Economic Evaluations of Universal or Targeted Parenting Support Services that aim to Enhance Parent-Infant Interaction: Results and Implications for Policy of a Systematic Review.
Abstract
Background: The benefits of positive early years experiences, included, good parent-infant interaction were accepted as having positive correlations with outcomes, such as, education, health and well-being and reduced criminality over the life course.
Aims: Provide policy actors with a synthesis of available economic data about parenting support services that aimed to enhance parent-infant interaction.
Methods: A literature search was undertaken using academic databases between 2004 and 2014 that included the search terms “parent”, “infant”, “interaction”, “cost benefit analysis” and their synonyms.
Results: The health service can save up to £2,556 per family over 25 years, moreover the criminal justice system could save £145,383 per person over the life course.
Discussion: Significant savings were observed, in light of the escalating costs of remedial services these potential savings may provide the Government with an incentive to invest.
Strengths: This topic is really important specifically in view of the Government’s emphasis on the Equalities Agenda and the Children and Young Peoples (Scotland) Bill.
Limitations: The review methodology is open to critique as generally existing economic studies focussed upon targeted short-run outcomes.
Learning: Synthesising analysis of available economic data can support decision making.
Conclusion: Parenting support services can be economically efficient, return savings on investment and contribute towards improving population health and reducing inequalities in health.
Recommendations: Debate early years policy and invest in parenting support services and research.
What is known about this topic?
Early years intervention can:
- improve academic achievement and employment opportunities
- improve health and wellbeing
- increase levels of income
- reduce inequalities in health
- limit criminality.
What this paper adds?
- bridges an identified gap in existing literature
- informs policy actors
- identifies areas for further research
Background
Economic Efficiency
The National Institute for Health and Clinical Excellence (National Institute for Health and Clinical Excellence 2006) recommended that parenting programme investment is guided by economic efficiency evidence as well as intervention effectiveness evidence. Analysis of the economic efficiency of an intervention is vitally important to healthcare decision makers, service commissioners and policy makers (Heckman 2011; Centre for Reviews and Dissemination 2009). Policy actors can utilise the evaluative concept of ‘economic efficiency’ to maximise societal benefit by directing resources to the best intervention (Dukhovny and Zupancic 2011; Mays et al. 2005). Policy actors must also take into consideration the wider issues of ethics, human rights and social justice as these important issues may compromise the purely statistical modelling of economic efficiency.
Early Years Policy
Children, no matter their background, have a right to opportunity. The desired outcomes of early years policy interventions include improving population health, reducing inequalities in health and supporting children and their parents to escape from an observed cycle of deprivation, anti-social behaviour and crime that may result in substantial societal savings (The Scottish Government 2011; Heckman 2011; The Scottish Government 2009a; Allen and Duncan Smith 2008). This is not a new policy goal, notable historical reports that highlighted health inequalities were: The Black Report (The Department of Health and Social Security 1980) and The Acheson Report (The Department of Health 1998).
Parenting Support Services
Parenting support services can enable parents to meet their infants’ needs (Zeedyk et al. 2008; Bunting 2004). Participating in a parenting intervention can provide parents with the knowledge and practical skills necessary to promote social inclusion, self-sufficiency, emotional wellbeing and can enhance parent-infant interaction (Gunning et al. 2011; Appleton and Cowley 2008; Zeedyk et al. 2008; Bunting 2004). This can lead towards positive short and long term outcomes for infants (Barlow et al. 2010; Bayer et al. 2009; Niccols 2008; Zeedyk et al. 2008; Bloomfield and Kendall 2007; Petrie et al. 2007; Barlow et al. 2005; Patterson et al. 2005). High quality parent-infant interaction has been shown to impact upon infants’ neurological development and the associated outcomes of IQ, academic achievement and comprehension (Sutton 2014; Ranson and Urickuk 2008). Consequently, healthy outcomes in adulthood, such as, higher levels of income and reduced criminality can benefit society by reducing inequalities (Allen and Duncan Smith 2008).
Universal and Targeted Parenting Support Services
Timely access to universal and targeted parenting support services can be the key to improved health (Department for Education 2011). Health visitors, as the named person and one of the universal and targeted parenting support service providers for preschool children, can potentially reach the most vulnerable and excluded families (The Scottish Government 2009b). Their assessment of families’ needs forms an important part of preventative work and may highlight children at risk. This assessment could make the difference between a situation escalating to safeguarding intervention or a family receiving a timely supportive intervention (Keys 2007).
Why this Systematic Review is relevant
This systematic review is important because every child has the right to be loved and nurtured in a safe home. Ed’s story (see box 1 below) provides an insight into their particular environment. This case emphasises the need for policy actors to intervene to support children at risk.
Ed’s Story
Ed was a 12 months old child who had lived in an economically deprived rural town with their parents, both with a long history of substance misuse and long term physical and mental health conditions. Three elder siblings, who had a history of conduct disorder, criminality, substance misuse and the eldest daughter was a teen parent. Violence and aggression had been normalised. In fact, the parents said, this had intentionally been used to ensure that “they were prepared” for the world in which they lived. Interaction in the community was limited, for example there was no engagement with local family services / activities. The health visitor had serious concerns regarding Ed’s safety and age and stage development. Historically the elder siblings, on several occasions, had been removed from the household and placed in care. When the social worker and health visitor had carried out a visit together, the parents displayed threatening and aggressive behaviour, in Ed’s presence, towards them. The social worker was aware of the long standing family situation, problems were intergenerational and the social worker, having visited to review, had no plans to act upon the health visitor’s concern for Ed’s safety and wellbeing. The view of the social worker was that Ed did not meet the set threshold for intervention at this time.
Summary
To improve spending decisions and allocative efficiency, policy actors require high quality economic evidence. Savings can be made, for example, through improved health and well-being outcomes including educational attainment and reduced criminality and social expenses. Directing resources to deliver early years services to families may contribute towards achieving improved population health and long-term economic sustainability, reduced inequalities in health and breaking the cycle of deprivation. This alongside a comprehensive early years economic efficiency strategy could be utilised to demonstrate the potential societal benefits and savings gained from an expansion in early years investment.