Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes

Dalziel, Kim; Segal, Leonie

doi:10.1136/archdischild-2011-300795

Cited by 41 publications

(46 citation statements)

References 55 publications

(16 reference statements)

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“…Three economic evaluation techniques suitable for priority setting are: CEA, outcomes are expressed in ‘natural units’ (e.g. case of child maltreatment prevented; Dalziel and Segal, ); cost‐utility analysis (CUA), outcomes are expressed in quality‐adjusted life years (QALYs) (Drummond et al , ); and cost‐benefit analysis (CBA), outcomes are expressed in dollars (Aos et al , ). The methods differ simply in the choice of outcome metric.…”

Section: Priority Setting In Child Protectionmentioning

confidence: 99%

“…If the objective is a reduction in child abuse and neglect, then adopting cost per case of child abuse or neglect avoided is the most powerful way of expressing performance. This is the approach we have taken in a recent economic evaluation of 35 neonate/infant home‐visiting programmes drawing on the published controlled trial literature (Dalziel and Segal, ). The included home‐visiting studies either directly reported child maltreatment outcomes (n = 27) or reported closely related outcomes such as injury or hospitalisation which were translated into maltreatment using published relationships (n = 8).…”

Section: Priority Setting In Child Protectionmentioning

confidence: 99%

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Investing to Protect Our Children: Using Economics to Derive an Evidence‐based Strategy

Segal

Dalziel

2011

Child Abuse Review

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Child abuse and neglect are global problems that affect over 25 per cent of children and have serious health, social and economic consequences. Government and other agencies are heavily committed to the provision of services to address the consequences of abuse and neglect. In a climate of scarce resources, there is increasing interest in developing costeffective strategies to prevent child maltreatment. Economic evaluation in the context of formal 'priority setting' can contribute to the development of an efficient child protection strategy and at the same time develop the arguments to support an increased investment in the prevention of child maltreatment. Key challenges arise from incompleteness of the evidence base of effective interventions and the considerable complexity of the cross-portfolio effects. The latter has resulted in the widespread failure to capture the full range of impacts, most notably intergenerational effects, quality of life and mortality. This means the benefits of investing in effective preventive strategies to address child maltreatment will be underestimated and too few resources allocated to this important task. Adoption of the proposed priority-setting framework and translation into action are likely to reduce child maltreatment and associated harms for children at risk now and in the future.

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Section: Priority Setting In Child Protectionmentioning

confidence: 99%

Section: Priority Setting In Child Protectionmentioning

confidence: 99%

Investing to Protect Our Children: Using Economics to Derive an Evidence‐based Strategy

Segal

Dalziel

2011

Child Abuse Review

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“…Child maltreatment is known to be associated with significant social and economic consequences, so it is therefore not surprising that a programme that is successful with a very high‐risk population would be cost saving. The value of investing in very high‐risk populations, such as the opioid‐dependent parents in this PuP trial, is consistent with a recent cost‐effectiveness analysis of infant home visiting programmes by Dalziel and Segal (). This study found that the most cost‐effective programmes were generally in the highest‐risk populations.…”

Section: Discussionmentioning

confidence: 99%

“…A recent economic evaluation of 33 home visiting programmes reported on five programmes that targeted very high/extreme‐risk mothers (current abuse/illicit drug use) of infants (less than 2 years of age). Three of these programmes were identified as either cost saving or highly cost‐effective against societal norms, while two performed poorly (Dalziel and Segal, ). The most cost‐effective of the 33 programmes typically used professional home visitors in a multidisciplinary team, targeted higher‐risk populations and included more than just home visiting.…”

