Child FIRST created an innovative, highly collaborative, early identification and treatment program to prevent serious emotional and learning problems among very young children in inner-city Bridgeport, CT.

The 2007 Behavioral Health Task Force Report of the American Hospital Association cited Child FIRST as a model behavioral health service strategy.

Emerging Issue  
New research shows that significant family stress can cause damage to brain architecture in very young children and that, without early intervention, these children may experience lifelong emotional, developmental and learning problems. Child FIRST was created to prevent these very negative outcomes.

“Enormous brain growth occurs during the first three-to-five years of life,” explains Darcy Lowell, M.D., executive director. “Ideally a loving caregiver helps children feel secure and supported during this time of rapid maturation. But a parent’s ability to nurture may be severely compromised by factors such as poverty, inadequate housing, domestic violence, substance abuse or unemployment.”

Vulnerable population
According to the latest studies, even the youngest children can exhibit emotional problems. Infants may be somber or excitable; a child may act extremely withdrawn or aggressive. Undiagnosed and without intervention, these children often embark on a path to more serious emotional disturbance, substance abuse, learning disability, violent behavior, crime, and repeating the cycle of unemployment and poverty.

Child FIRST intervenes as early as possible—assessing children in early care, pediatric primary care, shelters and other early childhood settings. Part of the screening involves surveying parents to learn about environmental risks such as maternal depression, substance use, domestic violence, illiteracy, teen and single parenthood, and lack of food, clothing, furniture and other basic needs.

New community intervention
Each year Child FIRST serves over 1,000 children under age six and their families by providing screening, consultation, and intensive home-based mental health treatment as well as care coordination to meet the family’s needs for health and social services.

Patricia Baker, President of the Connecticut Health Foundation, notes, “Child FIRST builds on the strength of the community, engaging families in existing wraparound services that they may not have used before and could use again. Going beyond a medical model, the team takes a holistic approach that includes consideration for each family’s cultural values and styles of parenting.”

Evidence-based model
When the pilot program began in 2001 Lowell recalls, “No national evidence-based practices had been established to intervene with children at such a young age. From the beginning we were committed to conducting a rigorous evaluation of our efforts.” Lowell serves as Assistant Clinical Professor of Pediatrics and Child Study Center at the Yale University School of Medicine and the Section Chief of Developmental and Behavioral Pediatrics at Bridgeport Hospital, Yale-New Haven Health System.

Most recently independent researchers evaluated data from a randomized trial that compared children who received ”usual care” with those who received Child FIRST interventions. The Child FIRST families show a statistically significant decrease in children’s emotional and behavioral problems, in parental stress and depression, and in the involvement of protective services. The children also showed improved language development, which is key for school readiness.

Medicaid reimbursement
In 2005 Child FIRST became the first home-based, psychotherapeutic intervention for very young children to receive approval for Medicaid reimbursement in Connecticut. Next the project plans to conduct a cost-benefit analysis to demonstrate that investing resources at the earliest signs of mental health problems can save thousands of dollars per child on later costs for special education, foster care, juvenile justice and teen pregnancy.

System change
“Many people think these children are too young to have mental health concerns,” remarks Judith Meyers, Ph.D., President and CEO of the Children’s Fund of Connecticut, Inc. “Child FIRST’s rigorous data demonstrates the extent of the problem and moves it beyond anecdotal evidence.” Meyers adds, “Funders and policymakers are encouraged to see that they documented not only a problem, but also an intervention that works to improve the lives of these children and families.” Early care coalitions from four other Connecticut cities have contacted the Child FIRST team to learn about replicating the program.

The Children’s Fund of Connecticut, Inc. nominated Child FIRST for the project’s 2005 Robert Wood Johnson Foundation Local Funding Partnerships grant. Funding partners include: Children’s Fund of Connecticut, Cohen and Wolf, P.C., Connecticut Health Foundation, Greater Bridgeport Area Foundation, New York Community Trust, United Way of Eastern Fairfield County, and William Casper Graustein Memorial Fund.

Thanks to the Child FIRST team for allowing us to highlight the program on the cover of the 2009 LFP Call for Proposals. Their commitment to innovation and community collaboration, their focus on helping a vulnerable population by trying to change accepted systems and practices, and their partnership with local grantmakers and nonprofits exemplify many of the traits for which LFP projects are known.

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