Child FIRST

Child FIRST (Family Interagency, Resource, Support, and Training) is a home-based program that aims to alleviate the effects of trauma and stress in order to prevent or reduce emotional disturbance, developmental and learning problems, and abuse and neglect in prenatal to 5-year-old children.

The intervention simultaneously focuses psychotherapy on the parent-child relationship and develops a comprehensive "system of care" that connects families to desired community services. Thus, the approach is tailored to individual families and driven by their unique circumstances and characteristics.

Due to the highly individualized nature of the program, treatment implementation can vary across families. Though, typically, each family is assigned one Child FIRST team, which is comprised of one Master's level mental health professional and one Bachelor's level care coordinator. The team visits the family in the home for 60 to 90 minute sessions. Visits generally occur twice per week during the initial assessment phase and taper to once or twice per week. These services usually span six to twelve months.

The qualifying study was conducted in Bridgeport, Connecticut from 2003 to 2005 with 157 low-income families. Participant selection criteria required either social, emotional, or behavioral problems in the child or increased psychosocial risk of the parent. Families of a variety of ethnicities with children between 6 and 36 months old were randomly assigned to the Child FIRST treatment or Usual Care condition.

Child FIRST treatment lasted 22 weeks and included an average of 12 in-home sessions with a standard Child FIRST team, with each session ranging between 45 and 90 minutes. Therapy was provided for all family members who were involved in the care of the child and focused on helping adults to better understand the motives and behavior of the child as well as their own emotions. Therapists strived to train healthier response patterns in parents and foster enjoyable relationships between parents and children. Additionally, the care coordinator assisted the family in connecting with desired community services.

A battery of assessments was given post-treatment and in a six-month follow-up to assess outcomes in child language, child social-emotional adjustment, maternal mental health symptoms, utilization of community services, and Child Protective Services (CPS) involvement. Compared to the Usual Care group, Child FIRST families had greater access to community services post-treatment and in follow-up.

Furthermore, results demonstrated a significant reduction in parenting stress post-treatment and an improvement in child language post-treatment and in six-month follow-up. Reduced externalizing behaviors in children and lower levels of psychological distress in parents were also evident at the six-month follow-up. Moreover, families that received Child FIRST were less likely to be involved in CPS after three years.

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Return to Blueprints Bulletin Issue 2. May 2017.

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