Abstract
High-quality evidence about the costs of effective interventions for children can provide a foundation for fiscally responsible policy capable of achieving impact. This study estimated the costs to society of the Family Check-up, an evidence-based brief home-visiting intervention for high-risk families implemented in the Early Steps multisite efficacy trial. Intervention arm families in three sites were offered 4 consecutive years of intervention, when target children were ages 2 through 5. Data for estimating total, average, and marginal costs and family burden (means and standard deviations, 2015 USD, discounted at 3% per year) came from a detailed database that prospectively documented resource use at the family level and a supplemental interview with trial leaders. Secondary analyses evaluated differences in costs among higher and lower risk families using repeated measures analysis of variance. Results indicated annual average costs of $1066 per family (SD = $400), with time spent by families valued at an additional $84 (SD = $99) on average. Costs declined significantly from ages 2 through 5. Once training and oversight patterns were established, additional families could be served at half the cost, $501 (SD = $404). On the margin, higher risk families cost more, $583 (SD = $444) compared to $463 (SD = $380) for lower risk families, but prior analyses showed they also benefited more. Sensitivity analyses indicated potential for wage-related cost savings in real-world implementation compared to the university-based trial. This study illustrates the dynamics of Family Check-up resource use over time and across families differing in risk.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ASEBA School-Age Forms & Profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.
Brennan, L. M., Shelleby, E. C., Shaw, D. S., Gardner, F., Dishion, T. J., & Wilson, M. (2013). Indirect effects of the family check-up on school-age academic achievement through improvements in parenting in early childhood. Journal of Educational Psychology, 105, 762–773.
Bureau of Labor Statistics (2015). Occupational Employment Statistics. Retrieved January 15, 2017 from: https://www.bls.gov/oes/2015/may/oes_research_estimates.htm.
Bureau of Labor Statistics (2016). CPI detailed report: Data for September, 2016, Table A, All items, Unadjusted 12 months ended September 2016. Retrieved October 1, 2017 from: https://www.bls.gov/cpi/detailed-report.htm.
Crowley, D. M., Dodge, K. A., Barnett, W. S., Corso, P., Duffy, S., Graham, P., . . . Plotnick, R. (2018). Standards of evidence for conducting and reporting economic evaluations in prevention science. Prevention Science, 19, 366–390.
Dishion, T. J., & Stormshak, E. A. (2007). Intervening in children's lives: An ecological, family-centered approach to mental health care. Washington, DC: American Psychological Association.
Dishion, T. J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The Family Check-Up with high-risk indigent families: Preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Development, 79, 1395–1414.
Dishion, T. J., Stormshak, E. A., & Kavanagh, K. A. (2011). Everyday Parenting: A therapist’s guide for supporting family management practices. Champaign: Research Press.
Dishion, T. J., Brennan, L. M., Shaw, D. S., McEachern, A. D., Wilson, M. N., & Jo, B. (2014). Prevention of problem behavior through annual family check-ups in early childhood: Intervention effects from home to early elementary school. Journal of Abnormal Child Psychology, 42, 343–354.
Dishion, T. J., Mun, C. J., Drake, E. C., Tein, J.-Y., Shaw, D. S., & Wilson, M. (2015). A transactional approach to preventing early childhood neglect: The Family Check-Up as a public health strategy. Development and Psychopathology, 27, 1647–1660.
Foster, E. M., Porter, M. M., Ayers, T. S., Kaplan, D. L., & Sandler, I. (2007). Estimating the costs of preventive interventions. Evaluation Review, 31, 261–286.
Frey, A. J., Kuklinski, M. R., Bills, K., Small, J. W., Forness, S. R., Walker, H. M., … Seeley, J. R. (2019). Comprehensive cost analysis of First Step Next for preschoolers with disruptive behavior disorder: Using real-world intervention data to estimate costs at scale. Prevention Science, 20, 1219–1232.
Gill, A. M., Dishion, T. J., & Shaw, D. S. (2014). The Family Check-Up: A tailored approach to intervention with high-risk families. In S. H. Landry & C. L. Cooper (Eds.), Wellbeing: A complete reference guide. Volume 1: Wellbeing in children and families (pp. 385–406). Sussex: John Wiley and Sons.
