A home-based mental health intervention for children and their families experiencing vulnerability.
The Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It does not necessarily reflect all the evidence about the program. The research was selected and assessed for inclusion on the Menu and towards the evidence rating because it met selection criteria related to the specific topic area, study design, quality assessment and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
Child FIRST is a two-generation, home-based mental health intervention for the most vulnerable young children and their families, who likely have current or past Child Welfare Services involvement. It is designed for young children who have usually experienced trauma and/or have social-emotional, behavioural, developmental and/or learning problems. Most of the children live in environments where there is violence, neglect, mental illness, substance abuse or homelessness.
Aims
- Support young children to heal from the effects of trauma and adversity
- Improve child and parent mental health
- Improve child development
- Reduce abuse and neglect.
Impact
Evidence suggests that Child FIRST was effective in health service use. Parents reported lesser use of services after intervention. Results were mixed across the other outcomes.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Health service use | Yes | Not found | Not found |
| Child | Mental health/behaviour | Yes | Yes | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
Child FIRST has an evidence rating of Supported.
This means that Child FIRST has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, short-term impact on at least one child and family outcome.
This assessment is based on one research output of RCT design. Child FIRST has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of evidence from this study.
The study was conducted in the United States and does not include Aboriginal children and families.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The study was conducted in the United States.
Sample characteristics
- 157 families (78 intervention, 79 control) participated in the study.
- The children were aged 6 to 36 months, lived in the city of Bridgeport, Connecticut and were in a permanent caregiving environment.
- Families had a child who screened positive for social-emotional/behavioural problems and/or a parent who screened high for psychosocial risk.
- Mothers identified as Latino/Hispanic (59%), African American (30%), Caucasian (8%) and other (4%).
Implementation
Delivery model, mode and setting
- Child FIRST is delivered in-person, to the parent only
Target cohort
- Children prenatal to age 5 and their parents/caregivers who are at risk of or have experienced child abuse, neglect or trauma, have social-emotional, behavioural or developmental problems, or live in families experiencing significant trauma and adversity.
Program delivery
- The Child FIRST model uses 2 team members:
- Clinician: Provides a psychotherapeutic, two-generation intervention designed to build a nurturing, responsive, protective parent-child relationship, fostering the child’s cognitive and social-emotional development and improving parent mental health.
- Care Coordinator: Facilitates connections to broad community-based services and supports for all family members with the aim of achieving family stabilization, decreased parental stress, and improved executive functioning.
- Child FIRST includes 8 intervention components
- Engagement of the family by the clinical team
- Stabilisation of the family by the Care Coordinator
- Comprehensive assessment by the clinical team
- Development of a comprehensive, well-coordinated, family driven plan of care by the clinical team
- Two-generation, trauma-informed psychotherapeutic intervention and parent guidance by the Clinician
- Promotion of executive functioning and self-regulation capacity by the clinical team
- Mental health consultation and assessment by the Clinician
- Connection to services and supports by the Care Coordinator.
Duration and intensity
- The recommended duration of Child FIRST is generally 6 to 12 months.
- All home visits are generally 60 to 90 minutes. During the first month, visits are usually scheduled twice per week, which then reduces to a weekly basis at a minimum. Visits may be more frequent if there is high family need.
Manuals and guides
- There is a manual that described how to deliver Child FIRST. The Child First Manual and Toolkit are not published but provided online through Child First’s Distance Learning Platform, Absorb. These (and other manuals) are provided to all staff at the beginning of training.
- There are fidelity measures for Child FIRST.
Additional information
- The Child FIRST website has more information about the program.
Staffing
- The Clinical Director/Supervisor should have a Master’s level or Doctoral level degree, be a licensed mental health clinician with extensive child development background, five years’ therapeutic experience with children aged 0 to 5 years, knowledge of adult mental health disorders, and 3 years of experience providing reflective, clinical supervision.
- The Mental Health/Developmental Clinician should have a Master’s level degree or higher, be licensed with at least 3 years’ experience in early childhood mental health and development.
- The Care Coordinator should have a Bachelor’s level degree or higher, with at least 3 years’ experience with young children and multi-challenged families and expertise in community-based services and supports.
- All staff must have excellent interpersonal skills and the ability to take a reflective stance with regard to self, child and caregivers. They also must possess flexibility, empathy and humility.
- Each Child First site must have one team with linguistic competence appropriate for a dominant non-English speaking community that is served. All staff must display cultural humility and be culturally competent and responsive.
Training
- For an agency that is beginning implementation of Child First, all staff members who will be delivering Child First services participate in a Learning Collaborative (LC), which consists of 4 learning sessions over a 7-month period for a total of 10 days. Child First has a Distance Learning platform with required Distance Learning modules and reading before the Learning Collaborative begins and between each of the Learning Sessions. Services begin after the second Learning Session (approximately one month after the LC begins).
- After an affiliate site has been established, Child First provides an accelerated version of the LC, Staff Accelerated Training (STAT), for new staff, which is delivered once a month over a 4-month period for a total of 6 days, with ongoing repetition (3 cycles per year). Trainers provide the training at the National Program Office (NPO), which is offered simultaneously by live videoconferencing at regional sites. That staff also completes the Distance Learning Modules between each of the sessions.
- Clinical Directors attend a 4-day training session before Child First begins implementation.
- All Clinicians and Clinical Directors also receive training in Child-Parent Psychotherapy – 3 sessions totalling 7 days over a 12-month period, interspersed with the Child First Learning Collaborative. There are 18 months of support calls.
- All Care Coordinators receive training in the Abecedarian Approach through the Learning Collaborative with quarterly support calls.
- Reflective supervision and consultation, and community collaboration is required.
To our knowledge, Child FIRST is not available and has not been implemented in Australia.
In Victoria, Child FIRST refers to an access point which links vulnerable children, young people and their families into the relevant services they need. Child FIRST, as the access point for family services, is progressively transitioning to The Orange Door.
Cost
We were unable to locate any information on the cost of Child FIRST.
References
Studies identified and included in the review
- Lowell DI, Carter AS, Godoy L, Paulicin B & Briggs-Gowan MJ (2005). A randomized controlled trial of Child FIRST: a comprehensive home-based intervention translating research into early childhood practice. Child Development, 82(1):193-208.
Studies identified but not counted towards the evidence rating due to study quality
- van der Put CE, Assink M, Gubbels J & Boekhout van Solinge NF (2018). Identifying effective components of child maltreatment interventions: A meta analysis. Clinical Child and Family Psychology Review, 21(2):171-202.