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Early Pathways Program (EPP)


Delivery Approach:
  • Individual
Delivery Format:
  • In-Person
  • Virtual
  • Hybrid
Provider Requirements:
  • Licensed/Certified Professional Led
Type of Experience Addressed:
  • Child Abuse 
  • Sexual Abuse
  • Community Violence
  • Neglect 
  • Family Separation
  • Grief/Bereavement 
  • Medical Trauma
  • Homelessness
  • Verbal/Emotional abuse
  • Mental Health Issues/Concerns
  • Historical trauma
Engagement Methods:
  • Experiential
  • Play-based
  • Talk-based
  • Culturally Grounded
  • Other Engagement Methods
    • In-home Treatment Model
Level of Intervention:
  • Primary Prevention
  • Secondary Prevention
  • Less than 6 weeks
  • Less than 12 weeks
  • Greater than 12 weeks
  • Home
  • Foster Care
  • Mental Health Setting
  • Community Based Agency
Program Details:
Type of services provided:

Home-based, parent-child therapy program designed to treat and prevent disruptive behaviors in young children. Early sessions focus on parent-child relationships and later sessions focus on discipline strategies. Trauma-informed strategies have been infused throughout the program. The primary focus of this program is children from diverse families living in poverty.
Five key program components are:

1. Strengthening the parent-child relationship through child-led play
2. Maintaining developmentally appropriate expectations of children and cognitive methods for calmly and thoughtfully responding to disruptive behaviors
3. Using positive reinforcement to strengthen prosocial behavior, improving home routines and parent supervision to provide a more predictable and safer home for young children.
4. Using time-limited strategies (time-out, redirection, ignoring) for reducing disruptive behaviors
5. Using trauma-informed strategies for children exposed to trauma.


Program setting:

Adoptive home, birth family home, community agency, foster/kinship care

Length of program/number of sessions:

8-16 weekly sessions (60-90 minutes)

Type(s) of trauma/concerns addressed:

Child abuse and neglect, domestic violence, complex trauma

Symptoms addressed:

Serious tantrums, aggression, property destruction, self-injury, hyperactivity, noncompliance and other behavior problems, separation anxiety, fears and nightmares, other emotional difficulties including trauma.

Education level of providers:

Master’s degree in human services field or working towards a graduate degree. Supervisors usually have a Master’s or Doctoral degree in psychology, social work or counseling, licensed in their state and have three years experience implementing EPP.

Additional information:


Unique/Innovative Characteristics:

Caregiver handouts are written at a 3rd to 4th grade reading level. EPP has several evaluations with low-income families. It can be delivered by certified EP professionals. Free on-line training and one and two-day on-site training programs with follow-up consultation sessions.

Date Added/Updated:


Population Served

  • 0-5 (Early Childhood)
Population Language:
  • English
  • Spanish
Ethnic Racial Group:
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Indigenous People – American Indian/Native American, Alaskan Native
  • Native Hawaiian or other Pacific Islander
  • White
  • Child and Non-abusive Parent/Caregiver
  • Child
  • Family
  • Grandparents
  • Parent who uses Violence
  • Survivor parent
  • Foster/Adoptive Parents
  • Other Client/Audience
    • Kinship Placements
Population Adaptations:
Age range of children served:

1 to 5 years old

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


Ethnic/racial and other groups served:

African Americans, Latina/o, Asians, Native Americans; Over 85% of families served by EP at the time of the NCTSN review (2017) met the federal definition of poverty.

Specific cultural adaptations:

None indicated

Languages that service/resource is available:

English, Spanish


Goals of the program/services:

• Strengthen the parent-child relationship
• Improve parent-child interactions during play
• Reduce child’s behavior problems and improve positive behaviors
• Improve parent’s nurturing skills and appropriate limit-setting skills for child’s challenging behaviors while discouraging use of verbal and corporal punishment
• Increase parent’s knowledge of appropriate developmental expectations for their child and apply them
• Improve parent’s thoughtfulness and calmness when managing child’s behavior problems
• Improve parent’s confidence in managing new problems that emerge after this intervention has ended
• Reduce child trauma symptoms.

