Building Healthy Children (BHC)

About This Program

Target Population: Parents who had their first child prior to 21 years of age, and who are experiencing economic challenges (e.g., eligible to receive public assistance) and their children under the age of three years

For children/adolescents ages: 0 – 2

For parents/caregivers of children ages: 0 – 2

Program Overview

Building Healthy Children (BHC) is designed to provide concrete support and manualized interventions to young families at heightened risk for maladaptive parenting practices, child maltreatment, and poor developmental outcomes. BHC is designed to be a preventive intervention that addresses enhanced risks of young and socioeconomically disadvantaged parents and their children. Three intervention models (Interpersonal Psychotherapy for Depressed Adolescents [IPT-A], Child-Parent Psychotherapy [CPP], and Parents as Teachers [PAT]) were incorporated into BHC to address additional risk factors associated with child maltreatment, poor parenting practices, and maladaptive outcomes in children. These risk factors include:

  • Parent–child insecure attachment
  • Parental insensitivity
  • Parental trauma history
  • Child trauma history
  • Maternal depression and low social support
  • Limited knowledge of appropriate developmental expectations.

Program Goals

The goals of Building Healthy Children (BHC) are:

For parents:

  • Reduce maternal depressive symptoms
  • Enhance parenting sensitivity
  • Reduce parenting stress
  • Improve interactions with child
  • Reduce maltreatment of child
  • Increase family functioning
  • Reduce likelihood of child being placed in out-of-home care
  • Enhance parental knowledge of child development
  • Increase self-sufficiency of access to education, employment, & stable housing

For children:

  • Improve physical, social, emotional, and cognitive health
  • Increase timely achievement of developmental milestones
  • Improve interactions with parent
  • Improve emotional security

Logic Model

View the Logic Model for Building Healthy Children (BHC).

Essential Components

The essential components of Building Healthy Children (BHC) include:

  • Comprised of three treatments (Child-Parent Psychotherapy (CPP), Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), and Parents as Teachers (PAT)), combined with a community health worker (CHW) support to address concrete service needs
  • Team approach to supporting the family, consisting of mental health therapists trained in CPP, IPT-A, and PAT partnering with CHWs:
    • Therapists:
      • Assess the parent
      • Provide the appropriate manualized treatment:
        • CPP:
          • Used when traumatic experiences have occurred for parents and/or children
          • Assessment of parents and children
          • Intervention with parents and children designed to:
            • Help parent acknowledge what child has witnessed and remembered
            • Help parent and child understand each other's reality with regards to the trauma
            • Provide developmental guidance acknowledging response to trauma
            • Make linkages between past experiences and current thoughts, feelings, and behaviors
            • Help parent understand link between her own experiences and current feelings and parenting practices
            • Highlight the difference between past and present circumstances
            • Support parent and child in creating a joint narrative
            • Reinforce behaviors that help parent and child master the trauma
            • Gain a new perspective
          • In fidelity with model
        • IPT-A:
          • Assessment of parental depression
          • Treatment of parental depression including postpartum depression
          • In fidelity with model
        • PAT:
          • Promotion of developmentally appropriate parenting practices
          • Group connections that facilitate social connectedness
          • Used when it is the focus of the treatment plan, and if other models (CPP, IPT-A) are not needed or prioritized at that time.
          • Utilizes the 4 PAT Components:
            • Personal/Home visits which focus on:
              • Parent-Child Interaction
              • Development-Centered Parenting
              • Family Well-Being
              • Group connections
              • Screening
              • Resource network
    • CHWs:
      • Address concrete service needs such as:
        • Housing
        • Food
        • Medical appointments
        • Employment
        • Education
      • Strive to connect families with resources and support the family to prevent crisis situations that may increase stress and interfere with mental health treatment
  • Treatment models flexibly applied to family needs and preferences, which may change over time.
  • Overall focus on safety by therapists and CHWs:
    • Focus on safety issues in the environment as needed
    • Promote safe behavior
    • Legitimize feelings while highlighting the need for safe/appropriate behavior
    • Foster appropriate limit setting
    • Help establish appropriate parent-child roles.
  • Embed treatment within the child’s pediatric or family medicine practice through a partnership:
    • Some practices may qualify as a federally qualified health center or may follow a medical home approach as recommended by the American Academy of Pediatrics
    • Partnerships with the medical practice can include having a dedicated staff person who can do any or all of the following:
      • Screen for eligibility
      • Provide outreach to families
      • Receive referrals from obstetric and pediatric practices
      • Exchange notes for communication in the electronic medical records
      • Transport families for medical appointments
      • Assisting with follow-up around medical appointments and recommendations, or all of the above.
    • This access to the medical provider’s records allows the BHC program to:
      • Facilitate timely completion of well-child visits
      • Ensure up-to-date immunizations
      • Adhere with medical recommendations
    • BHC services that emanate from the assessments that therapists and CHWs conduct can be entered into the electronic medical record to facilitate communication with the medical team.
  • Facilitate connections with resources to meet concrete services needs and ensure timely well-child pediatric care
  • Group connections events to reduce social isolation and build social supports and behavioral activation.

