• By Laura Whybra
  • Posted on Thursday 24th July, 2014

What price a more stable home life for maltreated children?

strong>Intensive, early intervention with maltreated children placed in foster homes can reduce emotional and behavioral problems while lowering the risk of added disruption when care placements break down. But if “intensive” equals “expensive” can the cost to taxpayers be justified?Multidimensional Treatment Foster Care (MTFC), developed at the Oregon Social Learning Center, is an internationally celebrated example of an intensive prevention program enabling foster families to support children and young people whose behavior and other problems are especially challenging.Foster parents are purpose-trained to provide a positive, consistent and structured environment that encourages pro-social and age-appropriate behavior.MFTC has been applied and adapted for use with children in different age groups and presenting a range wide of problems, including offending and mental health issues. The results over two decades have been encouraging and summaries of relevant articles can be found by searching the Prevention Action website.For policy makers, however, it is increasingly not enough to know whether a particular program is effective in achieving better outcomes. They also want to be sure it is cost effective – not least if the unit costs of treatment look high compared with the price of sticking with their existing services.Foster care for preschoolersWith that in mind, the Oregon researchers decided to conduct a cost benefit analysis of their MTFC support program for young children place in care. To do this, they based their calculation on results from a randomized clinical trial of 117 children (mainly of European origin) aged 3-5 year olds. The preschoolers were all beginning a new foster care placement: either as a new entrant to care, a re-entry into care or moving from another placement. Even at this early age, 52 of the children had already experienced four or more disrupted care placements. The foster carers of children assigned to the program (known as MTFC-P) were given 12 hours of intensive training and a 24-hour support service. The children received help from a behavior specialist and attended socialization playgroup sessions for 9-12 months. A family therapist was available in support. Children and foster parents in the control group received normal support services, which only included special help when necessary. Assessed over a 2-year period, it was found that foster placements were more likely to have endured among the MTFC-P group than the control group. However, the results (first published in 2009) showed the difference was only significant statistically among the sub-group of children who had already experienced multiple disruption with their care placements. Public agency benefitsIncorporating these results into a cost-benefit analysis was a complex exercise. The method used to assess “net benefit” calculates whether the value of additional outcomes delivered by the intervention is greater than the additional costs of achieving them. Taking a “public agency perspective”, the analysis took particular account of the estimated costs and benefits relating to health, social welfare and education.The result is that MTFC-P, when compared with conventional foster care support, shows a positive net benefit for all the children whose foster families took part in the program, but especially for those who had previously been through multiple placements. Although it necessitated extra initial expense, MTFC-P saved money in the long-term because of the stability it introduced into the lives of children at risk of high placement mobility and worsening outcomes.While limited in scope, the study adds to a growing list of high-risk children in different age groups and circumstances who can be helped provided those who commission services are prepared to invest in accredited, high quality support. The message – here reinforced - is that they can benefit the lives of abused and neglected children, while saving larger sums for taxpayers in future. *********References:Lynch, F.L., Dickerson, J.F., Saldana, L. and Fisher, P.A. (2014) Incremental Net Benefit of Early Intervention for Preschool-Aged Children with Emotional and Behavioral Problems in Foster Care, Children and Youth Services Review, 36, pp. 213–219Fisher, P.A., Kim, H.K. & Pears, K.C. (2009) Effects of Multidimensional Foster Care for Preschoolers (MTFC-P) on reducing permanent placement failures among children with placement instability. Children and Youth Services Review, 31, pp. 541-546.

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