Assessing Costs And Benefits Of Early Childhood Intervention Programs Executive Summary

This work summarizes a report that asks whether money invested early in a child's life pays dividends in the form of government savings or other societal benefits as he or she grows into adulthood. Is there a best method for determining what, if any, dividends have accrued? The authors identify the conceptual and methodological issues associated with the analysis of costs and outcomes of early intervention programs and review the prior application of these methods to several programs. This background leads to recommendations regarding the application of these tools for a particular public-private early intervention program, Starting Early Starting Smart (SESS). SESS was designed to test the effectiveness of integrating behavioral health services within primary care and early childhood service settings for children from birth to age seven. The specific recommendations are framed as a set of more general guidelines for decisionmakers to make choices about early childhood intervention programs.

Does money invested early in a child's life pay dividends in the form of government savings or other societal benefits as he or she grows into adulthood? Is there a best method for determining what, if any, dividends have accrued? The authors identify the conceptual and methodological issues associated with the analysis of costs and outcomes of early intervention programs and review the prior application of these methods to several programs. This background leads to recommendations regarding the application of these tools for a particular public-private early intervention program, Starting Early Starting Smart (SESS). SESS was designed to test the effectiveness of integrating behavioral health services within primary care and early childhood service settings for children from birth to age seven. The specific recommendations are framed as a set of more general guidelines for decisionmakers to make choices about early childhood intervention programs.

The deficiencies that many children experience from birth to school age-in health care, nutrition, emotional support, and intellectual stimulation, for example-play a major role in academic achievement gaps that persist for years, as well as in behavior and other problems. There are many intervention programs designed to strengthen families, provide disadvantaged children with the critical elements of healthy development, and prevent adverse experiences that can have lasting negative effects. In a climate of economic uncertainty and tight budgets, hard evidence not only that such interventions provide lasting benefits for children, their families, and society, but also that the benefits translate into savings that outweigh the costs is an extremely important asset in policy discussions. Convincing analysis of benefits and costs would provide a guide to the best ways to spend scarce resources for early childhood programs. Benefit-Cost Analysis for Early Childhood Interventions summarizes a workshop that was held to explore ways to strengthen benefit-cost analysis so it can be used to support effective policy decisions. This book describes the information and analysis that were presented at the workshop and the discussions that ensued.

Includes publications previously listed in the supplements to the Index of selected publications of the Rand Corporation (Oct. 1962-Feb. 1963).

There is increasing evidence that the first few years after birth are particularly important in child development and present opportunities for enrichment but also vulnerabilities do to poverty and other social stressors. Elected officials have begun proposing potentially costly programs to intervene early in the lives of disadvantaged children. Have such interventions been demonstrated to yield substantial benefits? To what extent might they pay for themselves through lower welfare and criminal justice costs incurred by participating children as they grow into adults? This study synthesizes the results of a number of previous evaluations in an effort to answer those questions. Conclusions are that under carefully controlled conditions, early childhood interventions can yield substantial advantages to recipients in terms of emotional and cognitive development, education, economic well-being, and health. (The latter two benefits apply to the children's families as well.) If these interventions can be duplicated on a large scale, the costs of the programs could be exceeded by subsequent savings to the government. However, the more carefully the interventions are targeted to children most likely to benefit, the more likely it is that savings will exceed costs. Unfortunately, these conclusions rest on only a few methodologically sound studies. The authors argue for broader demonstrations accompanied by rigorous evaluations to resolve several important unknowns. These include the most efficient ways to design and target programs, the extent to which effectiveness is lost on scale-up, and the implications of welfare reform and other safety net changes.

Benefit-cost analyses hold great promise for influencing policies related to children, youth, and families. By comparing the costs of preventive interventions with the long-term benefits of those interventions, benefit-cost analysis provides a tool for determining what kinds of investments have the greatest potential to reduce the physical, mental, and behavioral health problems of young people. More generally, the growth of benefit-cost analysis as a field of research and practice represents an exciting and promising trend in the development and implementation of public policies. The utility of benefit-cost analyses has been limited by a lack of uniformity in the methods and assumptions underlying these studies. For years, those who perform and those who use benefit-cost analyses have argued that the development and use of theoretical, technical, and reporting standards for benefit-cost analyses would enhance the validity of results, increase comparability across studies, and accelerate the progress of the field. Considerations in Applying Benefit-Cost Analysis to Preventive Interventions for Children, Youth, and Families is the summary of a workshop convened by the Board on Children, Youth, and Families of the Institute of Medicine and the National Research Council in November 2013 as the first phase of a possible two-part effort directed toward guiding future benefit-cost studies and enhancing the relevance of benefit-cost analysis to governments and other organizations wanting to make sound prevention decisions. The workshop brought together leading practitioners in the field, researchers who study the methodological and analytic dimensions of benefit-cost analysis, and representatives of organizations that use the results of benefit-cost analyses to shape and implement public policies. This report discusses a wide range of issues about benefit-cost analysis, including the level of research rigor that should be met before results from an evaluation are used to estimate or predict outcomes in a cost-benefit analysis; best practices and methodologies for costing prevention interventions; prevention outcomes that currently lend themselves to monetization; processes and methodologies that should be used when linking prevention outcomes to avoided costs or increased revenues; and best methods for handling risk and uncertainty in estimates.