Skip to main content

Advertisement

Log in

Cost-Effectiveness of Childcare Discounts on Parent Participation in Preventive Parent Training in Low-Income Communities

  • Original Paper
  • Published:
The Journal of Primary Prevention Aims and scope Submit manuscript

Abstract

We tested the cost-effectiveness of giving low-income parents childcare discounts contingent on their participation in the Chicago Parent Program, a 12-session preventive parent training (PT) program offered at their child’s daycare center. Eight centers were matched and randomized to an experimental condition in which parents received a discount on their childcare bill (M = $8.92 per session attended) or a control group with no financial incentive. Participants (n = 174) consisted mostly of African American (55%) or Latino (42%) mothers, 62% reporting annual household incomes less than $20,000. Parents in the discount condition were 15.4% more likely to enroll than control parents, though this difference was not significant. There were no differences in PT attendance, parents’ motivations for enrolling, or the degree to which parents were actively engaged in PT sessions by condition. Despite the added cost of the discounts, there was no difference in group costs by condition. Parent interviews revealed important challenges in implementing financial incentive programs in community-based agencies serving low-income families. Cost simulations show how low parent enrollment or low attendance negatively affect the economic efficiency of group-based PT. Implications for policies guiding financial incentive programs targeting low-income families and their participation in prevention programs are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Achenbach, T., & Rescorla, L. (2000). Manual for the ASEBA forms and profiles. Burlington, VT: University of Vermont.

    Google Scholar 

  • Baker, C. N., Arnold, D. H., & Meagher, S. (2011). Enrollment and attendance in a parent training prevention program for conduct problems. Prevention Science, 12(2), 126–138.

    Article  PubMed  Google Scholar 

  • Barth, J., & Green, J. (2007). Encouraging healthy behaviors in Medicaid: Early lessons from Florida and Idaho. Hamilton, NJ: Center for Health Care Strategies, Inc.

    Google Scholar 

  • Breitenstein, S., Fogg, L., Garvey, C., Resnick, B., Hill, C., & Gross, D. (2010). Measuring implementation fidelity in a community-based parenting intervention. Nursing Research, 59, 158–165.

    Article  PubMed  Google Scholar 

  • Breitenstein, S. M., Gross, D., Ordaz, I., Julion, W., Garvey, C., & Ridge, A. (2007). Promoting mental health in early childhood programs serving families from low-income neighborhoods. Journal of the American Psychiatric Nurses Association, 13(5), 313–320.

    Article  Google Scholar 

  • Briesmeister, J. M., & Schaefer, C. E. (2007). Handbook of parent training: Helping parents prevent and solve problem behaviors (3rd ed.). Hoboken, NJ: Wiley.

  • Brown, D. S., Finkelstein, E. A., Brown, D. R., Buchner, D. M., & Johnson, F. R. (2009). Estimating older adults’ preferences for walking programs via conjoint analysis. American Journal of Preventive Medicine, 36, 201–207.

    Article  PubMed  Google Scholar 

  • Coatsworth, J. D., Duncan, L. G., Pantin, H., & Szapocznik, J. (2006). Patterns of retention in a preventive intervention with ethnic minority families. Journal of Primary Prevention, 27(2), 171–193.

    Article  PubMed  Google Scholar 

  • De Janvry, A., & Sadoulet, E. (2006). Making conditional cash transfer programs more efficient: Designing for maximum effect of the conditionality. World Bank Economic Review, 20, 1–29.

    Article  Google Scholar 

  • Deci, E. L., Koestner, R., & Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 125(6), 627–668.

    Article  PubMed  CAS  Google Scholar 

  • DeFulio, A., & Silverman, K. (2011). Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: Post-intervention outcomes. Addiction, 106, 960–967.

    Article  PubMed  Google Scholar 

  • Dodge, K. A. (2009). Community intervention and public policy in the prevention of antisocial behavior. Journal of Child Psychology and Psychiatry, 50, 194–200.

    Article  PubMed  Google Scholar 

  • Drummond, M. F., Sculpher, M. J., Torrance, G. W., O’Brient, B. J., & Stoddart, G. L. (2005). Critical assessment of economic evaluation. Methods for economic evaluation of health care programmes (3rd ed., pp. 27–53). Oxford, UK: Oxford University Press.

    Google Scholar 

  • Dumas, J. E., Begle, A. M., French, B., & Pearl, A. (2010). Effects of monetary incentives on engagement in the PACE parenting program. Journal of Clinical Child & Adolescent Psychology, 39, 302–313.

    Article  Google Scholar 

  • Epstein, L. H., Salvy, S. J., Carr, K. A., Dearing, K. K., & Bickel, W. K. (2010). Food reinforcement, delay discounting and obesity. Physiology & Behavior, 100, 438–445.