Program Delivery

Child/Adolescent Services

Building Healthy Children (BHC) directly provides services to children/adolescents and addresses the following:

  • Cared for by parents who are possibly not knowledgeable about typical child development
  • Possible limited family understanding of and support for:
    • Socioemotional development
    • Mental and physical health
    • Well-being may be limited
  • Possible exposure to trauma
  • Possible internalizing and externalizing symptoms
  • Possible symptoms of posttraumatic stress disorder (PTSD)

Parent/Caregiver Services

Building Healthy Children (BHC) directly provides services to parents/caregivers and addresses the following:

  • Possible lack of parental knowledge of child development
  • Parental limited understanding of how to support developmental competencies
  • Parental symptoms of depression
  • Parental negative perceptions or attributions about the child
  • Problems in the parent-child relationship
  • Maladaptive parenting strategies
  • Possible PTSD symptoms (avoidance, intrusion, and hyperarousal)
  • Possible challenges with housing, limited education or employment, or other social determinants of health that may increase stress for the family
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Siblings, partners, and grandparents may be involved, depending on the family circumstances. CPP has a family perspective and incorporates perspectives of other family members who may play a role in the children’s lives.

Recommended Intensity:

Weekly hour-long sessions plus Community Health Worker support that varies in frequency and duration, according to family need

Recommended Duration:

Up to 3 to 3.5 years (from pregnancy to child’s age of 3 years)

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Daily Living Setting
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Virtual (Online, Telephone, Video, Zoom, etc.)


This program does not include a homework component.


Building Healthy Children (BHC) has materials available in a language other than English:


For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Transportation for home visitation and supporting families’ access to medical care
  • Interactive toys
  • Assessment tools
  • Computers and internet access
  • Interface with electronic medical records (if the BHC program is not implemented at a hospital, agencies may need to develop a business partner agreement to align with HIPAA and ensure communication via electronic medical records)

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Therapists are Master-level mental health clinicians. CHWs are paraprofessionals. The need for other types of staff (e.g., resource specialists in pediatric offices or pediatric social workers to work with CHWs) will be determined based on the implementing agency.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

  • Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2015). Don’t hit my mommy: A manual for Child-Parent Psychotherapy with young children exposed to violence and other trauma (2nd ed.). Zero to Three.
  • Mufson, L., Dorta, K. P., Moreau, D., & Weissman, M. M. (2004). Interpersonal Psychotherapy for Depressed Adolescents. Guilford Press.
  • Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2017). The guide to Interpersonal Psychotherapy: Updated and expanded edition. Oxford Press.
  • Parents as Teachers National Center, Inc. (2023). Parents as Teachers Foundational Curriculum: Prenatal to 3. Author.

Each manual is provided during training though many of them are available for purchase from booksellers online.

Training Information

There is training available for this program.

Training Contacts:
Training Type/Location:

Training can be provided at our organization, onsite at the trainee organization, virtually, or a combination of in-person and remote

Number of days/hours:

Training is provided in a Learning Collaborative format for teams within an organization. Ideally, the Learning Collaborative would include a team with Master-level therapists, paraprofessional CHWs, supervisors, and senior leaders who could address issues such as access to electronic medical records, funding and billing issues, partnerships with referral sources and medical providers, etc. The Learning Collaborative occurs over approximately 18 months with didactics during Learning Sessions and consultation calls that include case presentations and implementation discussions. However, the length and type of involvement would differ according to role. The therapists would need more extensive training to implement all 3 intervention models. The CHWs and senior leaders would need some familiarity with the models but would not be implementing them. The medical office staff would not attend the training, but senior leaders could develop materials to share with partners about the services provided. The training does include written materials on weaving together the three practices and CHW component parts. An agency that wants to implement BHC would need to have readiness to implement the model with the infrastructure support that could facilitate sustainability. Prior implementation experience (e.g., clinicians who have been trained in CPP or IPT-A) would be an asset but is not required. The agency would need to commit to allocating staff time for training, have supervisory structures in place to support the model, have partnership(s) with medical practices, and have funding mechanisms that could support sustainability.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Building Healthy Children (BHC).

Formal Support for Implementation

There is formal support available for implementation of Building Healthy Children (BHC) as listed below:

Didactics and consultation in fidelity with CPP and IPT-A component models are provided during the 18-month Learning Collaborative. If an organization was interested in implementing the full BHC model, technical assistance could be made available via teleconferencing, perhaps combined with in-person training, as well as leadership coaching and program evaluation.

Fidelity Measures

There are fidelity measures for Building Healthy Children (BHC) as listed below:

Fidelity measures are utilized within each BHC component (e.g., CPP, IPT-A, PAT). These measures are completed by therapists.

Implementation Guides or Manuals

There are no implementation guides or manuals for Building Healthy Children (BHC).

Implementation Cost

There are no studies of the costs of Building Healthy Children (BHC).