Evaluation Studies:
Has there been any evaluation?


Key evaluation results:

Several evaluations have been conducted including randomized controlled trials that demonstrated the following outcomes:


• Parents who received the EPP intervention reported significantly fewer concerns with their child’s challenging behavior compared with parents in the wait-list control group at posttest (Fung & Fox, 2014; Harris et al, 2014; Harris et al, 2015; Love & Fox, 2017)
• Parents who received the EPP intervention rated their children as having more positive behaviors compared with parents in the wait-list control group at posttest (Fung & Fox, 2014, Harris et al, 2015; Harris et al, 2016, Love & Fox, 2017))
• Both parents and children who received the EPP intervention were rated as having better quality interaction during a play assessment (Fung & Fox, 2014, Harris et al, 2015) and better scores on a global assessment of parent-child relationships (Fung & Fox, 2014) compared with those in the wait-list control group
• Parents who received the EPP intervention reported less frequent use of verbal and corporal punishment and more frequent use of positive nurturing activities compared with parents in the wait-list control group at posttest (Fung & Fox, 2014, Harris et al, 2015; Harris et al, 2016)
• At posttest, children in the intervention group had significant improvement in overall psychological, social and occupational/school functioning compared with those in the wait-list control group (Fung & Fox, 2014)
• At posttest, children in the intervention group had fewer trauma symptoms (Love & Fox, 2017).


Is there an evaluation currently in progress or planned?

Ongoing data collection often as a part of a doctoral student’s dissertation or to meet grant requirements (e.g., SAMHSA).

Publications about the program:

Fox RA, Holtz CA. Treatment outcomes for toddlers with behavior problems from families in poverty. Child and Adolescent Mental Health. 2009; 14:183-189.

Fung MH & Fox RA. The culturally-adapted Early Pathways program for young Latino children in poverty: A randomized controlled trial. Journal of Latina/o Psychology. 2014; 2(3):131-145.

Gresl BL, Fox RA, Fleischmann A. Home-based parent-child therapy in low income African-American, Caucasian and Latino Families: A comparative examination of treatment outcomes. Child & Family Therapy. 2014; 36(1):33-50.
Carrasco JM & Fox RA. Varying treatment intensity in a home-based parent and child therapy program for families living in poverty: A randomized controlled trial. Journal of Community Psychology. 2012; 40(5):621-630.

Gresl, BL, Fox, RA, & Besasie, LA. Development of a barriers scale to predict early treatment success for young children in poverty with behavior problems. Clinical Practice in Pediatric Psychology. 2016; 4 249-262.

Harris, SE, Fox, RA, & Holtz, CA Screening for significant behavior problems in young children living in poverty. Journal of Child and Family Studies 2016;25: 1076-1085.

Harris SE, Fox RA, Love JR. Early Pathways therapy for young children in poverty: A randomized controlled trial. Counseling Outcome Research and Evaluation. 2015; 6:3-17.

Holtz, CA, Fox, RA, & Meurer, J R. Incidence of behavior problems in toddlers and preschool children from families living in Poverty. Journal of Psychology, 2015;149:161-174.

Love, JR & Fox, RA. Home-based parent child therapy for young traumatized children living in poverty: A randomized controlled trial. Journal of Child and Adolescent Trauma, 2017;10(2): 1-11.

Mattek, RJ, Harris, SE, & Fox. RA. Predicting treatment success in child and parent therapy among families in poverty. Journal of Genetic Psychology. 2016; 177: 44-54.

Rated/Reviewed by Evidence Based Registries:

SAMHSA’s National Evidence Based Practice Resource Center 
California Evidence-Based Clearinghouse for Child Welfare
The National Traumatic Stress Network Treatments and Practices, Trauma Interventions 

Training & Resources

Training Language:
  • English
Training Availability:
  • Yes, onsite and online
Training Details:
Training manuals/protocols:

Fox, RA. Early Pathways Manual, 2nd Edition, 2017

Training Contact:

Not specified

Program Contact

Robert Fox, PhD
(414) 288-1469