Child FIRST, Inc.
At a Glance
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Description
Child FIRST (Child and Family Interagency Resource, Support, and Training) is an intensive, early childhood, two-generation home visiting intervention that works with a community’s most vulnerable young children (prenatal to age six years) and their families. The goal is to identify children at the earliest possible time to decrease emotional and behavioral problems, developmental and learning problems, and abuse and neglect.
Impact and Outcomes
What Major Funders Say
Mission & Goals
Child FIRST is an intensive home-based model that targets the most vulnerable young children and families to decrease the incidence of emotional and behavioral problems, developmental and learning disorders, and abuse and neglect. Child FIRST is based on scientific research that demonstrates that environments in which there is major adversity - like maternal depression, domestic violence, homelessness, and substance abuse - lead to levels of stress that are toxic to the developing brain of the young child. However, a strong, nurturing parent-child relationship protects the brain from damage and prevents lifelong problems in mental health, cognition, and physical health.
Child FIRST works collaboratively with community providers, identifying children from challenging environments or showing early signs of behavioral or developmental problems. This intensive home visiting model connects the family to comprehensive community-based resources, while providing a two-generation, psychotherapeutic intervention. Together, stress is decreased, the brain is protected, and growth is enhanced.
Program
Child FIRST is an evidence-based home visiting intervention that addresses the most challenged, hard to reach, and underserved families with young children, prenatal through age five. This includes families with poverty, maternal depression, domestic violence, homelessness, and substance use.
Child FIRST promotes strong collaboration among community providers, recognizing that creating an early childhood system of care is necessary both to identify children and families in need and to connect them to the services and supports necessary for their long-term success. Children are frequently referred for behavioral problems, developmental concerns, and abuse and neglect.
Based on the latest scientific research, Child FIRST uses a two-pronged, team approach:
- a Masters-level Mental Health/Developmental Clinician provides a two-generation psychotherapeutic intervention to create a protective, nurturing relationship; and
- a Bachelors-level Care Coordinator connects both children and their families with comprehensive community-based services.
This results in strong positive outcomes in child language, child and maternal mental health, abuse and neglect, healthcare utilization, and service access.
Given the difficulty of this work, Child FIRST clinical teams have intense training through a year-long Learning Collaborative and are supported by intensive clinical supervision, technical assistance, and ongoing professional development. The program is data-driven, with continuous quality improvement.
Impact
The Child FIRST intervention was evaluated with a randomized controlled trial. Children six to thirty-six months of age were identified through screening for both social-emotional concerns and familial psycho-social risk in Bridgeport, Connecticut. The population was 59% Latino, 30% African-American, and 7% Caucasian. Risk factors were extremely high: 93% receiving public assistance, 64% unemployed, 53% without high school diploma or GED, 67% unmarried, 54% with depression, 44% with a family history of substance abuse, and 25% with a history of homelessness.
Twelve month follow-up demonstrated very strong, statistically and clinically significant outcomes for families randomized into the Child FIRST Intervention in contrast to the Usual Care Control group:
- Child FIRST children:
o 68% less likely to have language problems (Odds ratio (OR)=4.4).
o 42% less likely to have aggressive and defiant behaviors (OR=4.7).
- Child FIRST mothers:
o 64% lower levels of depression and/or mental health problems (OR=4.0).
- Child FIRST families:
o 39% less likely to be involved with child protective services, by maternal self-report (OR=4.1),
which was sustained at 33% at 3 year follow-up (OR=2.1).
o 98% increase in access to community services and supports.
These results were published in the prestigious journal Child Development in 2011. A careful review of the research led the Health Resources and Services Administration (HRSA) to designate Child FIRST as one of only thirteen “evidence-based home visiting models” nationally. The Coalition of Evidence-Based Policy recently determined that Child FIRST was Near Top Tier, one of only three early childhood interventions highlighted at this level.
