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Child First


Delivery Approach:
  • Individual
  • Dyadic
Delivery Format:
  • In-Person
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Domestic Violence
  • Child Abuse
  • Neglect
  • Verbal/Emotional Abuse
  • Homelessness
  • Substance Abusing Caregiver
  • Family Separation
  • Reunification
  • Grief/Bereavement
  • Mental Health Issues/Concerns
  • Other type of experience addressed (see Program Details)
Engagement Methods:
  • Talk-Based
  • Play-Based
  • Experiential
  • Other Engagement Methods (see Program Details)
Level of Intervention:
  • Intervention
  • Greater than 12 weeks
  • Home
  • School
  • Domestic Violence Shelter
  • Homeless Shelter
  • Day Care
  • Foster Care
  • Family Service Agency
  • Community Based Agency
  • Mental Health Setting
  • Health Services
  • Other Settings (see Program Details)
Program Details:
Type of services provided

Child FIRST is a home-based, mental health intervention for children, parents and families who have or are likely to have involvement with child protection services.  Child FIRST is designed for young children who have been exposed to violence and other forms of trauma and/or have social-emotional, behavioral, developmental and/or learning problems.  The intervention begins with a comprehensive assessment including a history of the child’s and family’s trauma and adversities, parental challenges such as intimate partner violence, maternal depression, homelessness and substance abuse, the child’s and family’s strengths and resilience factors, the child’s past and current health and development and the caregiver-child relationship as well as other important relationships in the child’s life.  

The Child FIRST model uses a team approach composed of a clinician to provide psychotherapeutic services (Child-Parent Psychotherapy) to improve the mental health of the parents, to build safe, nurturing relationships between the parents and child and promote socio-emotional and cognitive development for the child.  Scaffolding of play and routines using the Abecedarian Approach are used to help the child with self-regulation and promoting executive function.  The other team member, a care coordinator, facilitates connections between the family and a wide range of community-based services to stabilize families and provide ongoing support. 

Program setting:

Birth family home, adoptive home, foster/kinship care, school settings including day care and day treatment programs, domestic violence shelters, homeless shelters, other shelters and places where children spend significant time 

Length of program/number of sessions:

The intervention is usually 6-12 months. Home visits are 60-90 minute sessions twice per week during the assessment phase (first month) and then at least once a week during the intervention phase. Service intensity provided by each team member is designed to meet the unique needs of each family.  

Type(s) of trauma/concerns addressed:

Children who are experiencing emotional/behavior problems including externalizing and internalizing behaviors, PTSD, difficulties in the parent-child relationship,  high risk of involvement with child protection services, a child with developmental/learning problems and/or children living within families with challenges that are likely to impede a child’s emotional or cognitive development including intimate partner violence (IPV), child abuse, neglect or other forms of trauma including homelessness or a caregiver with maternal depression, substance abuse, PTSD 

Education level of providers: 

Master’s or Doctoral level degree, licensed mental health clinician with extensive child development background and five years of therapeutic experience with children ages 0-5 years old, or minimum Bachelor’s degree with a minimum of three years of experience working with young children, families with multiple challenges and expertise in community-based services. 

Unique/Innovative Characteristics:

Child FIRST has detailed protocols, tools and monitoring strategies for implementation and maintaining fidelity; Child FIRST accreditation is required within two years of full implementation 

Data is collected in real time from all sites and technical support for data collection is available  

Intimate partner violence is part of the baseline assessment and a targeted risk factor for Child FIRST intervention; several other issues that frequently co-occur in homes with intimate partner violence are also addressed including maternal depression, PTSD, substance abuse and homelessness 

Mental health clinicians and care coordinators on the Child FIRST team receive 3.5 hours of clinical, reflective supervision weekly  

Child FIRST implements a wraparound approach that provides hands-on assistance to access, coordinate and overcome barriers to community-based services  

The Child FIRST approach is family-driven and asks families “How would you like us to help you and your family?” 

Date Added/Updated:


Population Served

  • 0-5 (Early Childhood)
Population Language:
  • English
  • Spanish
Ethnic Racial Group:
  • Hispanic or Latino
  • Child and Non-abusive Parent/Caregiver
  • Child
  • Family
  • Grandparents
  • Parent who uses Violence
  • Survivor parent
  • Community
  • Foster/Adoptive Parents
  • Other Client/audience
Population Adaptations:
Age range of children: 

Prenatal through 5 years old 

Are parent/adult caregiver(s) included in intervention?

Yes; Child FIRST involves all members of the family including any caregiver such as a father or grandparent who is living outside of the household  

Ethnic/racial and other groups served:

More than half of parents who participated in two evaluation studies of Child FIRST were Latino/Hispanic 

Specific cultural adaptations

Each Child FIRST site must have one team with linguistic competence specific to a dominant, non-English speaking community that is being served by Child FIRST. 