Haskins, R., & Margolis, G. (2015). Show me the evidence: Obama's fight for rigor and evidence in social policy. Washington, DC: Brookings.
Health Resources & Services Administration (2017). Maternal, Infant, and Early Childhood Home Visiting Program: Implementation - estimated costs, average cost per family. Retrieved October 9, 2017 from: https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview.
Jennings, E. T., Jr., & Hall, J. L. (2011). Evidence-based practice and the use of information in state agency decision making. Journal of Public Administration Research and Theory, 22, 245–266.
Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M., & Anderson, L. (2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-04-1201). Olympia: Washington State Institute for Public Policy.
Levin, H. M., & McEwan, P. J. (2001). Cost-effectiveness analysis: Methods and applications. Thousand Oaks: Sage.
Lunkenheimer, E. S., Dishion, T. J., Shaw, D. S., Connell, A. M., Gardner, F., Wilson, M. N., & Skuban, E. M. (2008). Collateral benefits of the Family Check-Up on early childhood school readiness: Indirect effects of parents' positive behavior support. Developmental Psychology, 44, 1737–1752.
McEachern, A. D., Fosco, G. M., Dishion, T. J., Shaw, D. S., Wilson, M. N., & Gardner, F. (2013). Collateral benefits of the Family Check-Up in early childhood: Primary caregivers' social support and relationship satisfaction. Journal of Family Psychology, 27, 271–281.
National Academies of Sciences, Engineering, and Medicine. (2016). Advancing the power of economic evidence to inform investments in children, youth, and families. Washington, DC: The National Academies Press.
Pelham, W. E., III, Dishion, T. J., Tein, J.-Y., Shaw, D. S., & Wilson, M. N. (2017). What doesn’t work for whom? Predicting responsiveness to the Family Check-Up in early childhood using a mixture model approach. Prevention Science, 18, 911–922.
Pew Center on the States. (2012). Results First. Washington, DC: Pew Center on the States. Retrieved January 24, 2013 from: http://www.pewstates.org/projects/results-first-328069.
Shaw, D. S., Dishion, T. J., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-year effects of the Family Check-Up in early childhood. Journal of Consulting and Clinical Psychology, 74, 1–9.
Shaw, D. S., Connell, A., Dishion, T. J., Wilson, M. N., & Gardner, F. (2009). Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Development and Psychopathology, 21, 417–439.
Shaw, D. S., Sitnick, S. L., Brennan, L. M., Choe, D. E., Dishion, T. J., Wilson, M. N., & Gardner, F. (2016). The long-term effectiveness of the Family Check-Up on school-age conduct problems: Moderation by neighborhood deprivation. Development and Psychopathology, 28, 1471–1486.
United States Preventive Services Task Force (2017). USPSTF A and B recommendations. Retrieved May 14, 2017 from: https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/.
White, D., & VanLandingham, G. (2015). Benefit-cost analysis in the states: Status, impact, and challenges. Journal of Benefit-Cost Analysis, 6, 369–399.
Acknowledgments
We dedicate this study to Tom Dishion, without whose support it would not have been possible. His intellectual curiosity and fortitude continue to inspire. We are also grateful to the Early Steps staff and families who participated in this study.
Funding
This research was supported by National Institute on Drug Abuse (NIDA) grant number DA036832 to authors Dishion, Shaw, and Wilson. Additional support was provided by grants from NIDA (DA039772) and the National Institute on Alcohol Abuse and Alcoholism (AA026768). This paper’s content is solely the authors’ responsibility and does not necessarily represent official views of study funders, who played no role in the study design; data collection, analysis and interpretation; writing of the report; or decision to submit the article for publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Ethical Approval
All research protocols involving human participants were approved by the institutional review board of the University of Pittsburgh and with the 1964 Helsinki declaration and its later amendments.
Informed Consent
Informed consent was obtained from all participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kuklinski, M.R., Crowley, D.M., Dishion, T.J. et al. Supporting Strategic Investment in Social Programs: a Cost Analysis of the Family Check-Up. Prev Sci 21, 256–267 (2020). https://doi.org/10.1007/s11121-019-01077-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-019-01077-3