Evaluation of an early childhood mental and developmental primary care clinic serving an inner-city, high risk population

Adverse childhood experiences and early exposure to poverty are well-documented precursors to lifetime mental and physical health problems. Early childhood mental and developmental therapeutic services are demonstrated to offset these risk factors in vulnerable populations. Investment in effective programs is vital however complex evaluation tends to fall beyond the capacity of many service providers. Here, we describe an integrated, ecological evaluation approach for such services. Parent-child psychosocial therapeutic and comprehensive wraparound services were delivered to children ages zero to five and their caregivers at an outpatient clinic. An integrated evaluation strategy captured demographic, service delivery and outcome data on over 1,200 children in an online database system completed by providers. At six-month intervals, clinicians and parents completed measures of development, behavior and psychosocial risk for children and depression, parenting stress and supports for parents. Here, we report the functioning of 600 children, 6-months and 1-year into treatment. Families consisted of inner-city minorities (62% Latino; 26% African-American; 8% Bi-racial/Other) living in poverty (98% Medicaid recipients), with 35% involved in the child welfare system and 96% exposed to multiple, severe social risk factors. Preliminary analyses show statistically significant changes in functioning across measures at each follow-up interval. Further analyses presented here will examine the interactions of these outcomes on each other as well as the specific socio-demographic attributes and service delivery components that determines who succeeds with intervention. This comprehensive evaluation was able to substantiate the efficacy of complex services within a high risk population with minimal demand on clinical resources.