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Other home visiting programs for at-risk mothers and children

Public Health & Prevention: Home- or Family-based
Benefit-cost estimates updated December 2017.  Literature review updated April 2012.
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This broad grouping of programs focuses on mothers considered to be at risk for parenting problems, based on factors such as maternal age, marital status and education, low household income, lack of social supports, or in some programs, mothers testing positive for drugs at the child’s birth. Depending on the program, the content of the home visits consists of instruction in child development and health, referrals for service, or social and emotional support. This group of programs also includes a subset that is specifically targeted toward preventing repeat pregnancy and birth in the adolescent years.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $6,363 Benefits minus costs $12,642
Participants $13,639 Benefit to cost ratio $3.13
Others $1,023 Chance the program will produce
Indirect ($2,444) benefits greater than the costs 67 %
Total benefits $18,580
Net program cost ($5,938)
Benefits minus cost $12,642
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with major depression ($77) ($170) $0 ($2) ($249)
Health care associated with major depression ($25) ($8) ($31) ($12) ($76)
Labor market earnings associated with anxiety disorder $1,573 $3,464 $0 $0 $5,037
Health care associated with anxiety disorder $142 $46 $175 $71 $434
Subtotals $1,613 $3,332 $144 $57 $5,146
From secondary participant
Crime $348 $0 $649 $174 $1,171
Child abuse and neglect $160 $1,810 $0 $80 $2,049
Out-of-home placement $34 $0 $0 $17 $51
K-12 grade repetition $52 $0 $0 $26 $79
K-12 special education $240 $0 $0 $120 $360
Property loss associated with alcohol abuse or dependence $0 $1 $1 $0 $2
Health care associated with PTSD $236 $77 $293 $117 $724
Labor market earnings associated with child abuse & neglect $3,913 $8,617 $0 $42 $12,572
Costs of higher education ($233) ($197) ($64) ($116) ($611)
Subtotals $4,750 $10,307 $879 $459 $16,395
Adjustment for deadweight cost of program $0 $0 $0 ($2,961) ($2,961)
Totals $6,363 $13,639 $1,023 ($2,444) $18,580
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $5,368 2008 Present value of net program costs (in 2016 dollars) ($5,938)
Comparison costs $0 2008 Cost range (+ or -) 20 %
Costs are based on a weighted average of per-family costs published in Black, M.M., Dubowitz, H. Hutcheson, J., Berenson-Howard, J., & Starr Jr., R.H. (1995). A randomized clinical trial of home intervention for children with failure to thrive. Pediatrics, 95(6): 807-814; Dawson, P., Van Doorninck, W.J., Robinson, J.L. (1989) Effects of home-based, informal social support on child health. Developmental and Behavioral Pediatrics, 10(2):63-67; Ernst, C.C., Grant, T.M., Streissguth, A.P., & Sampson, P.D. (1999). Intervention with high-risk alcohol and drug-abusing mothers: II. Three-year findings from the Seattle Model of Paraprofessional Advocacy.Journal of Community Psychology, 27(1), 19-38.; and Hardy, J.B. & Streett, R. (1989). Family support and parenting education in the home: An effective extension of clinic-based preventive health care services for poor children. Journal of Pediatrics, 115, 927-931.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Anxiety disorder Primary 2 121 -0.128 0.129 22 -0.067 0.158 24 -0.128 0.320
High school graduation Primary 1 392 0.000 0.092 19 0.000 0.092 19 0.062 0.504
Major depressive disorder Primary 3 152 0.012 0.122 22 0.006 0.149 24 0.012 0.920
Repeat teen birth^ Primary 2 79 -0.071 0.219 19 -0.071 0.219 19 -0.131 0.552
Repeat teen pregnancy^ Primary 4 129 0.056 0.159 19 0.056 0.159 19 -0.041 0.795
Child abuse and neglect Secondary 6 363 -0.404 0.182 3 -0.404 0.182 3 -0.404 0.027
Out-of-home placement Secondary 5 307 -0.076 0.110 3 -0.076 0.110 3 -0.084 0.443
Preschool test scores^ Secondary 5 169 0.136 0.117 3 0.029 0.128 17 0.229 0.105

Citations Used in the Meta-Analysis

Barlow, J., Davis, H., McIntosh, E., Jarrett, P., Mockford, C., & Stewart-Brown, S. (2007). Role of home visiting in improving parenting and health in families at risk of abuse and neglect: Results of a multicentre randomised controlled trial and economic evaluation. Archives of Disease in Childhood, 92(3), 229-233.

Barnet, B., Liu, J., DeVoe, M., Alperovitz-Bichell, K., & Duggan, A.K. (2007). Home visiting for adolescent mothers: Effects on parenting, maternal life course, and primary care linkage. Annals of Family Medicine, 5(3), 224-232.

Barth, R.P. (1991). An experimental evaluation of in-home child abuse prevention services. Child Abuse & Neglect, 15(4), 363-375.

Barth, R.P., Hacking, S., & Ash, J.R. (1988). Preventing child abuse: An experimental evaluation of the child parent enrichment project. Journal of Primary Prevention, 8(4), 201-217.

Black, M.M., Nair, P., Kight, C., Wachtel, R., Roby, P., & Schuler, M. (1994). Parenting and early development among children of drug-abusing women: Effects of home intervention. Pediatrics, 94(4), 440-448.

Cappleman, M. W., Thompson, R. J., Jr., DeRemer-Sullivan, P. A., King, A. A., & Sturm, J. M. (1982). Effectiveness of a home based early intervention program with infants of adolescent mothers. Child Psychiatry and Human Development, 13(1), 55-65.

Field, T., Widmayer, S., Greenberg, R., & Stoller, S. (1982). Effects of parent training on teenage mothers and their infants. Pediatrics, 69(6), 703-707.

Hardy, J.B., & Streett, R. (1989). Family support and parenting education in the home: An effective extension of clinic-based preventive health care services for poor children. The Journal of Pediatrics, 115(6), 927-931.

Huxley, P., & Warner, R. (1993). Primary prevention of parenting dysfunction in high-risk cases. American Journal of Orthopsychiatry, 63(4), 582-588.

Kelsey, M., Johnson, A., & Maynard, R. (2001). The potential of home visitor services to strengthen welfare-to-work programs for teenage parents on cash assistance (Mathematica Policy Research Document No. PR01-67). Philadelphia: University of Pennsylvania (with Mathematica Policy Research).

Lyons-Ruth, K., Connell, D.B., Grunebaum, H.U., & Botein, S. (1990). Infants at social risk: Maternal depression and family support services as mediators of infant development and security of attachment. Child Development, 61(1), 85-98.

Quinlivan, J.A., Box, H., & Evans, S.F. (2003). Postnatal home visits in teenage mothers: A randomised controlled trial. Lancet, 361(9361), 893-900.

Sims, K., & Luster, T. (2002). Factors related to early subsequent pregnancies and second births among adolescent mothers in a family support program. Journal of Family Issues, 23(8), 1006-1031.

Stevens-Simon, C., Nelligan, D., & Kelly, L. (2001). Adolescents at risk for mistreating their children: Part II: A home- and clinic-based prevention program. Child Abuse & Neglect, 25(6), 753-769.

Velasquez, J., Christensen, L., & Schommer, B.L. (1984). Part II: Intensive services help prevent child abuse. American Journal of Maternity and Child Nursing, 9(2), 113-117.

For more information on the methods
used please see our Technical Documentation.