Dynamic Cost Analysis of the Family Check-up: Maximizing Utility and Driving the Development of Cost-Efficient Interventions

Introduction: The rise of tailored interventions in a number of policy and practice environments requires thoughtful and detailed cost analyses that model the dynamics of resource flow across time at the individual level. The Family Check-up (FCU) is a family-oriented intervention that strengthens relationships between parents and children and addresses child and adolescent adjustment problems in a manner that is brief, timely, and adapted to the specific needs of each child and family. It has demonstrated significant reductions in substance abuse, delinquent behavior and developmental psychopathology in multiple randomized controlled trials (RCT) with indicated populations in diverse service settings. Based on this evidence, it is eligible for federal funding under the Maternal and Child Home Visiting Program. This presentation focuses on a cost analysis of the FCU as implemented in the Early Steps RCT involving 731 WIC-eligible families with children between the ages of 2 and 5 at three sites. Uniquely detailed data capturing variation in resources allocated to intervention families allows us to estimate the cost of high quality implementation in total and across families, time, different intervention sites, and key intervention components.

Method: We use the Ingredients and Cost-Procedures-Processes-Outcomes Methods to estimate the total, average, and marginal cost of the FCU as well as the variation in costs per family and across sites. We present costs (resource amount x unit price) of key ingredients (labor, supplies, travel) for major intervention components (training, intervention, ongoing support and technical assistance) at each age (2 through 5). Estimates utilize detailed records documenting all contact with individual families throughout the intervention, as well as interviews with key project staff. Records show time spent on key intervention subcomponents (family intervention meetings, preparation, travel, failed appointments) and the burden of the intervention on families. Unit prices are from publicly available, high quality sources (e.g., labor costs form the Bureau of Labor Statistics, supplies costs from national supply chains).

Results: Preliminary estimates indicate a total FCU intervention cost of $621,045 in constant 2015 dollars for 4 years of intervention with 367 FCU intervention families (SD across sites = $40,168), average cost of $1,692/family (SD = $64) and marginal cost of $759/family (SD = $85) for 4 years. Cost allocation: 13% training, 52% intervention, 24% ongoing intervention support, 10% travel, 1% failed appointments.

Conclusion: Identification of total and key drivers of cost has high utility for potential investors and other stakeholders and can be used to develop a more cost-efficient FCU.