Incredible Years parenting programme: cost-effectiveness and implementation
| Published date | 21 March 2016 |
| DOI | https://doi.org/10.1108/JCS-02-2015-0005 |
| Date | 21 March 2016 |
| Pages | 54-72 |
| Author | Rhiannon Tudor Edwards,Carys Jones,Vashti Berry,Joanna Charles,Pat Linck,Tracey Bywater,Judy Hutchings |
| Subject Matter | Health & social care,Vulnerable groups,Children's services |
Incredible Years parenting programme:
cost-effectiveness and implementation
Rhiannon Tudor Edwards, Carys Jones, Vashti Berry, Joanna Charles, Pat Linck,
Tracey Bywater and Judy Hutchings
Rhiannon TudorEdwards is
Professorat Centre for Health
Economics andMedicines
Evaluation,Bangor University,
Bangor, UK.
Carys Jonesis based at Centre for
Health Economicsand Medicines
Evaluation,Bangor University,
Bangor, UK.
Vashti Berry is Senior Research
Fellow at Peninsula Medical School,
Plymouth University, Plymouth, UK.
Joanna Charles is based at Centre for
Health Economics and Medicines
Evaluation, Bangor University,
Bangor, UK.
Pat Linck is currently retired, and
formerly worked at Centre for
Health Economics and Medicines
Evaluation, Bangor University,
Bangor, UK.
Tracey Bywater is based at Institute
for Effective Education, University of
York, York, UK.
JudyHutchings is Directorat Centre
for EvidenceBased Early
Intervention,School of Psychology,
Bangor University, Bangor, UK.
Abstract
Purpose –There is growing interest in the economic evaluation of public health prevention initiatives and
increasing government awareness of the societal costs of conduct disorder in early childhood.The purpose
of this paper is to investigate the cost-effectiveness of the Incredible Years (IY) BASIC parenting programme
compared with a six-month waiting list control.
Design/methodology/approach –Cost-effectiveness analysis alongside a prag matic randomised
controlled trial of a group-parenting programme. The primary outcome measure was the Strengths and
Difficulties Questionnaire (SDQ), a measure of child behaviour.
Findings –The IY programme was foundto have a high probabilityof being cost-effective, shiftingan additional
23 per centof children from above theclinical concern to belowthe cut-off on the SDQ comparedto the control
group, at a cost ranging from £1612-£2418per child, depending on the numberof children in the group.
Originality/value –The positive findings of this study have led to ongoing implementation of the IY
programme and is therefore an example of commitment to evidence-based service provision and investment
in prevention initiatives.
Keywords Policy, Implementation, Birmingham, Conduct disorder, Cost-effectiveness,
Incredible Years parenting programme
Paper type Research paper
Introduction
The economic evaluation of public health prevention initiatives brings additional challenges
for health economists and the need for a wider range of outcome measures than for clinical
interventions (National Institute for Health and Care Excellence (NICE), 2013a, Vos et al., 2010;
Edwards et al., 2013). Costs and consequences for a range of sectors need to be accounted for,
along with ripple effects, externalities and equity considerations (Drummond et al., 2005;
Weatherly et al., 2009).
Conduct disorder (CD) is a behavioural and emotional disorder which affects children and
adolescents (NICE, 2013b). CD is estimated to affect approximately 6 per cent of children aged
5-16 years in the UK and boys are more likely than girls to be affected (Green et al., 2004). CD is
the most prevalent mental disorder in children (Green et al., 2004). For children with early onset
CD, problems frequently persist into adulthood (Bonin et al., 2011a, b; Robins, 1978; Scott et al.,
2001) and, amongst other things, predict poor employment prospects, relationship breakdown
and self-harming and/or anti-social criminal behaviour (Kazdin, 1989; Department of Health,
1995; Robins and McEvoy, 1990). The economic implications of severe behavioural problems in
childhood are serious. It has been estimated that by age 28 the cumulative costs of publicly
resourced services between the ages of ten and 28 for those with CD in childhood are 10 times
Received 9 February 2015
Revised 2 July 2015
28 October 2015
Accepted 12 November 2015
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VOL. 11 NO. 1 2016, pp. 54-72, © Emerald Group Publishing Limited, ISSN 1746-6660 DOI 10.1108/JCS-02-2015-0005
higher (£91,854 in 2009/2010 prices) than for those with no childhood behavioural
problems (£9,737 in 2009/2010 prices) (Scott et al., 2001). Parenting is a key determinant of
child behaviour (Gardner, 1987).
In the UK there is growing recognition by Government of the need to ensure early intervention to
prevent the long term negative consequences of CD in young children (Allen, 2011). The Children
Act 2004 (UK Parliament, 2004) introduced a set of reforms and policy in the UK which aim to ensure
that everychild, irrespectiveof circumstancesor background, hasthe support neededto be healthy
and safe; and has the opportunity to make a positive contribution. Local governments are investing
significant resources into prevention initiatives (Buck and Gregory, 2013) . Birmingham City Council
(BCC), through its Brighter Futures programme, has been at the forefront in introducing and trialling
evidence-based, prevention and early intervention initiatives for children (Little et al., 2012).
One of the interventions implemented and evaluated was the Incredible Years (IY) BASIC
parenting programme, suitable for parents of children aged three-six years, which is described in
more detail elsewhere (Webster-Stratton and Hancock, 1998). As an overview, the programme
aims to strengthen parent-child interactions and promote children’s emotional regulation and
social skills. There is growing evidence of its shorter and longer term clinical effectiveness and
cost-effectiveness (Bywater et al., 2009; Hutchings et al., 2007; Furlong et al., 2012; O‘Neill et al.,
2013); however, research findings have not always resulted in the programme becoming
established in regular service.
The present study was conducted to evaluate the cost-effectiveness of the IY BASIC parenting
programme in Birmingham, UK, delivered as part of the Brighter Futures initiative. From the outset
the BCC funding for the research trial was undertaken with a view to adopting the IY programme if
it were found to be effective and cost-effective. With this in mind the programme was delivered by
regular BCC early years staff who would then be in a position to continue to deliver the
programme. Training and support for delivery was provided through the Children’s Early
Intervention Trust (www.childrensearlyinterventiontrust.org/).
Methods
The purpose of economic evaluation
The purpose of economic evaluation is to draw up a balance sheet of the costs and benefits
associated with implementing a new or existing programme, as compared with a relevant
comparator; because of the need for a comparator economic evaluations are often undertaken
alongside, or as part of, a randomised controlled trial (RCT) of the programme.
Study population and recruitment
This economic evaluation took place alongside a pragmatic RCT, details of which, including sample
size calculation, are given in Little et al. (2012). The Strengths and Difficulties Questionnaire (SDQ)
(Goodman, 1997) was administered to parents of children aged three-four years as a screening tool.
Parents who rated their child as above the cut-off for clinical concern on the SDQ (total difficulties)
were invited to discuss the trial, and their potential participation, with a researcher. The researcher
obtained consent from willing, and eligible, parents. A waiting list control design was adopted and
control families had access to the programme after the six-month (post-baseline) follow-up.
Data collection
Service utilisation and effectiveness (outcome) measures were collected during home visits
by researchers blind to condition at baseline and six-month follow-up. The sample for the
economic evaluation consisted of those for whom complete cost and outcome data were
available at both time-points.
Measurement of IY programme costs
We undertook our micro-costing (a method of calculating unit costs) from a payer perspective,
i.e. from BCC as they were the ones implementing the programme. Our micro-costing of the
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