Research on How to Implement the Program

Research has not been conducted on how to implement Building Healthy Children (BHC).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Paradis, H. A., Sandler, M., Manly, J. T., & Valentine, L. (2013). Building Healthy Children: Evidence-based home visitation integrated with pediatric medical homes. Pediatrics, 132, S174–S179.

Type of Study: Randomized controlled trial
Number of Participants: 497


  • Age — Mothers: Mean=18.9 years; Child: Mean=6.34 months
  • Race/Ethnicity — Mothers: 68% African American, 20% White, 19% Hispanic, and 11% Biracial/Other
  • Gender — Children: 48% Female
  • Status — Participants were low-income mothers under the age of 21 at first delivery with two or less children under the age of 3 years.

Location/Institution: Rochester, New York

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the integration and effectiveness of 3 combined practices of Building Healthy Children (BHC) versus community service only in avoiding child maltreatment, improving parent and child health, and enhancing family functioning. Participants were randomized to either the BHC treatment group that received Parents as Teachers, Child-Parent Psychotherapy, and Interpersonal Psychotherapy for Depressed Adolescents as needed or to a comparison group. Measures utilized include the Electronic Medical Record (EMR). Results indicate that there was a successful avoidance of indicated child protective services (CPS) reports and foster placement, and there were educational and employment gains for treatment parents. An independent review of CPS reports for the sample to date has shown 98% of the treatment group and 95% of the comparison group has avoided indicated CPS reports. Although the difference between groups is not statistically significant, it suggests that an overwhelming majority of treatment families avoided the child welfare system despite the much closer surveillance that comes with participating in home visiting. On follow-up of initial program graduates, 97% of BHC treatment graduates continued to avoid CPS indications after services ended. Only 1 participant, who did not complete the program, had an out-of-home placement. Limitations include challenges by combining the 3 practices and a lack of detail on study design and methods.

Length of controlled postintervention follow-up: None.

Demeusy, E. M., Handley, E. D., Manly, J. T., Sturm, R., & Toth, S. L. (2021). Building Healthy Children: A preventive intervention for high-risk young families. Development and Psychopathology, 33(2), 598–613.

Type of Study: Randomized controlled trial
Number of Participants: 232


  • Age — At Baseline: Mothers: Mean=19.08 years; Children: Mean=5.22 months; At follow-up: Mothers: Mean=27 years; Children: Mean Age=7.5 years
  • Race/Ethnicity — 66% African American, 23% Caucasian, 18% Latina, 6% Other, and 5% Biracial
  • Gender — Children: 53% Male
  • Status — Participants were low-income mothers under the age of 21 at first delivery with two or less children under the age of 3 years with no prior CPS indication with their child.

Location/Institution: Rochester, New York

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test the short and long-term effects of Building Healthy Children (BHC) at promoting positive parenting and maternal mental health, while preventing child maltreatment and harsh parenting, and to examine the interventions sustained effect on child symptomatology and self-regulation. Participants were randomly assigned to BHC or Enhanced Community Standard that received community service resources and referrals. Measures utilized include the Demographic Interview, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory – II (BDI-II), Maternal Efficacy Questionnaire (MEQ), Parenting Stress Index, Child Behavior Checklist (CBCL), the Maltreatment Classification System, Demographic Update Interview – Enhanced, Conflict Tactics Scales: Parent-child version, Parenting Practices Interview, Behavior Rating Inventory of Executive Functioning Second Edition (BRIEF-2), and the Emotion Regulation Checklist. Results indicate that mothers who received BHC evidenced significant reductions in depression at mid-intervention, which was associated with improvements in self-efficacy and stress as well as decreased child internalizing and externalizing symptoms at postintervention. The follow-up study found that BHC mothers exhibited less harsh and inconsistent parenting, and marginally less psychological aggression. BHC children also exhibited less externalizing behavior and self-regulatory difficulties across parent and teacher reports. Limitations include risk of self-bias due to maternal reports and sample bias due to a high number of participants unenrolled by the time of postintervention follow-up. In addition, the postintervention follow-up only followed a subset of the intervention sample.

Length of controlled postintervention follow-up: None.

Additional References

Kash, B., Tan, D., Tittle, K., & Tomaszewski, L. (2016). The pediatric medical home: what do evidence-based models look like. The American Journal of Accountable Care, 4(2).

Toth, S. L., & Gravener, J. (2012). Bridging research and practice: Relational interventions for maltreated children. Child and Adolescent Mental Health, 17(3), 131–138.

Valentino, K. (2017). Relational interventions for maltreated children. Child Development, 88(2), 359–367.

Contact Information

Jody Todd. Manly, PhD
Agency/Affiliation: Mt. Hope Family Center/University of Rochester
Phone: (585) 275-2991
Robin Sturm, EdD
Agency/Affiliation: Mt. Hope Family Center/University of Rochester
Phone: (585) 275-2991

Date Research Evidence Last Reviewed by CEBC: November 2023

Date Program Content Last Reviewed by Program Staff: February 2024

Date Program Originally Loaded onto CEBC: March 2024