Replication of Child FIRST across Connecticut has continued to demonstrate highly statistically and clinically significant findings with 78% of children and families showing improvement in one or more areas, including emotional and behavioral problems (57%), social competence (67%), language development (73%), and maternal depression (82%).
Growth Plan
Economic Model
The Child FIRST Central Program Office trains and certifies affiliate sites to implement this evidenced-based intervention and become part of the Child FIRST National Network. During the twelve-month start-up, new affiliate sites participate in a Learning Collaborative which includes both intensive training and site-based weekly to biweekly clinical consultation. Child FIRST plans for new states to begin with a minimum of three agencies, with four home visiting teams each, serving different geographic localities. The operating budget for a typical implementing agency averages $615,000/year, though costs will vary depending on local salary and geographic spread.
The Child FIRST Central Program Office is responsible for:
- pre-launch planning projected at a cost of $240,000;
- start-up training of three new sites within a state projected at $257,000; and
- ongoing data analysis, quality assurance, certification, and training projected at $107,000 annually.
Child FIRST has developed a fee schedule per implementing agency that reflects these costs. In addition, the Central Program Office will establish a Child FIRST State Office providing local oversight, clinical consultation, technical assistance, and state network support, at a cost of $106,000 annually.
Following the growth pattern in Connecticut, Child FIRST expects to start operations of sites in new states with funding from a combination of sources, including federal grants, national and local philanthropy, and/or state government support. The sustainability of Child FIRST sites will come primarily from these sources and Medicaid reimbursement.
The Child FIRST Central Program Office will be funded through a combination of start-up and annual fees from Network members, state contracts, and private philanthropy. Child FIRST will work with key state stakeholders to develop their state funding package both for start-up and ongoing sustainability.
Growth Plan
Over the next three years, Child FIRST seeks to expand its network beyond Connecticut to at least two new states. As of April 2012, Child FIRST had 10 affiliate sites with 24 home visiting teams. By January 2013, Child FIRST will have 15 Connecticut sites, one in each of the 15 areas of the state Department of Children and Families, with a total of at least 38 home visiting teams. By June 2015, Child FIRST will have added six sites in two new states with 24 teams, for a national total of 21 sites and 62 teams. Over this three year period (2012-2015), the Child FIRST network will increase its capacity to provide services from approximately 650 families to almost 1,500. Child FIRST will need approximately $1.7 million over the next three years - at a cumulative annual growth rate (CAGR) of 21% - to build a strong Central Program Office, and establish and support new state networks, compared to a 33% CAGR in number of teams and capacity, evidence of cost efficiencies with growth.
Child FIRST also intends to conduct a second randomized controlled trial (RCT) - at a total cost of up to $1.2 million - to document outcomes across multiple program sites, within designated risk groups, for children prenatally to age 6 years old. Although Child FIRST currently has cost-benefit data that shows that the model is cost neutral within a single year, this RCT will follow children longitudinally, documenting long-term savings through prevention of costly disability. An important intended impact is to drive public policy toward a focus on optimizing early brain development.
Location of Sites
To make a contribution to a program site:
- Click on the "Make a Contribution Now" button and include the name, city and state of the program you would like to support, in the "notes" text box on the organization's donation form, if available.
- If a "notes" or "designation" box is not available, write the city and state on your check in the "notes" section or call the national office to designate your contribution to a local program site.
Locations in the following states:
Connecticut
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Financials
Most Recent Budget
Year Ended:
REVENUE
EXPENSES
Training of staff at affiliate sites, database hosting and maintenance, back office support contract.
NET GAIN/LOSS
Prior Year Actuals
Year Ended:
REVENUE
EXPENSES
Training of staff at affiliate sites. indirect costs (paid to fiscal sponsor).
NET GAIN/LOSS
Major Funders
Bullitt Foundation
Grossman Family Foundation
Robert Wood Johnson Foundation
State of Connecticut Department of Children and Families
The Children’s Fund of Connecticut
William Caspar Graustein Memorial Fund
