|Benefit-Cost Summary Statistics Per Participant|
|Taxpayers||$765||Benefits minus costs||($655)|
|Participants||$324||Benefit to cost ratio||$0.53|
|Others||$32||Chance the program will produce|
|Indirect||($396)||benefits greater than the costs||47 %|
|Net program cost||($1,380)|
|Benefits minus cost||($655)|
|Meta-Analysis of Program Effects|
|Outcomes measured||Treatment age||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|
Child abuse and neglect
Substantiated or founded reports to child protective services.
The removal of a child from parental care, most often to foster care.
“Final” placement in a permanent home, which can include reunification with parents, formalized guardianships, or legal adoption.
Externalizing behavior symptoms
Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.
Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.
A measure of the how readily a child feels comforted and protected by the caregiver. This is typically determined using validated assessments based on observation of child and caregiver by trained observers.
Stress reported by a parent, typically measured on a validated scale such as the Parental Stress Index.
A measure of the caregiver’s supportive and encouraging relationship with the child, typically measured through validated assessments based on observation parent-child interaction.
|Detailed Monetary Benefit Estimates Per Participant|
|Affected outcome:||Resulting benefits:1||Benefits accrue to:|
|Child abuse and neglect||Criminal justice system||$13||$0||$24||$6||$43|
|Child abuse and neglect||$26||$10||$0||$13||$49|
|K-12 grade repetition||$1||$0||$0||$1||$2|
|K-12 special education||$34||$0||$0||$17||$51|
|Property loss associated with alcohol abuse or dependence||$0||$0||$0||$0||$0|
|Health care associated with PTSD||$8||$2||$8||$4||$22|
|Labor market earnings associated with child abuse & neglect||$130||$306||$0||($65)||$372|
|Mortality associated with child abuse and neglect||$2||$5||$0||$43||$50|
|Out-of-home placement||Out-of-home placement||$551||$0||$0||$275||$826|
|Program cost||Adjustment for deadweight cost of program||$0||$0||$0||($690)||($690)|
|Detailed Annual Cost Estimates Per Participant|
|Annual cost||Year dollars||Summary|
|Program costs||$1,331||2017||Present value of net program costs (in 2018 dollars)||($1,380)|
|Comparison costs||$0||2017||Cost range (+ or -)||15 %|
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
|Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.|
Oxford, M., Hash J., Lohr, J.J., Bleil, M., Flemieng, C., Unutzer, J., & Spieker, S. (2021). Randomized trial of Promoting First Relationships for new mothers who received community mental health services in pregnancy.
Oxford, M.L., Spieker, S.J., Lohr, M.J., & Fleming, C.B. (J2016). Promoting First Relationships®: Randomized trial of a 10-week home visiting program with families referred to child protective services. Child Maltreatment, 21(4), 267-277.
Spieker, S.J., Oxford, M.L., & Fleming, C.B. (2014). Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention. Children and Youth Services Review, 44, 201-206.