Strengthening families, strengthening the public purse?

Strengthening families, strengthening the public purse?
03 June 2013

As social service budgets are squeezed, the search is on for programs that reduce public costs without putting children at risk. In the case of families affected by substance use, the Strengthening Families Program (SFP) may fit the bill.

SFP has mainly been used to treat and prevent alcohol misuse among youth, but the program only touches on drug and alcohol use. Its main focus is the family dynamic, helping to strengthen relationships, increase family organization, and improve the social skills of all involved.

So when the US government offered funding in 2006 to test activities that would improve the well-being of children in out-of-home care whose parent or parents were substance abusers, SFP was among the programs chosen for the five-year test.

Now the findings of a cost-benefit analysis are in. Researchers from the University of Kansas have concluded that every dollar invested in SFP resulted in nearly $10 in savings, because the program greatly reduced the time children spent in care. Typical children participating in SFP returned to their families 190 days sooner than similar children whose families did not take part in the program.

Each day the child is able to stay with their family saves $86 – so by this measure, SFP saves over $16,000 per child served. Such savings are a conservative estimate, the authors say, as they were unable to include legal and court costs in the current model.

Importantly, it seems that getting these considerable cost savings did not increase the risk to children. Both the SFP participants and the comparison group had low rates of re-entry into care: in an initial follow-up, fewer than 3% of the children in each group who had been reunified with their families returned to care.

The Strengthening Families Program

SFP has been around since the early 1980s, but it continues to be applied to different types of families with different goals. In the Kansas case, the curriculum was taught to groups of families during fourteen 2-hour sessions. Children ranged from 2 to 14 years old.

The program involves both children and parents. While the groups of parents learn ways to interact positively with their children, improve family communication, and use effective and consistent discipline, the groups of children work on skills for communication, relationship-building, problem-solving, and emotional management.

Then families have practice sessions to test out their skills together, while coached by group leaders.

While only one of the 14 sessions focuses on substance use, the program is built on the premise that improved family functioning can help to reduce drug and alcohol use among parents, making it possible for children in care to be reunited with their birth families more quickly – and saving the cost of foster care.

The complexities of the cost-benefit analysis process

However, arriving at a figure for the overall costs and benefits involves a complex process of analysis.

The first issue was creating a group of families that could realistically be compared to the families who received the SFP treatment. The researchers looked at a pool of almost 12,000 children and chose two non-participants for each of the 262 participants. The resulting treatment and comparison groups should be as similar as possible, making the comparison of their outcomes with and without the SFP program a useful one.

The second issue was how to measure time to reunification. Although the children were tracked for three years, a relatively large number of the comparison children had not been reunited at the end of the study period. A year after the start of SFP, almost half of the SFP children had been reunified with their families, compared to just over a quarter of the comparison children. After 810 days (2.2 years), 82% of SFP children had been reunified, compared to 43% of comparison children.

One good statistical way to measure durations uses a method called event history analysis (sometimes called survival analysis). This method takes into account the fact that some children will probably be returned to their families after the study ends. Using this method, the typical SFP family was reunited 190 days more quickly than similar non-participants.

Finally, the researchers calculated costs and savings. The cost of an out-of-home placement to the child welfare system came from information provided by a federal audit. Costs of training and staffing came from the Lutra Group, which provides all the training and materials for SFP group leaders. Given that training was the greatest cost incurred, the researchers describe and cost three staffing scenarios that may occur.

While the variations in staffing had an impact on the exact results, SFP was cost-beneficial regardless of this. However, the results may differ in other locations due to local variation in the costs of care.

Limitations

There are some limitations to the cost data that should be considered. Not all possible costs of SFP could be captured. For instance, SFP may have increased the use of other child welfare services (some of which are very expensive) through increased contact with the system and an increased chance of other problems being spotted. While this may be good for children and families, it may also result in higher costs.

In addition, the impact of SFP was not assessed for different sub-groups of children, and it may be that it works well with families with certain characteristics but not so well with others.

What does this mean?

The Kansas demonstration project has some important implications, not least in providing commissioners within the child welfare system evidence that SFP may help reduce the duration of out-of-home placements without increasing the chance that the child will re-enter the system at a later date.

In other words, among substance-abusing families who are willing to participate, SFP can successfully improve the state of the family without putting the child at higher risk than if they had received “services as usual” - at least, the usual services available to Kansas families.

Furthermore, the cost calculation used required technical expertise outside of many researchers’ and developers’ skill sets. More attention should be given to how the field can build the ability to conduct cost analysis into their program implementation and evaluation processes.

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References:

Johnson-Motoyama, M., Brook, J., Yan, Y., & McDonald, T. P. (2013). Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families. Children and Youth Services Review, 35, 244-252.

Links:

Strengthening Families Program

Explainers

Cost-benefit analysis (CBA)

CBA is a process by which expected costs are weighed against expected benefits to determine whether the course of action is profitable. In CBA, both the costs and the benefits are defined in monetary terms.

In the context of social interventions, the technique adds up the value of the benefits of an intervention, and subtracts the costs associated with it. In its simple form, cost-benefit analysis is carried out using only financial costs and financial benefits. A more sophisticated approach to cost-benefit measurement models puts a financial value on intangible costs and benefits. For example, a cost-benefit analysis of a smoking reduction would transform a quitter’s improved health or longer life into a monetary value.

Strengthening Families Program (SFP)

 Strengthening Families Program (SFP) is an intervention to improve family skills through a series of group training sessions that follow a curriculum. There are distinct components for parents, children, and families.SFP has typically been used to treat substance misuse among youth, but it has also been applied to other populations such as parents with substance abuse problems whose children have been removed from the family and are in foster care. SFP was developed in the 1980s by Karol Kumpfer; training and support are provided by the Lutra Group.

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