Q&A with Child First on Supporting Children and Families

Modern Medicaid Alliance (MMA) partner Nurse-Family Partnership recently merged with Child First, a leading evidence-based home visiting model, to form one national service office. MMA spoke with Darcy Lowell, M.D., Chief Child First & Mental Health Officer and Founder of Child First and a developmental behavioral pediatrician, to learn more about the model and services they provide to help ensure the health and wellness of children and their families.

Modern Medicaid Alliance: Tell us about Child First and how your organization supports children and their families.

Dr. Lowell: We are a two-generational home-based mental health model for very young children and families across four states, soon to be six. We serve families facing multiple challenges. 99% of the parents or caregivers we serve have experienced trauma, and many are suffering from depression, anxiety, substance misuse, homelessness, extreme poverty, and/or domestic violence.

About 88% of the children we serve have also experienced trauma, even at their very early ages. Over 60% of children come to us with major mental health problems or emotional challenges. Our referrals are very broad because children can come into our model at any point between the prenatal period up to their 6th birthday.

Child First implements a team approach with licensed mental health clinicians providing dyadic parent-child psychotherapeutic intervention and care coordinators connecting families with critical services and supports.

Modern Medicaid Alliance: How does Medicaid support Child First?

Dr. Lowell: Medicaid is an important source of funding for Child First. In one state, it may be the only source of funding, and then in another state, Medicaid may be braided with multiple other funding sources; so it can be complex. Given that Child First is a mental health model, we have pursued Medicaid funding as a mental health intervention.

In North Carolina, all our Child First affiliate agencies are funded entirely by Medicaid. With North Carolina’s transformation to the managed care model, we created an Early and Periodic Screening, Diagnosis and Treatment (EPSDT) definition that was approved by the state. All the managed care organizations serving North Carolina have agreed to use that definition for reimbursement for Child First services, which is a tremendous success.

Additionally, as part of North Carolina’s Medicaid Transformation, the implementation of a monthly reimbursement rate for each child receiving Child First services has enabled Child First to effectively tailor our services to meet the level of need for each unique child and family.

Modern Medicaid Alliance: How did Child First adapt to the COVID-19 pandemic?

Dr. Lowell: With the onset of the pandemic, Child First had a very rapid switch to provide virtual services. We had never provided services via telehealth in the past, so we raised a significant amount of money to buy tablets and service contracts for the families we served.

Additionally, with the pandemic, our intensive care coordination, which was always a major part of our work, was increased substantially. The families’ needs were so immense that care coordinators continued to visit homes and drop off necessities on the front steps, whether that be food, diapers, cleaning supplies, or masks. Some of the care coordination was ensuring families maintained their childcare, transportation, or their housing so that they didn’t get displaced.

Given the intensity of care coordination during the pandemic, we continued to maintain strong relationships with families. Often, they were seen through telehealth more frequently than before the pandemic because touching base with them was easier virtually than when our team traveled to their homes.

The greatest challenge was with dyadic treatment since it is difficult for a 2-year-old to sit still in front of a screen. However, we utilized many creative ideas throughout the pandemic, including having our clinicians drop toys off on the doorstep for the sessions. Then the caregiver would play with those toys with their child, and the clinician would have a second set on the other side of the screen, fostering their relationship in that way.

Modern Medicaid Alliance: What impacts have you seen through Child First?

Dr. Lowell: We have been looking at our outcome data for over 12 years. The Child First model has led to very significant decreases in emotional and behavioral problems in the children and decreases in parent depression, parent stress, and post-traumatic stress disorder. We also see marked improvements in child language development, parent-child relationships, and connections to community-based services and supports. Additionally, the Child First randomized controlled (RCT) trial demonstrated decreased involvement with child welfare involvement, even three years after Child First services.

At the beginning of the pandemic, we were in the middle of a randomized controlled trial (RCT) and had to abruptly stop the RCT. MDRC, the nonprofit research organization who conducted the RCT, had enrolled 226 families. They followed up with 80% of the families at 12 months and found that the families participating in Child First had a lower rate of job loss, substance abuse, and homelessness. This reinforced how effective our clinicians and care coordinators were in providing support for the families, and that telehealth worked effectively with our caregivers. This may well be integrated into our work in the future to increase our contacts with families in extremely rural areas or when there is family illness.

Darcy Lowell, M.D is the Chief Child First & Mental Health Officer and Founder of Child First.