while building adult reflective and executive capacity, to prevent or diminish serious emotional disturbance, developmental and learning disabilities, and abuse and neglect among young children.

Program Outcomes

  • Child Maltreatment
  • Early Cognitive Development
  • Externalizing

Program Type

  • Cognitive-Behavioral Training
  • Family Therapy
  • Home Visitation
  • Parent Training
  • Social Emotional Learning

Program Setting

  • Home

Continuum of Intervention

  • Selective Prevention (Elevated Risk)
  • Indicated Prevention (Early Symptoms of Problem)

Age

  • Infant (0-2)
  • Early Childhood (3-4) - Preschool

Gender

  • Male and Female

Race/Ethnicity

  • All Race/Ethnicity

Endorsements

  • Blueprints: Promising
  • Coalition for Evidence-Based Policy: Near Top Tier

Program Information Contact

Child First
35 Nutmeg Dr., Suite 385
Trumbull, CT 06611
(203) 538-5222
www.ChildFirst.com

Program Developer/Owner

  • Mary Peniston Darcy I. Lowell, M.D.
  • Child First, Inc.

Brief Description of the Program

Child First is a two-generation, home-based intervention that works with very vulnerable young children, prenatal through age 5 years, and their families in order to decrease serious mental health concerns in child and parent, child development and learning problems, and abuse and neglect. It has two core components: (a) a system of care approach to stabilize and provide comprehensive, integrated services and supports to the child and his/her family (e.g., early education, housing, substance abuse treatment), while enhancing adult executive capacity and (b) a relationship-based, psychotherapeutic approach to enhance nurturing, responsive parent-child relationships and promote positive social-emotional and cognitive development. The program is implemented by a team of a master’s level mental health clinician and a bachelor’s level care coordinator. Duration is adjusted based on families’ needs with an average length of 6 to 12 months. Mental health consultation to early care and education is included. All staff receive intensive reflective clinical supervision.

See: Full Description

Outcomes

Comparing the Child FIRST intervention to a control group, the following significant program effects were reported by Lowell et al. (2011):

  • Decrease in externalizing behavior (at the 6-month follow-up),
  • Improvement in language skills (at both posttest and 6-month follow-up),
  • Among parents, improvement in overall psychiatric well-being, lowering of depression symptoms (at 6-month follow-up), and reduction in stress (at posttest),
  • Lower levels of involvement with Child Protective Services (at the 30-month follow-up),
  • Increased access to community-based services (at both posttest and 6-month follow-up).

Race/Ethnicity/Gender Details

The study conducted no subgroup analysis. However, the results indicate that the program is generalizable to a variety of ethnic groups and has been proven effective among a sample of diverse racial/ethnic composition (8% Caucasian, 30% African American, 59% Latino, 3% Other) with children of both genders equally represented (56% male, 44% female).

Risk and Protective Factors

Risk Factors
  • Individual: Antisocial/aggressive behavior*, Early initiation of antisocial behavior*, Physical violence*
  • Family: Family conflict/violence*, Family history of problem behavior, Family transitions and mobility, Low socioeconomic status, Neglectful parenting*, Parent history of mental health difficulties*, Parent stress*, Poor family management, Unplanned pregnancy, Violent discipline*
Protective Factors
  • Individual: Problem solving skills, Prosocial behavior*
  • Family: Attachment to parents, Non-violent discipline*, Parent social support
  • Neighborhood/Community: Opportunities for prosocial involvement

*Risk/Protective Factor was significantly impacted by the program.

See also: Child First Logic Model (PDF)

Training and Technical Assistance

Overview of Child First Training

Training staff at new affiliate Child First agencies or for a major expansion extends over a 12-month period and integrates five major training components: (1) A Learning Collaborative, which is a year-long process with four in-person Learning Sessions, (2) Trauma-informed Child-Parent Psychotherapy (CPP) training, (3) On-line Distance Learning, which combines guided web-based modules, video-conferencing, and readings, (4) Reflective clinical consultation from the State Clinical Director or an expert Child First Senior Clinical Consultant, and (5) Specialty Trainings and Annual Conference. The Learning Sessions and CPP training are scheduled in tandem. Distance Learning is interspersed between the Learning Sessions. The clinical consultation begins with the Child First affiliate site Clinical Directors prior to the first Learning Session and continues intensively throughout the training year.

