Structure & Funding Required for Replication
Child First, Inc. has developed a framework for replication of the Child First model. Our intent is to integrate Child First into a wider early childhood system of care responsible for promoting the healthy development of young children and strengthening family capacity. These systems of care are usually delineated by geographic area or political jurisdiction (e.g., a state, county, or a large city).
Child First works with local partners to (a) identify a State/County Lead Organization, (b) identify affiliate agencies with the necessary qualifications to successfully implement the Child First model, and (c) develop a financing plan for start-up and sustainability.
The following costs need to be covered for full implementation.
Child First State/Regional Program Office
Child First needs a lead organization at the state, regional, or city level to work with the National Program Office (NPO) to help manage start-up and ongoing implementation within the state or region, and to ensure sustainability of the Child First network in the state/region/city. At a minimum, a full time Child First State/Regional Clinical Director is hired by the National Program Office (NPO), with funding from the replication state/region, and is located in the replication state. Child First replication also needs a State/Regional Program Director at the leadership level to nurture the relationships with the state/regional early childhood system of care and develop a long term replication and sustainability plan. This State Program Director/Manager for Child First will likely be an individual from the State Lead Organization. Given the tremendous variation in state structures, the creation and funding of the State/Regional Program Office will be highly individualized.
State Program Office staff need office space, administrative support, and related expenses (travel, cell phone, office supplies). Depending on the circumstances of replication, this could be structured in a variety of ways.
Child First Affiliate Agencies
Most of the cost to implement Child First is at the agency level - for the staffing and related program operations costs. The State Lead Organization has responsibility for identifying and securing funding for a minimum of three years and works with Child First NPO on a long-term sustainability plan.
The typical implementation scenario is for an Affiliate Agency implementing Child First to commit to hiring four teams, each with a licensed, Master’s level Clinician and a Bachelor’s level Care Coordinator. A full time affiliate site Clinical Director/Supervisor oversees the program within the agency, provides the necessary reflective clinical and administrative supervision, and serves as the primary contact within the regional Child First Network. Costs will vary depending on local salaries and the geographic region to be served (affecting mileage and numbers served).
There are three types of fees paid to the Child First NPO. These include start-up fees, training fees, and annual support fees.
- Operational costs: Establishing data systems, purchasing equipment and furniture, office space
- Child First programmatic costs: Published assessment measures, reference books, toys, etc.
- Costs of personnel: A start-up Child First site optimally requires four teams (but a minimum of two teams) made up of a Mental Health/Developmental Clinician and a Care Coordinator and a Clinical Director who supervises the teams. A full-time Clinical Director can oversee four to seven teams. In addition, sites need both administrative support and data entry/tracking support.
- Learning Collaborative training costs include cost of Child First trainers, travel, site location, food.
- Reflective clinical consultation on-site (whenever possible) or by web or phone
- Distance Learning: On-line and video-conferencing
Annual Support Fees:
- Annual training: Specialty and Annual Conference
- Data analysis and reporting
- Reflective clinical consultation
- Quality enhancement and fidelity monitoring
- Technical assistance
- Child First Annual Accreditation
Potential sources for both start-up and sustainability funding include, but are not limited to:
Maternal Infant Early Childhood Home Visiting Initiative (MIECHV)
This is an important source for establishing the Child First model in a new state. Child First programs are eligible for this funding because Child First has been designated by Health and Human Services as one of the national, evidence-based home visiting models. Funding is targeted for high need communities as defined in state MIECHV plans. In Connecticut, MIECHV provides full or partial funding for eight affiliate sites. All states are receiving Formula funding through FY2015, with many receiving competitive funding as well. Reauthorization of MIECHV funding by Congress will be determined in 2015.
Child First anticipates certification for Medicaid reimbursement in Connecticut through the Rehabilitation Option for all Child First accredited sites. The Early and Periodic, Screening, Diagnostic, and Treatment program (EPSDT) of Medicaid is another avenue that is being explored.
State Agency Funding
Within Connecticut, the Department of Children and Families (DCF, which includes both child protective services and child mental health) has funded the operating budgets of nine Child First affiliate sites as part of the state system. The positive outcomes of the Child First intervention directly impact the work of other state agencies as well. In the future, sustainable funding could come from braided dollars from state and federal funds in departments of public health, education, early childhood, disability, and adult mental health and substance abuse.
The Robert Wood Johnson Foundation and almost 20 matching philanthropic partners have been major supporters of Child First, especially during the period of training and early implementation.
Social Impact Bonds or Pay for Success
This is a strategy to engage state agencies and funders (philanthropy or investors) in a public-private partnership to begin implementation of evidence-based models. The initial implementation is through private funding mechanisms with the commitment of state funding if the outcomes are cost-effective for the state. Child First would be an excellent candidate for this funding mechanism.
Federal Grants and Funding Streams
Federal grants and initiatives (e.g., Project LAUNCH) from the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Education (DOE), Office of Juvenile Justice and Delinquency Prevention (OJJDP), and others have been a significant source of Child First start-up in individual communities. Other possible funding streams include Child Abuse and Protection Treatment Act (CAPTA), Individuals with Disabilities Education Act (IDEA Parts B and C), and Temporary Assistance to Needy Families (TANF).
Child First can leverage private and public grants to establish new service areas, but needs to become part of a public funding system to sustain services. Currently, the braiding of public, private and philanthropic funding supports serve as a vehicle for establishing local, state and national partnerships. The work supported by these sources is a foundation for the system of services accessible by vulnerable children and families.