Near Top Tier
The Triple P System
Randomized controlled trial of the full system as implemented county-wide shows sizable reductions in child maltreatment and foster care placements.
Updated: NOV 20, 2017
Child FIRST
Evidence Rating:
Near Top Tier
Highlights
Program: A home visitation program for low-income families with young children at high risk of emotional, behavioral, or developmental problems, or child maltreatment.
Evaluation Methods: A well-conducted randomized controlled trial (RCT) with a sample of 157 low-income families.
Key Findings: At the three-year follow-up, a 33% reduction in families’ involvement with child protective services (CPS) for possible child maltreatment. At the one-year follow-up, 40-70% reductions in serious levels of (i) child conduct and language development problems, and (ii) mothers’ psychological distress.
Other: A study limitation is that its sample was geographically concentrated in Bridgeport, Connecticut. Replication of these findings in a second trial, in another setting, would be desirable to confirm the initial results and establish that they generalize to other settings where the program might be implemented.
Child FIRST (Child and Family Interagency Resource, Support, and Training) is a home visitation program for low-income families with children ages 6-36 months at high risk of emotional, behavioral, or developmental problems, or child maltreatment, based on child screening and/or family characteristics such as maternal depression.[1] Families are visited in their homes by a trained clinical team consisting of (i) a master’s level developmental/mental health clinician, and (ii) a bachelor’s level care coordinator. In the study described in our full evidence summary, the team provided an average of 12 home visits over 22 weeks, each lasting 45-90 minutes.
The clinical team first partners with the parents to assess child and family strengths and needs, and develops a plan, tailored to all family members, to provide support and services. Based on this plan, the clinician provides parent-child psychotherapy and parent guidance designed to (i) help parents understand the reasons for and meaning of their child’s negative behavior, and develop effective responses; and (ii) encourage positive maternal and child behaviors through parent-child play, reading, and family routines. The care coordinator, meanwhile, facilitates family utilization of appropriate community services (e.g., early education, housing, substance abuse treatment).
The program’s cost is approximately $7,285 per family, in 2017 dollars.[2]Â
References
[1] Child FIRST serves families with children in utero through age five, but the study described here only evaluated its effectiveness in families with children ages 6-36 months.
[2] This does not include the cost of any additional community services that the family received as a result of Child FIRST efforts to connect families to such services.
Lowell, Darcy I., Alice S. Carter, Leandra Godoy, Belinda Paulicin, and Margaret J. Briggs-Gowan. “A Randomized Controlled Trial of Child FIRST: A Comprehensive Home-Based Intervention Translating Research Into Early Childhood Practice.” Child Development, January/February 2011, vol. 82, no. 1, pp. 193–208.
To see our full evidence summary:
Related Programs
Top Tier
Nurse-Family Partnership
Randomized controlled trials show major impact on life outcomes of the mothers and their children.
Suggestive Tier
Abecedarian Project
Randomized controlled trial found major impacts on educational and life outcomes; we note, however, that it was a relatively small study that included departures from random assignment, reducing confidence in the findings.