Program Goals
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, needs, and culture of the family (Knitzer 2000; Stroul 2002).
Program Components
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. Steps are taken to match each family with clinical team members of the same ethnicity as the family members and who can speak the language of the family’s choosing. 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, culture, 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).
