• By Dartington SRU
  • Posted on Monday 03rd September, 2012

An expensive solution to a more expensive problem?

strong>Can a $60,000-per-child parenting program be cost-effective? Yes, if it’s well targeted, argue the developers of Fast Track. Although the program is 10 years long, intensive, complex, and certainly not cheap, it helps some very high-risk children avoid developing long-lasting conduct disorders that come with high social and economic costs.The Washington State Institute for Public Policy costs Fast Track at $59,000 per child. With this level of investment, the pressure is on to prove that Fast Track saves more then it costs. But it may be that the problems that Fast Track prevents are even more expensive. The “lifetime cost of a career criminal” is estimated at more than $2 million, the program’s developers point out – and academic failure and unemployment are other costly risks.In fact, the Conduct Problems Prevention Research Group (CPPRG), who both developed Fast Track and conducted the evaluation, argue that for children who are at very high risk of conduct problems that may result in life-long involvement in violence and crime, this type of heavy and expensive intervention is, paradoxically, a cheap alternative. Fast Track already has a strong evidence base, showing that it is effective in preventing clinical-level antisocial behavior in at-risk children. But the cost of this multifaceted and lengthy intervention may prove prohibitive. So a recent evaluation by CPPRG tested who best to target and the optimal time to intervene in order to ensure those purchasing the intervention will get most bang for their buck.The intervention attempts to mitigate family, parenting, peer and school risk factors, while also improving children's cognitive, social and emotional coping skills. Fast Track starts with children who are at risk of developing life-course-persistent conduct disorders in the first grade of elementary school, with the intervention carrying through until grade 10 of high school. How to target investmentIs Fast Track an expensive solution to a more expensive problem? CPPRG wanted to figure out how best to target the program to get the best return on the $60,000 investment. So the evaluation was set up to ask two questions about risk and timing.The first question focuses on prediction: what level of early risk gives rise to a high level of likelihood that without intervention children will develop life-course persistent conduct problems? The evaluation found that children in the top three percentile of risk would 82% of the time develop life-course persistent conduct disorder if they received no intervention. The authors therefore concluded that these are the children who should be the focus of such expensive intervention. The authors also found that two years after the program ceased, Fast Track was still preventing development of clinical-level conduct disorder among this subgroup of very at-risk children.The second question focuses on the timing of intervention effects: does all of the positive effect of the intervention occur during its first few years, or does each year of intervention add a constant, if modest, improvement?The long-term evaluation demonstrated that for the highest risk group, modest improvements did in fact occur consistently throughout Fast Track’s ten-year duration, cementing the case for the lengthy nature of this intervention. Using these findings, CPPRG are attempting to make Fast Track more beneficial for potential users. While the data suggested that the intervention should not be shortened, the group established that it is most effective with those most at risk, providing the greatest possibility of generating later savings through reduced crime and service use. Another open “black box”This report is also unusual in that it moves beyond asking “what works,” which is the typical goal of most randomized control trials (RCTs). In other words, most RCTs want to determine whether the intervention under scrutiny improves outcomes. When done well, these “gold standard” evaluations leave little doubt over a program or treatment’s effectiveness. But this can leave a “black box,” critics charge – researchers see what goes in and what comes out of an intervention, but miss critical information about how and why the program works. Opening this “black box” in RCTs is rare but increasingly frequent. Prevention Action recently reported on an evaluation by the Oregon Social Learning Center which investigated which specific activities bundled up within an intervention are causing which effects (See: Shining light into the black box). The CPPRG’s trial also goes further than most, providing a detailed picture of how Fast Track performs best for which children and at what time. Their report neatly demonstrates how findings from RCTs can enable developers to alter their programs to reduce costs and improve benefits.**********References: Conduct Problems Prevention Research Group. (2011). The Effects of the Fast Track Preventive Intervention on the Development of Conduct Disorder Across Childhood. Child Development, 82(1), 331-345. Washington State Institute for Public Policy. (2012). Fast Track Prevention Program, [http://www.wsipp.wa.gov/rptfiles/.FastTrack.pdf, Accessed 21//]

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