Assessing the cost-effectiveness of Family Connections.

OBJECTIVE To assess the cost-effectiveness of two alternate forms of Family Connections (FC), a child neglect prevention program, in relation to changes in risk and protective factors and improvements in child safety and behavioral outcomes. METHODS In the original FC study, a sample of 154 families (473 children) in a poor, urban neighborhood, who met risk criteria for child neglect, were randomly assigned to receive either a 3- or 9-month intervention. CPS reports and self-report and observational data on risk and protective factors, safety, and behavioral outcomes were collected prior to, at the end of, and 6-months post intervention. The current study compared the costs of delivering the 3- or 9-month intervention in relation to reported improvements in risk and protective factors, safety, and behavioral outcomes for each group. RESULTS The 3-month intervention was more cost effective than the 9-month intervention in relation to positive changes in risk and protective factors and child safety. However, cost-effectiveness analysis indicated that the 9-month intervention was more cost effective (CE ratio=$276) than the 3-month intervention (CE ratio=$337) in relation to improved unit changes in the child's behavior between baseline and 6 months after service closure. CONCLUSIONS This study successfully explored the cost-effectiveness of the FC intervention in relation to its intended outcomes. More extensive cost analyses are currently being conducted in the replication of this program in multiple jurisdictions across the United States. PRACTICE IMPLICATIONS Practitioners in community-based programs must make difficult decisions about the optimal length of time to serve children and families. Prevention programs may be more competitive for funding when they have demonstrated cost-effectiveness. Study results indicated that a 3-month intervention was more cost effective than a 9-month intervention in enhancing protective factors and reducing the risk of child neglect; 9-month intervention was more cost effective than 3-month intervention in reducing problematic child behavior. Further research is needed before practitioners should consider these findings in relation to their own decisions about the timing of service closures.