Effects of the Child First Home Visiting Program Implemented in Three States

• In Event: Federal Goals, State Realities: What Home Visiting Evidence Reveals About State Variation in Family Outcomes

Abstract

Introduction / Background
Child First is a comprehensive, home-based, therapeutic intervention embedded in a coordinated system of care. This home visiting program has two components: 1) a system of care approach to provide comprehensive, integrated services and supports; 2) a relationship-based approach, rooted in parent-child psychotherapy, that promotes nurturing, responsive parent-child interactions as well as positive social-emotional and cognitive development.

Families with children from birth to 6 years old are eligible for Child First services if the target child has shown evidence of developmental delays, or a parent/caregiver in the family has screened high for psycho-social risk. The clinician and care coordinator partner with the parent(s) in a comprehensive assessment of the child and family. The result is a family-driven plan of broad, integrated supports and services, which reflect family priorities, strengths, culture, and needs.

An earlier experimental study in Connecticut found some positive effects of Child First a year after study enrollment on children’s development and parental psychosocial functioning, and a reduction in families’ involvement with the child welfare system three years after study enrollment (Lowell et al., 2011). 

Purpose / Research Question
The purpose of the study is to estimate the impacts of Child First on child, parent, and family outcomes when implemented at-scale in three states. Twelve months after study entry, impacts on primary outcomes will be examined in two high priority outcome areas for Child First: parental psychological functioning and family involvement in child welfare systems, and on secondary outcomes that include family service and benefit receipt, children’s emotional regulation, parental employment, and parenting stress. The study team will also examine the overall effects of Child First and whether services are more beneficial for certain subgroups of families.

Methods
The study design is a family-level randomized controlled trial in which 526 families across Connecticut, North Carolina, and Colorado were randomly assigned to either the Child First program or to a usual care control group (60% of eligible families were randomly assigned to receive the Child First treatment; the remaining 40% of families were able to access any other services in their community). Study outcomes 12 months after study enrollment are measured using caregiver surveys and child welfare administrative records.

Results / Findings
Results are forthcoming; analysis will be completed by summer 2026. However, an earlier analysis using the study sample that enrolled prior to March 2020 examined the effects of Child First when services included some telehealth and hybrid services during the early period of the COVID-19 pandemic. There was suggested evidence of positive effects on a subset of outcomes for caregivers and families (Xia et al., 2023).

Conclusion / Implications
The current study will add to the existing evidence about the Child First home visiting model, when the program was implemented at scale in three varying state settings and with a larger sample than the original study. Subgroup analysis may help policymakers and practitioners target services to families most likely to benefit from Child First.

Author

• Kristen Faucetta, MDRC
  Presenting Author