Child First also provides training for new staff due to staff turnover at established affiliate agencies. This training is a combination of Distance Learning and periodic Brief Intensive Training.

I. Learning Collaborative

Child First uses Learning Collaborative methodology for start-up training at agencies new to Child First or for major expansion of capacity. This is generally a 12-month process which brings together staff from multiple new affiliate sites (including the Clinical Director, Clinical Supervisors, Mental Health/ Developmental Clinicians, Care Coordinators, and a “Senior Leader” who is in a senior position within the agency) in a single location to learn together. Child First Clinical Faculty provide the training. This includes current members of our National Program Office Clinical Leadership Team (National Clinical Director, Training Director, State Clinical Director, Child First CEO), Child First Clinical Faculty (who are guest presenters), and may include regional Clinical Faculty who reside in the geographic location where replication is occurring.

There are several components of the Learning Collaborative:

A. Child First Affiliate Site Clinical Directors/Supervisor Training:

This four-day training is designed to help new Clinical Directors and Supervisors learn the skills necessary to lead a Child First affiliate site. Training includes Fundamentals of the Child First model and underlying theory of change; roles of the State Clinical Director, site Clinical Director, and Clinical Supervisors; reflective clinical supervision; use of video in intervention and supervision; implementation of Distance Learning with on-site discussions, activities, and observations; the referral process and prioritization; accessing community services; staff safety within the community; and the development of the Child First Community Advisory Board.

B. Learning Sessions:

Learning Session 1: The first Learning Session is a 2-day training designed to help new Child First providers understand the basic components of the model, provide foundational knowledge around toxic stress and ACEs, understand the importance of early relationships, understand how Child First is integrated into the local early childhood system of care, and provide training in the use of Distance Learning tools. The importance of culture is infused throughout.

Learning Session 2: This is an intensive 5-day session which follows a 3-week period of online learning (see Online Section 1 below) in which the staff learn fundamental content. This is a highly interactive training that includes the basics of attachment theory and the relationship-based, psychodynamic approach used in infant- and child-parent psychotherapy. It covers motivational interviewing, use of video in intervention with families, therapeutic and interactive play, executive functioning, mental health consultation in early care and education, understanding the strengths and vulnerabilities of families, and the development of the formulation and treatment plan. It also includes working with caregivers affected by depression, substance abuse, and interpersonal violence, with strategies to help them with emotional regulation.

Learning Sessions 3 and 4: Reinforcement of basic model tenets and procedures, plus additional technical and theoretical didactic and experiential sessions constitute the core of these two-day sessions. This is an opportunity for further in-depth training around some of the online topics.

C. Materials:

1) All staff receive the Child First Training Manual and Child First Toolkit (which provides all assessments and procedures) prior to the first training.

2) All Child First affiliate sites receive a library of child development and early childhood mental health articles and books. Child First staff are directed in their reading by discussion questions presented by their Clinical Director and during their online training modules. Discussions are facilitated by both their Clinical Director and the State Clinical Director.

3) At each Learning Session, staff receive an agenda and curriculum for that session, including all PowerPoints, additional readings, and handouts (with the purpose of providing a comprehensive reference resource in the form of a Learning Collaborative Notebook).

4) Each site receives an Assessment Notebook (with samples of each assessment used in the Child First Assessment Protocol) and copies of each assessment as a “start-up kit” for the Child First intervention.

II. Trauma-Informed Child-Parent Psychotherapy

Trauma-informed Child-Parent Psychotherapy (CPP) is taught by a certified CPP trainer. There are three sessions (the first lasting four days, and two other boosters lasting two days each) which are embedded within the Child First Learning Collaborative over the 12-month period. The first day of the first session is provided for all staff, and the subsequent training is for Clinicians and Clinical Directors only. The training also includes 18 months of biweekly phone consultation with the CPP trainer. (If staff have already had formal trauma-informed CPP training and are eligible to be “rostered” – meaning included on the national CPP roster of trained clinicians – they do not have to attend this component of the Child First training.)

III. Distance Learning

Child First is developing a blended training model that incorporates distance learning using web-based technology between Learning Sessions. During each Online Training Period, staff will utilize narrated PowerPoints, videos, guided discussions, observations, exercises, activities, process notes, and readings. The online training will be delivered in three ways:

1) Online training modules covering foundational information completed by each individual independently. These are self-guided, narrated modules with PowerPoint and video. They include additional written material and questions for reflection or subsequent discussion.

