Enhancing Adoptive Parenting: A Cost-Effectiveness Analysis

Abstract

Background: Children adopted from care often exhibit behavioural difficulties. There is however limited cost‐effectiveness evidence regarding different interventions to address this. This paper reports a cost‐effectiveness analysis of parenting programmes for these children. Method: Adoptive parents of children aged between 3 and 8 years participated in home‐based, manualised, parenting programmes delivered by trained family social workers. The adopters were randomly allocated to one of two interventions (n = 19) or to a ‘services as usual’ control group (n = 18). Baseline, immediate post‐intervention and 6‐month follow‐ups were assessed by questionnaires and adopter interviews. Economic costs were calculated. Results: At 6‐month follow‐up, a significant difference (p < .007) was found for ‘satisfaction with parenting’ in favour of the intervention group. No significant differences were found on child measures between the combined intervention groups and control group, adjusting for baseline scores. The mean costs for the combined intervention group were £1528 higher than for the control group at the post‐intervention point, which was statistically significant (95% CI, £67 to £2782). However, over the entire follow‐up period the difference (£1652) was not statistically significant (−£1709 to £4268). The cost‐effectiveness analysis showed that costs of £731 would be incurred to achieve a point improvement in satisfaction with parenting compared to routine care by the end of treatment, whilst the figure was £337 for a point improvement by the 6‐month follow‐up. Conclusions: Findings suggest that a home‐based parenting programme for adopters caring for difficult children in the first 18 months of placement may be cost‐effective in enhancing satisfaction with parenting, but not in reducing child behavioural problems, compared with ‘services‐as‐usual’.

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

“…Age In the RCT-based evaluations, one study 615 included preschool children in foster care aged between 3 and 5 years, one study 615 included children who had been adopted between the ages of 3 and 8 years, 613 and two studies 198,614 included a broader age range: the first study 198 involved maltreated children between 1 and 16 years and the second study 614 used a sexual abuse sample of children aged between 6 and 14 years. In the cohort study, 616 no age range was reported, just the mean of the groups, which was 8.9 years in one group and 5.4 years in the other.…”

“…The method of economic evaluation was a cost-effectiveness analysis in two studies 613,615 (effects measured on disease-specific scales), a cost-utility analysis in a third study 612 [effects measured using a generic quality-of-life scale capable of generating quality-adjusted life-years (QALYs)] and the remaining three studies 198,614,616 are most accurately described as cost-consequences analyses (costs and outcomes presented separately and not formally combined).…”

“…Gender Four 198,613,615,616 of the five trial-based studies included both girls and boys, with an average of 49% being girls (range 43-54%). The exception focused on an intervention that was specifically for girls who had been victims of sexual abuse.…”

“…In total we identified six studies 198,[612][613][614][615][616] assessing the cost-effectiveness of relevant psychosocial interventions for maltreated children: five studies 198,[613][614][615][616] were carried out using data from a trial and one study 612 used a decision-analytic model. Of the five trial-based studies, 198,[613][614][615][616] data were from four RCTs 198,[613][614][615] and one cohort study.…”

“…Of the five trial-based studies, 198,[613][614][615][616] data were from four RCTs 198,[613][614][615] and one cohort study. 616 All six studies 198,[612][613][614][615][616] were published in English and were carried out in the USA 198,615,616 (n = 3), the UK 613,614 (n = 2) and Australia 612 (n = 1). The basic characteristics of the six included studies 198,[612][613][614][615][616] are presented in Table 8, and more detailed descriptions are presented in Chapter 4.…”