Cost-effectiveness of a parenting program to reduce children's behavioral problems among families receiving child protection services and other family support services - A randomized controlled trial

Background: Children's behavioral problems have high prevalence among families in the child welfare system, raising the need for cost-effective ways to diminish the problems. Objective: We evaluated the cost-effectiveness of the Incredible Years (R) (IY) Parenting Program for children's behavioral problems compared with a treatment-as-usual (TAU) in families receiving child protection services (CPS) and other family support services in Finland, from the health and social care payer's perspective at the intervention end (post-assessment) and with a 12-month follow-up. Participants and setting: The randomized controlled trial included 102 families of 3-7-year-olds with behavioral problems. Families were recruited from CPS and other family support services in Finland. Methods: Incremental net monetary benefit analysis combined the costs and effects of IY intervention and TAU groups. Costs included intervention costs and register-based children's and mothers' health and social care costs. Effectiveness measures were the Eyberg Child Behavior Inventory and the Child Behavior Checklist. Results: In the postassessment, the cost-effectiveness results varied according to the effectiveness measures. Compared to TAU, the IY intervention was either not cost-effective or the cost-effectiveness depended on the decision-makers' willingness to pay. In the 12-month follow-up, IY and TAU did not differ in costs or effects. Conclusions: The cost-effectiveness estimates from previously studied populations may not generalize to families receiving CPS. Families receiving CPS are in urgent need of costeffective support to reduce the high prevalence of children's behavioral problems. Keywords: cost-effectiveness, parenting program, behavioral problems, child protection services, social services