Case Studies

Yale-New Haven Health System - Child First

New Haven, CT

In 1995, a group of Bridgeport health, education, and social service providers began meeting to address the challenges of young children and families who were “falling through the cracks” and not receiving critically needed services. A collaboration among early childhood service providers began, known as the “FIRST Team” (later, Child FIRST). “FIRST” was an acronym for “Family Interagency, Resource, Support, and Training.” Yale-New Haven’s Bridgeport Hospital served as the home and fiduciary. Today, the intervention is known simply as “Child First.”

Stable and nurturing caregiver-child relationships are the cornerstone of a child’s emotional well-being and the foundation for their language and cognitive development. When young children live in environments with high levels of stress, such as extreme poverty, maternal depression, domestic violence, substance abuse, and homelessness, and do not have nurturing relationships, the children experience “toxic stress” that damages their young, developing brains. Disruption of brain architecture during this critical period leads to major problems in emotional and behavioral health, learning and memory, and physical health (including heart disease and diabetes) throughout the lifespan.

Child First serves children up to five years old, at onset of care, with emotional/behavioral or developmental/learning problems in families facing many challenges. Child First is an innovative, home-based, early childhood intervention, embedded in a system of care that helps to heal and protect children and families from the devastating effects of trauma and chronic stress by fostering the development of strong, nurturing, caregiver-child relationships, promoting adult capacity, and connecting families with needed services. Child First uses a two-generation approach, providing psychotherapy to parents and children together in their homes, and connecting them with the services they need to make healthy child development possible.

Research shows that Child First stabilizes families and improves the health and well-being of both parents and children. Results of a randomized, controlled trial demonstrated that at 12-month follow-up, Child First intervention families had strong positive outcomes, as compared with Usual Care control families:

  • Child First children were 68 percent less likely to have language problems and 42 percent less likely to have aggressive and defiant behaviors.
  • Child First mothers had 64 percent lower levels of depression and/or mental health problems.
  • Child First families were 39 percent less likely to be involved with child protective services, which was sustained at 33 percent at three-year follow-up.
  • Child First families had a 98 percent increase in access to community services supports.

The model has been so successful in Bridgeport that it has been replicated in all 15 of Connecticut’s Department of Children and Families regions, three affiliate sites in Palm Beach County, Florida, and in five sites in North Carolina. In 2016, Child First served 968 children and families in Connecticut, 229 in Florida and 206 in North Carolina for a total of 1,403.

Child First has received many distinctions including:

  • Child First is recognized by the National Registry for Effective Programs and Practices of the Substance Abuse and Mental Health Services Administration as an evidence-based “Effective” intervention.
  • Child First is recognized by the British Early Intervention Foundation (EIF) as “Evidence-based.” EIF is an independent charity and What Works Centre, which champions and supports the use of effective early intervention for children with signals of risk.
  • Child First was invited to participate on Oct. 17, 2016, in a showcase at the White House of “What Works” for “My Brother’s Keeper,” an initiative of President Obama.
  • In October 2011, Child First was designated by Health and Human Services as one of the national, “evidence-based home visiting models” of the Maternal, Infant and Early Childhood Home Visiting Program.
  • The Coalition for Evidence-Based Policy, a nonprofit, nonpartisan organization, rated Child First as “Near Top Tier” in 2012. This organization identifies the most promising interventions, using evidence to advocate for government support. Only three early-childhood programs have met this standard.
  • Child First was recognized by the Social Impact Exchange as an S&I 100 non-profit in 2012.
  • The Connecticut Hospital Association and Department of Public Health gave Child First at Bridgeport Hospital the 2007 Award for Community Service.

Lessons Learned
It is far more effective to intervene early to promote healthy brain structures than to attempt to repair circuitry after it has been hard-wired. The Child First approach is unique in combining the comprehensive, coordinated services of the system of care and psychotherapeutic intervention in a single model in which the two components act synergistically.

Future Goals
Child First is a replicable model that is growing nationally. Having successfully replicated in Connecticut, Florida, and North Carolina, Child First is in discussion with other states interested in bringing the Child First intervention to their communities.

For information about Child First Program at Bridgeport Hospital:
Contact: Kristina Foye, MSW
Director, Child First Program at Bridgeport Hospital
Telephone: 203-336-7370

For information about Child First nationally:
Contact: Dr. Darcy Lowell
Founder & CEO, Child First, Inc.
Telephone: 203-538-5225

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