Program Profile: Child FIRST

This program is a comprehensive, home-based, therapeutic intervention for high-risk families with children ages 6–36 months. The program is rated No Effects. Although children in the program showed statistically significantly reduced externalizing problems, there was no impact on other outcomes, including internalizing problems, dysregulation, parent–child dysfunction, and parent distress. Overall, the preponderance of evidence suggests the program did not have an impact on children or parents.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

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).

Study

Lowell and colleagues (2011) conducted a randomized controlled trial of Child FIRST (Child and Family Interagency, Resource, Support, and Training) with a sample of 157 multi-risk urban mothers and children. Parents were given 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. To be eligible, the family had to have a child aged 6–36 months; screened positive on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA; Briggs-Gowan and Carter 2006) and/or a parent who screened high for psychosocial risk on a risk screen developed for the study (Parent Risk Questionnaire [PRQ]); lived in the city of Bridgeport, Connecticut; and was in a permanent caregiving environment. The clinician and care coordinator completed a comprehensive assessment of the child and family.

Following screening, families were randomized by coin toss into the Child FIRST intervention group (n = 78) or Usual Care (UC) control group (n = 79). Randomization was stratified by child age (6–20 months and 21–36 months), socioemotional/behavior problems (low, moderate, or high), and family psychosocial risk (moderate or high). The CHILD First and UC groups were similar on all baseline measures of age, sex, sociodemographic and psychosocial risk, service needs, and history of child protective services (CPS) involvement. The only difference between the two groups was in terms of maternal education, which was lower in the Child FIRST group at baseline and at the 6-month follow up, but not at the 12-month follow up. Maternal education was the only covariate included in the models.

At baseline, children were 5.4–35.9 months of age and mothers ranged in age from 17 to 47 years. Of the Child FIRST group, 42.3 percent were boys; in the UC group, 45.6 percent were boys. In terms of race/ethnicity, 60.3. percent  of the Child FIRST group was Latino/Hispanic, followed by 26.9 percent African American, 6.4 percent white, and 6.4 percent other maternal ethnicity. In the UC group, 57 percent were Latino/Hispanic, followed by 32.9 percent African American, 8.9 percent white, and 1.3 percent other maternal ethnicity.

Approximately 6 to 12 months after completing the screening measures, families were reassessed with self-report questionnaires and interviews. Outcomes were measured using the PRQ (a parent-report screener developed for this study), the BITSEA, the Infant-Toddler Developmental Assessment (IDA), the Infant-Toddler Social and Emotional Assessment (ITSEA), the Parenting Stress Index (PSI) Short Form, the Center for Epidemiological Studies Depression Scale (CES-D), the Brief Symptom Inventory (BSI), and parent interviews.

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:

These sources were used in the development of the program profile: