Assessing the Costs of Home Visiting Programs Designed to Prevent Child Maltreatment

Home visiting programs offer a promising method for delivering support services to at-risk families and children, and preventing child maltreatment. Although estimates of the costs of implementing some home visiting program models are available, comparing them is difficult because the types of costs included, the time period covered, and the methods for estimating costs per family vary. This study adopted a consistent method to analyze costs among 25 agencies that implemented one of five home visiting program models: (1) Healthy Families America (HFA), (2) the Nurse Family Partnership (NFP), (3) Parents as Teachers (PAT), (4) SafeCare, and (5) the Positive Parenting Program (Triple P). The agencies were participants in the Supporting Evidence-Based Home Visiting to Prevent Child Maltreatment (EBHV) initiative funded by the Children’s Bureau in the Administration for Children and Families at the U.S. Department of Health and Human Services.

The cost study aimed to provide estimates of the overall costs to implementing agencies of providing home visiting services during a 1-year period of steady-state operation (July 2011—June 2012), the proportion of costs allocated to specific program activities, and costs per participating family. Analyses relied on three types of data collected from implementing agencies:

 

1. Aggregate cost data. Retrospective data on expenditures and resources used for program operations were collected through a spreadsheet-based survey and follow-up discussions with agency staff from December 2012 through March 2013. The survey gathered information on program inputs including personnel, facilities, equipment, supplies and materials, travel, contracted services, and overhead.
2. Staff time use data. Program staff and researchers      participating in a cross-site process evaluation identified and developed definitions of activities comprising home visiting programs. To help develop estimates of the allocation of costs among program activities, we surveyed program staff regarding the number of hours they spent on each    activity in a typical week.  A web-based survey of program staff was conducted in spring 2012, during the cost analysis period.

1. Home visiting service data. For the EBHV cross-site evaluation, agencies reported data prospectively from October  2009 through June 2012 on services provided, including the number families  served, the number of home visits delivered to each family, and the dates of program entry and exit for each family. Thus, data collection on      program outputs conducted for a process evaluation also supported development of estimates of costs per family.

 Analyses include calculation of average cost allocations and costs per participant across all agencies and comparisons of costs among subgroups defined by such agency features as home visiting program model, geographic location, and type of organization implementing the program. Study results will be available in early 2014, prior to the SPR Annual Conference.