When people hear the name Coastal Horizons, a lot think of substance use treatment. That work remains central to our mission, but it represents only one part of a much broader continuum of care.

Across North Carolina, Coastal Horizons provides services that address mental health, family stability, violence and trauma, justice involvement, youth development, and other challenges that affect the health and economic vitality of our communities. One of the clearest examples is Child First, an evidence-based program focused on infants, young children, and their families.



Why should early-childhood mental health matter to business leaders? Because the well-being of children and families is directly connected to workforce stability, employee productivity, school readiness, and the long-term strength of our communities.

Parents cannot fully focus at work when their family is in crisis. Employers feel the effects through absenteeism, turnover, and lost productivity. Communities bear the long-term costs when children’s developmental and emotional needs go unaddressed. Investing early is not only compassionate; it is practical.

Reaching Families Where They Are

Child First is a nationally recognized infant and early-childhood mental health treatment and prevention program for families facing significant stress and adversity. Services are provided in the home with the child, parents, and other primary caregivers. This allows teams to understand the family’s daily environment, build trusted relationships, and address barriers that may prevent families from receiving care in a traditional office setting.

The program serves children from birth through age five-and-a-half who are experiencing challenges with their emotional, social, or physical development. Children may also qualify when their families have experienced trauma, caregiver mental illness or substance use, domestic violence, chronic poverty, incarceration, separation from a primary caregiver, or other circumstances that can create chronic toxic stress.

Child First works to reduce stress in the home, improve child and family stability, connect families with community resources, and strengthen the nurturing and protective relationships between young children and their caregivers. These relationships form the foundation for healthy development, learning, and future resilience.

A Growing Statewide Impact

Coastal Horizons is now the largest Child First site in the country. Through 34 Child First teams and nine clinical supervisors, the program reaches families across 41 North Carolina counties.

During Fiscal Year 2025–2026, the program served 424 families and grew by nearly 57 percent. This expansion was made possible through funding opportunities and partnerships with local managed care organizations, allowing Coastal Horizons to serve families enrolled in all Standard and Tailored Plans.

Growth, however, is meaningful only when it produces results. Child First uses standardized, validated assessments at the beginning of services, at six months, and at discharge to measure progress and guide treatment.

Among the program’s most recent outcomes:

• Of children who had developmental or behavioral concerns at the beginning of services, 92 percent improved in at least one area, including communication, social skills, or behavior.
• Seventy-four percent of families remained engaged in services for six months or longer.
• Sixty percent of primary caregivers experienced a measurable reduction in parenting stress.
• Ninety-four percent of families reported that treatment goals were met during their episode of care.

The program also continues to strengthen its clinical practices through Child-Parent Psychotherapy learning collaboratives and training provided by the North Carolina Child Treatment Program. Family Resource Partners receive training in the Abecedarian Approach, which uses language-enriched caregiving and conversational reading to support children’s communication and development.

Child First recently completed participation in a randomized controlled trial, widely considered the strongest standard for evaluating program effectiveness. The resulting data demonstrate the model’s effectiveness compared with alternative approaches for this population and may help build greater awareness and investment in these services.

An Investment in North Carolina’s Future

The challenges confronting families do not remain neatly contained within the home. They affect schools, workplaces, health care systems, public safety, and the broader economy. Conversely, when families are stable and children have the opportunity to thrive, the benefits extend throughout the community.

For business leaders, supporting early-childhood mental health is an investment in today’s workforce and tomorrow’s. Child First demonstrates that addressing challenges early, strengthening caregivers, and surrounding families with effective support can change trajectories—not only for individual children, but for generations.

That is an important part of Coastal Horizons’ work and an essential part of building healthier families, stronger communities, and a more resilient North Carolina.

Read more at coastalhorizons.org.