1. If my community wants to start a Child First program, which agency should take the lead?
It is important that the entire early childhood community be involved in this decision because this is an early childhood intervention embedded in a system of care. Child First does not stand apart from other community resources, but works collaboratively with others to serve the most vulnerable children and families as a part of a continuum of supports and services. There is only a single lead agency in a given geographic area. The lead agency must be a trusted collaborator, dedicated to serving children identified and referred from all agencies. It is most likely to be either a mental health agency or a hospital that has the capacity to provide both mental health services for young children and high quality reflective supervision. It is recommended that the agency have the capacity to receive Medicaid reimbursement, as leveraging federal funding for children with mental health diagnoses can be a major source of sustained funding. The agency must also have the capacity to provide ongoing data to the Child First National Program Office in order to maintain ongoing quality improvement, fidelity to the model, and Child First certification.
2. What is the cost of the program?
The cost of the program has three components from an implementing agency perspective: (a) the start-up cost to train staff in the model; (this is an intensive one year process which will vary depending on the number involved in training and local costs); (b) the staff salaries and related direct costs (largely dependent on the salary levels within a given community), and (c) an annual fee as part of the Child First network, supporting ongoing training and certification. A state will also need to invest resources to develop and maintain a Child First statewide network.
3. What are some typical sources of funding?
Sources of funding may be:
- State funds from the state agencies responsible for child protective services, child mental health, education, public health, early intervention, health insurance for the underserved, and adult mental health
- The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program either through the Formula grants or through the Competitive grants
- Medicaid reimbursement for those children who have medical necessity (EPSDT) or mental health diagnoses
- Funding from TANF, CAPTA, IDEA, or other federal sources
4. How will the quality of services be monitored in new sites adopting the Child First model?
- Child First has developed a process to ensure fidelity to the model. This includes:
- Monitoring of Metrics and clinical fidelity from each staff person, on a monthly basis, begins at the time of training within the Learning Collaborative. This information is analysed and returned to each site so that it can develop its own quality improvement strategies.
- During the first year of training, Child First sites receive weekly reflective consultation/supervision by an experienced Child First Supervisor (progressing from weekly to biweekly), including review of videotapes of the home visits.
- Monthly technical assistance calls with Senior Leaders and quarterly visits are provided, including quality improvement strategies, if needed.
- Completion, entry into the cross-site database, and analysis of baseline and discharge measures for all families served is required.
- Completion of parent/caregiver satisfaction measures is required.
- Annual certification is granted based on fidelity to the Child First model.
5. Can the Child First model work successfully in a rural community?
Yes, the home-based intervention makes it very accessible for families in rural communities, who would otherwise find it extremely difficult to get to mental health and family support services. Care Coordinators may initially need to transport families to other community-based services, if public transportation is inadequate. Most importantly, it is necessary for all service providers from the region to come together and assess the resources available for families with young children, looking at both gaps in services and barriers to access. Together, providers may come to collaborative solutions that help extend their resources and better serve families.
6. Can a family be involved with Child First if members are already being served by another community agency?
Yes, families are almost always involved with Child First and other community agencies. Referrals usually come from other service providers and Child First almost always refers families to new community resources to meet unmet needs. A close collaborative relationship and communication among providers is an essential component of the Child First model. Child First may partner flexibly with other home visiting models to insure efficiency of services. For example, if a home visiting program has identified depressive symptoms in a mother or a child has behavioral problems, Child First may provide either consultation or ongoing home-based services in collaboration. If the home visitor is already providing care coordination, only the Mental Health and Developmental Clinician may be necessary. However, it is important to insure that Child First is not duplicating an existing service that the family is receiving. For example, a child should not be receiving outpatient mental health services and Child First simultaneously.
7. Does Child First replace other services, such as early intervention?
No, Child First frequently works with IDEA early intervention and multiple other service providers. Frequently, in this partnership, the outcomes desired by the other interventions are enhanced as well. For example, Child First concentrates on the emotional/behavioral component by intervening with the parent-child relationship. As a result of increased positive interaction and communication, not only do behavioral problems resolve, but language development is very often significantly enhanced. Maternal mental health is very frequently improved as well. It is recommended that the outcomes desired by the family be carefully assessed to see what array of services will accomplish these most effectively and efficiently.
8. Will the Child First program in my community be connected to Child First programs elsewhere?
Yes, a national Child First Network is being formed. There will be opportunities to share new ideas, problem solving, and data. There will also be a Child First Annual Conference.
9. How will the Child First Central Program Office use our locally-generated data?
- Analyze and return to the local site so that they may improve quality.
- Ensure that each site maintains fidelity to the Child First model.
- Identify programs that might be in need of technical assistance to improve outcomes.
- Examine success with subpopulations of families, where large numbers are important for analysis (e.g., ethnic groups, rural population, adult psychopathology).
- Examine successful innovations by local sites for further evaluation and dissemination.
10. Does Child First help children develop school readiness skills?
Yes, in multiple ways. By decreasing the stress experienced by the child and enhancing the parent-child relationship, the Child First intervention can prevent damage to the child’s developing brain in two very important ways. 1) It can prevent emotional and behavioral problems, which directly interfere with the child’s ability to concentrate and learn, and 2) It can directly impact the development of executive functioning (located in the prefrontal cortex of the brain), which is responsible for such functions as working memory, attention, impulse control, cognitive flexibility, and self-regulation, all necessary for successful learning. Further, with improvement of the parent-child relationship, there is increased communication and language development, which is the foundation for literacy. As the child’s sense of security increases, so does exploration, mastery, and self-esteem. The family may also be directly connected to services that impact school readiness, like early intervention, early care and education, or adult literacy.
11. Where are there Child First programs at this time?
Child First programs are throughout the state of Connecticut, one in each of the 15 Areas of the Department of Children and Families. [See list of current Child First communities]
what people are saying
Child First “has transformed scientific research into an extremely effective, evidence-based practice.”— Jack P. Shonkoff, M.D.
Professor of Pediatrics
Harvard Medical School and Children's Hospital Boston
Director, Center on the Developing Child at Harvard University
what people are saying
“You are amazing… Even though you're here for my daughter, you have impacted me in such a positive way... Thank you for not judging me.”— Child First Parent
what people are saying
“I'm glad this program exists. To me personally you are a blessing. Angels in disguise.”— Child First Parent
what people are saying
“Child First has marshaled strong evidence demonstrating the ability to intervene early, at relatively low cost, to reduce the harm caused by childhood stress in extremely high-need families.”— David Bornstein
Read and share the article on NYTimes.com >>
New York Times "Fixes" Columnist
Author of “How to Change the World”
what people are saying
“I consider Child First one of the most impressive interventions for young children that I have ever witnessed in my long lifetime.”— Edward Zigler, Ph.D.
Founder and Director Emeritus
Zigler Center for Child Development at Yale University
Founder of Head Start