Program Profile: Child First

Program Goals

Child First (formerly referred to as 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 and needs of the family (Knitzer 2000; Stroul 2002).

Program Components/Key Personnel

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. 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, 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).

The child internalizing behavior outcome (Lowell et al. 2011) was reviewed and expert Study Reviewers determined that the available evidence was insufficient for a rating to be assigned. In accordance with CrimeSolutions policy, this outcome is not included in the profile.

Lowell and colleagues (2011) estimated that the psychotherapeutic and care coordination components of the Child First intervention cost less than $4,000 per family.

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:

Carter, Alice S. 2013. “Infant-Toddler Social and Emotional Assessment (ITSEA).” In: Volkmar, F.R. (eds.). Encyclopedia of Autism Spectrum Disorders. New York: Springer.

Bronfenbrenner, Urie. 1994. “Ecological Models of Human Development.” In International Encyclopedia of Education, Vol. 3, 2nd Edition. Oxford: Elsevier. [Reprinted in Gauvain, M., and Cole, M. (eds.). Readings on the Development of Children, 2nd Edition . 1993. New York: Freeman, 37–43.]

Crusto, Cindy A., Melissa L. Whitson, Richard Feinn, Jo-Ann Gargiulo, Cyndy Holt, Belinda Paulicin, Wendy Simmons, and Darcy I. Lowell. 2013. “Evaluation of a Mental Health Consultation Intervention in Preschool Settings.” Best Practices in Mental Health 2:1–21.

Knitzer, J. 2000. “Early Childhood Mental Health Services: A Policy and Systems Development Perspective.” In J. P. Shonkoff and S. J. Meisels (eds.). Handbook of Early Childhood Intervention, Second Edition. New York: Cambridge University Press, 416–38.

Streeck-Fischer, Annette, and Bessel A. van der Kolk. 2000. “Down Will Come Baby, Cradle and All: Diagnostic and Therapeutic Implications of Chronic Trauma on Child Development.” Australian and New Zealand Journal of Psychiatry 34:903–18.

Stroul, B. 2002 . System of Care: A Framework for System Reform in Children’s Mental Health. Washington, D.C.: Georgetown University Child Development Center, National Technical Assistance Center for Children’s Mental Health.