2) Online training modules covering foundational information completed by site staff together as group, with the guidance of the affiliate site Clinical Director, or as a Network, with the guidance of the State Clinical Director. They include PowerPoints with video and narrative. They will be accompanied by group discussion and group exercises and activities.

3) Video-conferencing with live trainers at the National Program Office will supplement the above training for specific subject matter, with discussion and local exercises and activities.

The Online Training Periods occur between Learning Sessions. These provide foundational knowledge which will prepare all staff for the subsequent Learning Session and for the work with children and families. All modules will be able to be reviewed at any future time to reinforce learning or when the topic is especially relevant to a specific family. PowerPoints presented in person will also be available online for future review.

Online Training Period 1 is completed between Learning Sessions 1 and 2. It covers the Child First process, the roles of the Mental Health Clinician and Care Coordinator, infant and early childhood development and normal developmental challenges, the psychological transition into parenthood, attachment, psycho-social risk and protective factors, and the Child First Assessment Protocol.

Online Training Period 2 is completed between Learning Sessions 2 and 3. Training Period 2A is covered immediately after Learning Session 2, prior to beginning work with families. It includes the Child First Fidelity Framework, quality enhancement, and safety for both staff and family. Online Training Period 2B should be completed before Learning Session 3, but may be accessed at any time as needed. It covers more in depth content about working with caregivers and children in the child welfare system and with specific vulnerabilities, including mental health, cognitive limitations, teen parenting, court involvement, and autistic spectrum disorders. It also includes diagnosis with DC: 0-3, diagnosis of adult mental health disorders, and psychotropic medication.

IV. Brief Intensive Training

This five day training is provided to newly hired staff of existing Child First affiliate sites when they cannot be incorporated into a Learning Collaborative in a timely fashion.

1) Topics covered include the same topics covered in Learning Sessions 1 and 2 of the Child First in-person Learning Collaborative

2) A Brief Intensive Training is held every six to twelve months, depending on the need.

V. Child First Reflective Consultation

A. Reflective, Clinical, Site-based Consultation:

Each new Child First affiliate site receives reflective, clinical consultation by the State Clinical Director or a Senior Clinical Consultant weekly for 6 months and then biweekly for 6 months. This includes working both individually with the affiliate site Clinical Director for 1 hour and with all teams in a group format for 1 ½ hours. After 12 months, the affiliate Clinical Director assumes full responsibility for the ongoing group reflective supervision at his/her site. He/she will continue to receive biweekly individual consultation from the State Clinical Director or Senior Clinical Consultant. (If the Clinical Director is receiving weekly, individual, reflective clinical supervision from a senior clinician who has knowledge of infant and early childhood mental health and the Child First model and is employed by his/her agency, this consultation may be monthly.)

B. Clinical Directors’ Network Meeting:

All Clinical Directors/Supervisors meet on a monthly basis for a combination of clinical consultation around their own cases and the reflective supervisory process, and administrative consultation around the Child First implementation process. This is an opportunity for the Clinical Directors to share both their challenges and successes with their colleagues, in order to facilitate peer learning and quality enhancement. This meeting is facilitated by the State Clinical Director.

VI. Specialty Trainings and Annual Conference

The Learning Sessions are supplemented by specialty trainings, usually provided by outside experts. The content of these sessions is based on the specific needs of the Child First staff of the affiliate agencies. There are 3-4 sessions per year. Each year, there will be a Child First Annual Conference with a topic of relevance for all Child First staff.

3/30/15

Brief Evaluation Methodology

The study employed a randomized control trial design. Pre-screened families (n = 157) from Bridgeport, Connecticut, were randomly assigned to the Child Firat intervention group (n = 78) or a Usual Care control group (n = 79). The Child First intervention lasted on average 22.1 weeks with weekly visits of 45-90 minutes. Families were assessed at baseline, posttest and 6-month follow-up. The study measured child behavior (e.g., externalizing and internalizing behavior, language skills), parental psychological well-being (e.g., depression, parenting stress), connection with community-based services, and involvement with Child Protective Services.

References

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.