Effective and Efficient Early Childhood Home Visiting Intervention: Benefit-Cost Analysis of Promoting First Relationships

Introduction: High-quality economic evaluation of evidence-based interventions can promote investments that improve children’s lives and generate favorable returns to society. This presentation shares a benefit-cost analysis of Promoting First Relationships (PFR), a 10-week home visiting intervention for families of infants and toddlers at increased risk of child welfare system (CWS) involvement and removal from the home. In contrast to more resource-intensive approaches, PFR assumes that brief attachment-based intervention at a time of heightened family need can have an enduring impact on the emotional bond between parents and children, improve developmental outcomes, and reduce CWS involvement. Results from the Supporting Parents Project, a randomized trial with 247 parents and their 10-24 month old children, showed significant improvements in social-emotional outcomes and reductions in out-of-home placements in PFR compared to control families. Effects were sustained for 18-months post-intervention, the latest funded follow-up. This presentation highlights the costs and long-term economic benefits of this effective intervention.

Methods: We used the Ingredients Method to estimate the average cost per family of delivering PFR in comparison to the alternative resource and referral intervention offered controls. We disaggregated costs by intervention component (e.g., training, intervention delivery, ongoing support) and major ingredient (e.g., labor, materials and supplies, overhead) to illuminate costs and support adequate budgeting. We estimated economic benefits expected to flow over target children’s lifetimes from reductions in out-of-home placements and associated improvement in child abuse and neglect. We compared benefits to costs to see if the intervention was cost-beneficial.

Results: PFR cost $1,765 per family, $1,701 per family more than the control intervention (all values in discounted 2014 dollars). Major cost drivers were intervention delivery (79% of total costs), with training and support comprising the remaining 21%. Among key ingredients personnel was the major cost driver (72%). PFR was projected to generate $8,938 in long-term benefits per family due to reductions in child welfare system involvement, exceeding costs by $7,230 and returning $5.23 per dollar invested. Cumulative benefits were expected to exceed costs by the time target children were age 6 and be cash positive thereafter. Sensitivity analyses including presumed improvements in child abuse and neglect indicated additional benefits of $14,681 per family, increasing returns to $13.83 per dollar invested.

Conclusions: PFR is a cost-beneficial home visiting intervention that improves children’s wellbeing and generates substantial economic returns to society.