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confidence: 99%

Cost‐Effectiveness Analysis of the Parents under Pressure Programme for Methadone‐Maintained Parents

et al. 2015

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Children living in families with parental substance abuse are at high risk of child maltreatment and associated adverse outcomes. A trial of methadone‐maintained parents randomised to the Parents under Pressure (PuP) parenting programme reported significant improvements in family functioning relative to standard care or a brief intervention, as indicated by a reduction in scores on the Child Abuse Potential Inventory. We sought to determine the cost‐effectiveness of the PuP programme to inform policy and programme implementation. The cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment and sensitivity analyses were conducted. Compared to usual care, the PuP programme costs an additional AU$8777 (£4880) per family to deliver. Assuming the most conservative estimate of one in five cases of maltreatment prevented, a cost‐effectiveness estimate of AU$43 975 (£24 451) per case of potential maltreatment prevented for the PuP group was obtained. This is significantly less than the estimated mean lifetime cost of a case of child maltreatment of AU$200 000 (2013 present value) (£110 000). For 100 families in this population treated with PuP, there would be a net present value saving of an estimated AU$3.1 million (£1.7 million). Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages The PuP programme is a cost‐effective and likely cost‐saving means of preventing maltreatment in opioid‐dependent parents in receipt of methadone maintenance. These data suggest that investment in intensive home‐based parenting programmes addressing multiple domains in very high‐risk families, including substance‐misusing parents, may result in both improvements in clinical outcomes and considerable net cost savings. Even though intensive programmes may seem more expensive, because the costs of maltreatment are so substantial, the cost of doing nothing or minimally intervening is likely to be more costly for society.

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“…While child physical abuse and neglect have a number of well tested strategies directed towards prevention (Appleyard, Berlin, Rosanbalm, & Dodge, 2011;Dalziel & Segal, 2012;Dubowitz, Lane, Semiatin, Magder, Venepally, & Jans, 2011;Mikton & Butchart, 2009;Moyer, 2013;Nelson & Caplan, 2014;Prinz, Sanders, Shapiro, Whitaker, & Lutzker, 2009;Scribano, 2010;Shapiro, Prinz, & Sanders, 2010), no strategies have been demonstrated to decrease the risk of CSA (Zollner, Fuchs, & Fegert, 2014). Currently, most CSA prevention efforts are embedded in the justice system (Finkelhor, 2009) and are intended to reduce perpetrator recidivism.…”

Section: Introductionmentioning

confidence: 96%

Community Characteristics Associated With Seeking Medical Evaluation for Suspected Child Sexual Abuse in Greater Houston

et al. 2016

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Child sexual abuse (CSA) affects over 62,000 children annually in the United States. A primary obstacle to the success of a public health prevention strategy is the lack of knowledge around community level risk factors for CSA. We evaluated community level characteristics for children seeking care for suspected CSA in the Greater Houston area for 2009. There was a total incidence rate of medical evaluations for suspected CSA of 5.9/1000 children. We abstracted the medical charts of 1982 (86 %) children who sought a medical evaluation for suspected CSA at three main medical systems in the Greater Houston area for 2009. We evaluated 18 community level variables from the American Community Survey for the 396 zip codes these children lived in. The mean number of cases per Greater Houston zip code was 2.77 (range 0-27), with 62 % of zip codes not having a case at any of the three sites surveyed. Zip codes with a higher than Houston average rate of vacant houses, never married females and unemployed labor force with high family poverty rate, were associated with an increased rate of children seeking care for suspected CSA. We demonstrated zip codes level characteristics which were associated with an increased rate of children seeking care for suspected CSA. Our modelling process and our data have implications for community based strategies aimed at improved surveillance or prevention of CSA. The process of identifying locally specific community level factors suggests target areas which have particular socioeconomic characteristics which are associated with increased rate of seeking CSA evaluations.

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Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes

Cited by 41 publications

References 55 publications

Investing to Protect Our Children: Using Economics to Derive an Evidence‐based Strategy

Investing to Protect Our Children: Using Economics to Derive an Evidence‐based Strategy

Cost‐Effectiveness Analysis of the Parents under Pressure Programme for Methadone‐Maintained Parents

Community Characteristics Associated With Seeking Medical Evaluation for Suspected Child Sexual Abuse in Greater Houston

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