    Article  CAS  Google Scholar 

  • Fernald, L. C., Gertler, P. J., & Neufeld, L. M. (2008). Role of cash in conditional cash transfer programmes for child health, growth, and development: An analysis of Mexico’s Oportunidades. Lancet, 371(9615), 828–837.

    Article  PubMed  Google Scholar 

  • Fiszbein, A., Schady, N., Ferreira, F., Grosh, M., Kelleher, N., Olinto, P., et al. (2009). Conditional cash transfers: Reducing present and future poverty. Washington, DC: World Bank.

    Google Scholar 

  • Garvey, C., Julion, W., Fogg, L., Kratovil, A., & Gross, D. (2006). Measuring participation in a prevention trial with parents of young children. Research in Nursing and Health, 29(3), 212–222.

    Article  PubMed  Google Scholar 

  • Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18, 377–386.

    Article  Google Scholar 

  • Gross, D., Fogg, L., Young, M., Ridge, A., Cowell, J., Sivan, A., et al. (2007a). Reliability and validity of the Eyberg child behavior inventory with African-American and Latino parents of young children. Research in Nursing and Health, 30(2), 213–233.

    Article  PubMed  Google Scholar 

  • Gross, D., Garvey, C., Julion, W. A., & Fogg, L. (2007b). Preventive parent training with low-income, ethnic minority families of preschoolers. In J. M. Briesmeister & C. E. Schaefer (Eds.), Handbook of parent training: Helping parents prevent and solve problem behaviors (3rd ed., pp. 5–24). New York, NY: Wiley.

    Google Scholar 

  • Gross, D., Garvey, C., Julion, W., Fogg, L., Tucker, S., & Mokros, H. (2009). Efficacy of the Chicago Parent Program with low-income African American and Latino parents of young children. Prevention Science, 10(1), 54–65.

    Article  PubMed  Google Scholar 

  • Gross, D., Julion, W., & Fogg, L. (2001). What motivates participation and dropout among low-income urban families of color in a prevention intervention? Family Relations, 50(3), 246–254.

    Article  Google Scholar 

  • Gross, D., Young, M., Fogg, L., Ridge, A., Cowell, J., Richardson, R., et al. (2006). The equivalence of the child behavior checklist/1–1/2–5 across parent race/ethnicity, income level, and language. Psychological Assessment, 18, 313–323.

    Article  PubMed  Google Scholar 

  • Guyll, M., Spoth, R., & Redmond, C. (2003). The effects of incentives and research requirements on participation rates for a community-based preventive intervention research study. Journal of Primary Prevention, 24(1), 25–41.

    Article  Google Scholar 

  • Heinrichs, N. (2006). The effects of two different incentives on recruitment rates of families into a prevention program. Journal of Primary Prevention, 27, 345–365.

    Article  PubMed  Google Scholar 

  • Heinrichs, N., Bertram, H., Kuschel, A., & Hahlweg, K. (2005). Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: Barriers to research and program participation. Prevention Science, 6, 275–286.

    Article  PubMed  Google Scholar 

  • Hosseini, H. (2003). The arrival of behavioral economics: From Michigan, or the Carnegie School in the 1950s and the early 1960s. Journal of Socio-Economics, 32(4), 391–409.

    Article  Google Scholar 

  • Kane, R. L., Johnson, P. E., & Town, R. J. (2004a). Economic incentives for preventive care No. AHRQ Publication No. 04–E024-2). Rockville, MD: Agency for Health Care Research and Quality.

    Google Scholar 

  • Kane, R. L., Johnson, P. E., Town, R. J., & Butler, M. (2004b). A structured review of the effect of economic incentives on consumers’ preventive behavior. American Journal of Preventive Medicine, 27, 327–352.

    Article  PubMed  Google Scholar 

  • Knudsen, E. I., Heckman, J. J., Cameron, J. L., & Shonkoff, J. P. (2006). Economic, neurobiological, and behavioral perspectives on building America’s future workforce. Proceedings of the National Academy of Sciences of the United States of America, 103(27), 10155–10162.

    Article  PubMed  CAS  Google Scholar 

  • Lippman, L., Vandivere, S., Keith, J., & Atienza, A. (2008). Child care use by low-income families: Variations across states (Research Brief No. 2008–23). Washington, DC: Child Trends.

    Google Scholar 

  • Long, J. A., Helweg-Larsen, M., & Volpp, K. G. (2008). Patient options regarding ‘pay for performance for patients’. Journal of General Internal Medicine, 23, 1647–1652.

