EBD Blog

The Incredible Years programs, which comprise a coordinated set of (a) parent training programs and individual family counseling, (b) teacher training and school consultation, and (c) group child training in social skills, problem-solving, and anger management, are in the news again. The IY programs are aimed at reducing conduct problems in young children. They have been researched extensively.

The parenting program, the most extensively researched component of the IY programs, was tested in Wales (UK) by R. T. Edwards and colleagues; they reported the positive results of the program in the British Medical Journal.

Objective To investigate the cost effectiveness of a parenting programme.

Design An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community.

Setting Sure Start areas in north and mid Wales.

Participants Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team.

Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control.

Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory.

Results The bootstrapped incremental cost effectiveness ratio point estimate was £73 (€109, $142) per one point improvement on the intensity score (95% confidence interval £42 to £140). It would cost £5486 (€8190, $10 666) to bring the child with the highest intensity score to below the clinical cut-off point and £1344 (€2006, $2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of £100 (€149, $194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was £1934 (€2887, $3760) for eight children and £1289 (€1924, $2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder.

Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.

One should interpret this study as indicating that fault for Emotional and Behavioral Disorders lies with parents. This is simply another demonstration that parents who implement evidence-based behavior management procedures in a sensitive and thoughtful way are likely to have children who have fewer such problems, and the public policy cost of doing so is relatively low.

Link to the Britsh Medical Journal abstract (reproduced here). Visit the Parenting Clinic, the lab of Carolyn Webster-Stratton at the University of Washington (Seattle, WA, US) who has been the lead researcher in the development of the IY programs. Read the Science Daily story about the BMJ study.