Incremental net benefit of early intervention for preschool-aged children with emotional and behavioral problems in foster care

Abstract

Of 1 million cases of child maltreatment identified every year in the United States, one-fifth result in foster care. Many of these children suffer from significant emotional and behavioral conditions. Decision-makers must allocate highly constrained budgets to serve these children. Recent evidence suggests that Multidimensional Treatment Foster Care for Preschoolers can reduce negative outcomes for these children, but the relative benefits and costs of the program have not been evaluated. The objective of this study was to assess net benefit, over 24 months, of Multidimensional Treatment Foster Care for Preschoolers compared to regular foster care. Data were from a randomized controlled trial of 117 young children entering a new foster placement. A subsample exhibited placement instability (n = 52). Intervention services including parent training, lasted 9–12 months. Multidimensional Treatment Foster Care for Preschoolers significantly increased permanent placements for the placement instability sample. Average total cost for the new intervention sample was significantly less than for regular foster care (full sample: $27,204 vs. $30,090; P = .004; placement instability sample: $29,595 vs. $36,061; P = .045). Incremental average net benefit was positive at all levels of willingness to pay of zero or greater, indicating that the value of benefits exceeded costs. Multidimensional Treatment Foster Care for Preschoolers has significant benefit for preschool children in foster care with emotional and behavioral disorders compared to regular foster care services. At even modest levels of willingness to pay, benefits exceed costs indicating a strong likeliness that this program is an efficient choice for improving outcomes for young children with emotional and behavioral disorders in foster care.

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.…”