Early Pathways is a home-based therapeutic intervention for disadvantaged families with concerns about the behaviour of a child between the ages of 1 and 5. It is delivered by a master’s qualified social worker or therapist to families for 14 to 18 weeks.
The information above is as offered/supported by the intervention provider.
1 to 5 years old
Home visiting
Early Pathways is a home-based therapeutic intervention for disadvantaged families with concerns about the behaviour of a child aged between 1 and 5 years.
Early Pathways is delivered by a mental health professional (typically a master’s qualified psychologist, counsellor, or social worker) who visits the parent and child in their home for 14 to 18 sessions. During these sessions, parents learn strategies for strengthening the parent–child relationship through activities which promote child-led play.
The first session introduces the parent to the Early Pathways principles and the parent and child participate in a joint play session. The practitioner then rates the quality of the interaction and introduces the parent to strategies which encourage child-led play. The family is also connected with advocacy resources as needed.
In subsequent sessions, further strategies are introduced, including age-appropriate expectations for the child’s behaviour, responding calmly to challenging child behaviours, reinforcing positive child behaviours, establishing family routines, and implementing limit-setting strategies to reduce challenging behaviours in children. Parents also learn narrative techniques to facilitate discussions with children about their trauma experiences when necessary.
1 to 5 years
Children from disadvantaged families who demonstrate behavioural and emotional problems associated with trauma.
Disclaimer: The information in this section is as offered/supported by the intervention provider.
Science-based assumption
Family disadvantage and trauma exposure during the early years increases the risk of behavioural and emotional problems as children grow older.
Science-based assumption
Sensitive and predictable parenting reduces the risk of behavioural and emotional problems in children living in disadvantaged circumstances.
Science-based assumption
Higher levels of family stress can interfere with parents’ ability to respond to the emotional and behavioural needs of their child.
Intervention
Parents learn strategies for understanding their child’s needs and responding appropriately to them through home-based sessions involving child-led play.
Short-term
Parents feeling more confident in addressing negative behaviours using positive strategies
Parents spend more quality time with their children through child-led play.
Medium-term
Increased nurturing behaviours from parent
Improved parent–child relationship.
Long-term
Decreased challenging behaviours in child
Increased prosocial behaviours in child.
Disadvantaged families with children aged 1 to 5 years who exhibit significant behavioural and emotional problems and may have been exposed to trauma.
Early Pathways is delivered in 14 to 18 sessions of one-hour duration each by one practitioner, to individual families. Sessions are delivered separately in two components: one for caregivers (up to two in each session), and children from the same family (between one to three children in each session).
The intervention aims to reduce child trauma or behavioural and/or mental health symptoms by teaching caregiver’s effective trauma-informed parenting skills.
Parenting skills are delivered through a structured psychoeducational intervention where clinicians provide direct instruction and counsel to caregivers to learn trauma-informed parenting strategies.
Sessions progressively build upon prior knowledge, involving observation of parent–child play, coaching in engagement, setting play time, identifying effective praise methods, and utilising narrative techniques to support children in discussing trauma experiences.
The practitioner who delivers this intervention is a licensed professional therapist or social worker.
The practitioners have 340 of training in the intervention model. Booster training of practitioners is not required.
It is recommended that practitioners are supervised by one clinical supervisor, with 30 hours of training in the intervention model.
Fidelity to the intervention model is maintained through the following processes:
Contact person: Heather Rotolo
Organisation: Penfield Children’s Center
Email address: heatherrotolo@penfieldchildren.org
Website/s: https://penfieldchildren.org/early-pathways-training-program/
*Please note that this information may not be up to date. In this case, please visit the listed intervention website for up to date contact details.
Early Pathway’s most rigorous evidence comes from a single RCT conducted in the United States that is consistent with Foundations’ Level 2+ evidence strength criteria. This study identified statistically significant improvements in children’s behaviours and social interactions.
| Identified in search | 20 |
| Studies reviewed | 2 |
| Meeting the L2 threshold | 2 |
| Meeting the L3 threshold | 0 |
| Contributing to the L4 threshold | 0 |
| Ineligible | 18 |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 199 disadvantaged families with children between 1 and 5 years old (average age of 2.88 years) who experience externalising behavioural problems and where families are living in poverty. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | Families receiving public assistance with an annual income below the federal poverty line. |
| Timing |
|
| Child outcomes | Post-intervention
3-month follow-up
|
| Other outcomes | Post-intervention
3-month follow-up
|
| Study rating | 2+ |
| Citations | Harris, S. E., Fox, R. A. & Love, J. R. (2015) Early pathways therapy for young children in poverty: A randomized controlled trial. Counseling Outcome Research and Evaluation. 6 (1), 3–17. |
| Study design | RCT |
| Country | United States |
| Sample characteristics | 64 disadvantaged families with a child between the ages of 1 and 5 living in an urban community in the midwestern United States. |
| Race, ethnicities, and nationalities |
|
| Population risk factors | Children who were receiving public assistance, which required that their annual family income was below the federal poverty line. and who have experienced a potentially traumatising event. 20.3% of children were diagnosed with a developmental delay. |
| Timing |
|
| Child outcomes |
|
| Other outcomes | Improved parent–child relationship |
| Study rating | 2 |
| Citations | Love, J.R. & Fox, R.A. (2019) Home-based parent child therapy for young traumatized children living in poverty: A randomized controlled trial. Journal of Child & Adolescent Trauma. 12, 73–83. |
The following studies were identified for this intervention but did not count towards the intervention’s overall evidence rating. An intervention receives the same rating as its most robust study or studies.
Carrasco, J. M. & Fox, R. A. (2012) Varying treatment intensity in a home‐based parent and child therapy program for families living in poverty: a randomized clinic trial. Journal of Community Psychology. 40 (5), 621–630.
Fung, M. P. & Fox, R. A. (2014) The culturally-adapted Early Pathways program for young Latino children in poverty: A randomized controlled trial. Journal of Latina/o Psychology. 2 (3), 131.
Fung, M. P. (2015) A parent-child therapy program for Latino families. Marquette University.
Fung, M.P., Fox, R. A. & Harris, S. E. (2014) Treatment outcomes for at-risk young children with behavior problems: Toward a new definition of success. Journal of Social Service Research. 40 (5), 623–641.
Gresl, B. L., Fox, R. A. & Besasie, L. A. (2016) Development of a barriers scale to predict early treatment success for young children in poverty with behavior problems. Clinical Practice in Pediatric Psychology. 4 (3), 249.
Mattek, R. J., Harris, S. E. & Fox, R. A. (2016) Predicting treatment success in child and parent therapy among families in poverty. The Journal of Genetic Psychology. 177 (2), 44–54.
Panahipour, H., Hosseinian, S. & Ghasemzadeh, S. (2018) The efficacy of Early Pathways program on parent-child interaction and warmth. Contemporary Psychology, Biannual Journal of the Iranian Psychological Association. 13 (1), 78–88.
Note on provider involvement: This provider has agreed to Foundations’ terms of reference (or the Early Intervention Foundation's terms of reference), and the assessment has been conducted and published with the full cooperation of the intervention provider.
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
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Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
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