    Article  PubMed  Google Scholar 

  • Murray, D. M. (1998). Design and analysis of group randomized trials. New York, NY: Oxford University Press.

    Google Scholar 

  • Nock, M. K., & Ferriter, C. (2005). Parent management of attendance and adherence in child and adolescent therapy: A conceptual and empirical review. Clinical Child and Family Psychology Review, 8(2), 149–166.

    Article  PubMed  Google Scholar 

  • Ozer, E. J., Fernald, L. C. H., Manley, J. G., & Gertler, P. J. (2009). Effect of a conditional cash transfer program on children’s behavior problems. Pediatrics, 123, e630–e637.

    Article  PubMed  Google Scholar 

  • Pearl, E. S. (2009). Parent management training for reducing oppositional and aggressive behavior in preschoolers. Aggression and Violent Behavior, 14, 295–305.

    Article  Google Scholar 

  • Petry, N. M., Tedford, J., Austin, M., Nich, C., Carroll, K. M., & Rounsaville, B. J. (2004). Prize reinforcement contingency management for treating cocaine users: How low can we go, and with whom? Addiction, 99, 349–360.

    Article  PubMed  Google Scholar 

  • Riccio, J., Dechausay, N., Greenberg, D., Miller, C., Rucks, Z., & Verma, N. (2010). Toward reduced poverty across generations: Early findings from New York City’s conditional cash transfer program. Retrieved from http://www.mdrc.org/.

  • Ridge, A. C. (2010). Developing a model for cost-effective dissemination of an evidence-based parenting program. Unpublished doctoral dissertation, Rush University, Chicago, IL.

  • Ripley, A. (2010, April). Is cash the answer? Time Magazine, pp 40–47.

  • Roll, J. M., Reilly, M. P., & Johanson, C. E. (2000). The influence of exchange delays on cigarette versus money choice: A laboratory analog of voucher-based reinforcement therapy. Experimental and Clinical Psychopharmacology, 8, 366–370.

    Article  PubMed  CAS  Google Scholar 

  • Safeer, R. (2008). The role of incentives in the improvement of health. Disease Management, 11, 65–67.

    Article  PubMed  Google Scholar 

  • Silverman, K., Chutuape, M. A., Bigelow, G. E., & Stitzer, M. L. (1999). Voucher-based reinforcement of cocaine abstinence in treatment-resistant methadone patients: Effects of reinforcement magnitude. Psychopharmacology, 146, 128–138.

    Article  PubMed  CAS  Google Scholar 

  • Skinner, B. F. (1953). Science and human behavior. New York, NY: Macmillan.

    Google Scholar 

  • Small, M. L., Jacobs, E. M., & Massengill, R. P. (2008). Why organizational ties matter for neighborhood effects: Resource access through childcare centers. Social Forces, 87, 387–414.

    Article  Google Scholar 

  • Spoth, R., & Redmond, C. (2000). Research on family engagement in preventive interventions: Toward improved use of scientific findings in primary prevention practice. Journal of Primary Prevention, 21(1), 267–284.

    Article  Google Scholar 

  • Sutherland, K., Christianson, J. B., & Leatherman, S. (2008). Impact of targeted financial incentives on personal health behavior: A review of the literature. Medical Care Research and Review, 65(6), 36S–78S.

    Article  PubMed  Google Scholar 

  • Varian, H. R. (1996). Intermediate microeconomics: A modern approach (4th ed.). New York, NY: W.W. Norton & Company.

    Google Scholar 

  • Volpp, K. G., Asch, D. A., Galvin, R., & Loewenstein, G. (2011). Redesigning employee health incentives–lessons from behavioral economics. New England Journal of Medicine, 365(5), 388–390.

    Article  PubMed  CAS  Google Scholar 

  • Volpp, K. G., John, L. K., Troxel, A. G., Norton, L., Fassbender, J., & Loewenstein, G. (2008). Financial incentive-based approaches for weight loss: A randomized trial. Journal of the American Medical Association, 300(22), 2631–2637.

    Article  PubMed  CAS  Google Scholar 

  • Winslow, E. B., Bonds, B., Wolchik, S., Sander, I., & Braver, S. (2009). Predictors of enrollment and retention in a preventive parenting intervention for divorced families. Journal of Primary Prevention, 30(2), 151–172.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from the National Institute for Nursing Research, R01 NR004085.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Deborah Gross.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gross, D., Johnson, T., Ridge, A. et al. Cost-Effectiveness of Childcare Discounts on Parent Participation in Preventive Parent Training in Low-Income Communities. J Primary Prevent 32, 283–298 (2011). https://doi.org/10.1007/s10935-011-0255-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10935-011-0255-7

Keywords

Navigation