big effects of a home visit program – Child FIRST – on children’s cognitive development and involvement with child protective services, among others

A randomized-controlled trial of Child FIRST just came out in Child Development. The results are pretty impressive.

What is Child FIRST?

The Child FIRST Intervention was designed to span the continuum from prevention to intervention, avoiding the fragmentation of categorical programs focused on a single-risk population. For this RCT, child enrollment was limited to ages 6–36 months; however, Child FIRST is routinely available to any child, prenatal to 6 years of age, evidencing emotional/behavior or developmental/learning problems or living within a family experiencing significant psychosocial risk. Each family was assigned a clinical team, consisting of a master’s level developmental/mental health clinician and an associate’s or bachelor’s level care coordinator/case manager, who usually reflected the ethnic diversity of the family and spoke the language of the family’s choosing. Engagement and building trust were fundamental goals of the intervention. Staff were trained to approach families with warmth, empathy, and respect and to communicate in words and deeds that they were there as partners and advocates. Outreach continued even in the face of multiple missed appointments. The approach was to ask without judgment or agenda, “How would you like us to help you and your family?”

Guided by the issues that were most salient to the family and driven by the child and family strengths, needs, and psychological availability, a highly individualized, multilevel, parent–child psychotherapeutic and psychoeducational approach was used (Heinicke et al., 2001; Lieberman & Van Horn, 2008). There was no set curriculum; however, child development materials often were shared. These materials were written at sixth grade reading level and available in English and Spanish. A major goal of the therapeutic relationship was to help the parent(s) reflect on their child’s experiences and the motivations and feelings underlying their child’s behavior and, in turn, on their own feelings and responses to the behavior. This often involved exploring connections between the parent’s past and current relationships and feelings toward the child. Together, parent and clinician explored alternate interpretations of the meaning of the child’s behavior and developed more effective responses.

And the results? Regardless of starting place (whether delayed or advanced in language development), children out of the program were more than twice as likely to have language problems. Children out of the program were also much more likely to have their families visited by child protective services. Mother stress was also lower in the program.

How much did it cost?

We have estimated that the cost associated with the psychotherapeutic and care coordination components of this short-term intervention was relatively low, less than $4,000 per family.

Well, it’s not a shoestring, but the results are pretty compelling. Hopefully someone can calculate some rate of return estimates to compare this to some of the other oft-cited programs, like Perry Pre-school and Abecedarian.

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