Languages that service/resource is available:



Goals of the program/services: 


  • Help children heal from trauma and adversity
  • Decrease problem behaviors
  • Improve social-emotional regulation and well-being
  • Improve language, communication and cognitive skills


  • Reduce child abuse and neglect
  • Improve mental health and executive functioning


  • Increase nurturing, responsive, and protective parent-child relationships
  • Increase family stabilization and connection to community services and supports
Evaluation Studies:

In a randomized clinical trial, 78 children were randomized to the Child FIRST intervention and 79 children were randomized to a Usual Care control group. Children ranged in age from 6-36 months old and were predominantly Latino/Hispanic or African American. Families in the intervention group received a mean of 22.1 week of services. Findings included:

  • At 6- and 12-month follow-up, Child FIRST families accessed significantly more services than the Usual Care control group (91% versus 33%)
  • At 6- and 12-month follow-up, children receiving Child FIRST had significantly greater improvement in language compared to children receiving Usual care
  • At 12-month follow-up, children receiving Child FIRST had fewer externalizing symptoms compared to children receiving Usual care
  • At 6-month follow-up, Child FIRST mothers reported significantly lower parenting stress (not maintained at 12-month follow-up)
  • Child FIRST mothers had significantly lower psychopathology symptoms, including depressive symptoms, at 12-month follow-up
  • Child FIRST families had significantly less involvement with children protective services at 36-month follow-up based on CPS records and parent report

Lowell, D. I., Carter, A. S., Godoy, L., Paulicin, B., & Briggs‐Gowan, M. J. (2011). A randomized controlled trial of Child FIRST: A comprehensive home‐based intervention translating research into early childhood practice. Child Development, 82(1), 193-208. doi:10.1111/j.1467-8624.2010.01550.x

A one-group pre-test, post-test of 82 children who had been exposed to family violence (87% witnessed family violence, 9% had been physically injured, 5% were exposed other types of family violence, 3% type of violence unknown) were enrolled in Child FIRST. The study sample was predominantly children of ethnic and minority status (55% Latino/Hispanic, 27% black/non-Hispanic, 9% white, 1% other, 9% unknown). Study participants received Child FIRST services for an average of 7.5 months, receiving an average of 55.27 hours of services while in the program. At the time of discharge from the program:

  • Children had significantly fewer potentially traumatic events, including family and nonfamily violence events
  • There were significant decreases over time in children’s post-traumatic stress-intrusive thoughts and post-traumatic stress avoidance behaviors
  • Caregivers self-reported significant decreases in stress associated with the parenting role
  • Favorable ratings of services by caregivers and high levels of receiving services (84% of families received recommended services within 90 days)
  • Children who received more hours of service and were enrolled in the program for a longer period of time improved the most

Crusto, C.A. Lowell, D.I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S. R., & Kaufman, J. S. (2008). Evaluation of a Wraparound process for children exposed to family violence. Best Practices in Mental Health: An International Journal, 4(1), 1-18.

Child FIRST collects outcome data for children and primary caregivers at 6 months from baseline and prior to discharge from the program. The following data is posted on the Child FIRST website for families served between August, 2010 and December, 2018:

  • 76% of children and families showed improvement in at least one area, 55% showed improvement in two areas and 37% improved in at least three areas
  • Analysis of Child FIRST data indicates strong outcomes for many areas including improvements in child language development and child social skills, decreases in child behavioral problems, maternal depression, parent stress, and caregiver PTSD symptoms and strengthening of the parent-child relationship
  • In most areas, the effect size (Cohen’s d) of Child FIRST’s impact on outcomes is large to very large

Child FIRST Evaluation: Highlights of Outcome Data Analysis for Children and Families Served from August 2010 through December 2018; downloaded 7/7/20 at

Diehl, D. (2013). Child FIRST: A program to help very young at-risk children. In S. L. Issacs, & D. C. Colby (Eds.). The Robert Wood Johnson Foundation Anthology: To improve health and health care. (Vol. XV, pp. 279-305). Princeton, NJ: The Robert Wood Johnson Foundation Anthology.

Training & Resources

Training Language
  • Not Specified
Training Available:
  • Yes
Training Details:
Training manuals/protocols:

Yes, there is a manual and a toolkit 

Training available:

Yes, formal training requirements vary by position in the Child FIRST program (Clinical Director, Clinician or Care Coordinator) 

Training costs:

Not Specified 

Training Contact:

Program Contact

Darcy Lowell, MD 
(203) 538-5225