Using Condition Cash Transfer Programs for Raising Parent Participation Rates in Parent Training in Underserved Communities

Introduction: To boost participation rates in parent training (PT) interventions, prevention researchers typically pay participants cash incentives for enrolling, attending, or completing assessments.  Cash incentives help meet recruitment targets and maintain statistical power.  But they diminish external validity when under-resourced agencies cannot offer the same incentives for attaining comparable parent participation and adherence rates. We examine the feasibility, acceptability, sustainability, and impact of a conditional cash transfer (CCT) program for raising parent participation rates in a 12-session PT program, the Chicago Parent Program, offered in low-income Baltimore City schools.  CCT programs use a behavioral economics model and provide cash incentives conditioned on completing a set of desired activities. CCT programs have been used in over 30 low resource countries and shown to improve a range of child health outcomes.

Method: Parents of pre-kindergarten (preK) children in 8 high-need Baltimore City Public Schools (>92% low-income; 96% African American or Latino) were given a bank issued debit card and offered up to $230 to participate in PT at their child’s school; $15 for each 2 hour session attended and $5 for each weekly practice assignment submitted. Group leaders submitted weekly attendance and practice assignment completion records electronically within 24 hours of PT sessions; incentives were loaded onto parents’ debit cards within 48 hours of PT session. Data were collected on attendance, practice assignment completion, quality of parent engagement in PT sessions, parents’ motivations for enrolling in PT, importance of cash incentives on their decision to enroll and attend PT, and how cash incentives were used.

Results:  To date, 138 preK parents in 7 schools have enrolled (51% unemployed; 77% unmarried).  Across PT groups, 91% of groups enrolled > 12 parents and 83% of those parents attended at least one PT session (M attendance= 63% of sessions).  45% of practice assignments were submitted: a four-fold increase over rates without incentives.  58% of parents reported that the debit cards influenced their decision to enroll and 29% reported it made a “big” difference on attendance.  Parent engagement quality during PT sessions was high and comparable to results obtained when no incentive provided.  Parents used debit cards for food, clothing, gas, school supplies, medicine, and other basic necessities.

Conclusion:  CCT programs are feasible, acceptable, and useful for improving PT participation rates in underserved communities.  Features of high impact CCT programs and efforts for sustaining CCT programs in schools will be described.