• By Dartington SRU
  • Posted on Tuesday 05th July, 2011

What’s the value of satisfaction?

Take an innovation designed to improve challenging behavior among adopted children. Say that it actually does very little to improve children’s challenging behavior – but it does improve adoptive parents’ sense of satisfaction with their parenting. Is that a successful intervention? Is it good value for money?The answer given by a team of London-based researchers is pessimistic. “An increase in parenting satisfaction has to be valued very highly for these interventions to be cost effective,” they say, because the extra costs required to deliver the parenting programs were not offset by reduced costs elsewhere.The challenges of “late placed” adoptionThere are many challenges for parents who adopt children older than three years who have previously been cared for by local authorities. Many will have suffered several serious adversities, including disruptions to important early relationships. They will likely have had several different carers. As a consequence, so-called “late placed” children are at high risk of significant psycho-social difficulties. What is more, only half of late placed children remain successfully in their adoptive placement. The remainder either experience placement breakdown or have ongoing difficulties in their relationships with their adoptive families. In an attempt to address large gaps in the “what works” literature for this particular group of children, researchers from King’s College London and the University of London led by Alan Rushton set up a project that involved the development and testing (via randomized controlled trial) of two different post-adoption parenting support services for families who had recently adopted a child aged between three and eight years.Thirty-seven families were randomly assigned to one of three conditions. About half (19) were assigned to one of two parenting programs and the other half (18) to a “services as usual” control condition. While those assigned to the latter group did receive some support, it was less intensive than the two parenting programs, one of which was an adaptation of the popular Incredible Years program and the other an educational approach developed by a county adoption adviser. The cost of increasing parenting satisfactionLast year, Alan Rushton and colleagues reported the results of this experiment: the interventions didn’t improve children’s behavior, but they did improve the adoptive parents’ satisfaction with their parenting. Now, findings from the cost-effectiveness arm of the project have been published in Child and Adolescent Mental Health. No impact was observed in terms of improvements in children’s outcomes, perhaps because the children’s difficulties were too deeply entrenched to be remedied in the short 10 weeks of the intervention. Because there was no improvement, the interventions were clearly not cost-effective in relation to children’s behavior, emotions or general mental health, when compared to services as usual. However, adoptive parents did report significantly higher levels of satisfaction with parenting as a result of the intervention. The cost-effectiveness analysis revealed that a “one unit improvement” in parental satisfaction costs £731. Of course, “one unit” on the parental satisfaction scale is hard to interpret, and as the authors point out, the question of whether this particular innovation provides value for money depends on how much importance is placed on parenting satisfaction, bearing in mind that parenting satisfaction is not one of the major predictors of whether an adoption is successful or not. The research team also cautions that the generalizability of these findings is significantly hindered by the small number of families involved in this research (only 37 in total), but nevertheless the findings support the argument for more research on this largely neglected topic.References:Sharac, Jessica, Paul McCrone, Alan Rushton, and Elizabeth Monck. 2011. “Enhancing Adoptive Parenting: A Cost-Effectiveness Analysis,” Child and Adolescent Mental Health 16(2): 110-115.Rushton, Alan, Elizabeth Monck, Morven Leese, Paul McCrone, and Jessica Sharac. 2010. “Enhancing Adoptive Parenting: A randomized controlled trial.” Clinical Child Psychology and Psychiatry 15(4): 529-542.

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