Cost-Effectiveness of Parent–Child Interaction Therapy in Clinics versus Homes: Client, Provider, Administrator, and Overall Perspectives

Abstract

Parent–Child Interaction Therapy (PCIT) is effective in decreasing negative child behaviors when delivered in clinics. Emerging research suggests that delivering PCIT in client homes can produce similar outcomes … but at what cost? Home PCIT still consumes valuable client time, but only for sessions. Home PCIT could reduce barriers to continued parent participation, and costs, by not requiring clients to spend time and money traveling to and from clinics. Home PCIT also does not require that parenting skills learned in clinics be generalized to homes. We assessed and compared costs of clinic and home PCIT at individual client and program levels of specificity from client and provider perspectives for 264 children and parents (clinic = 139, home = 125). We also included an administrator perspective and a client + provider + administrator = overall perspective. Multivariate analyses of covariance applied to imputed datasets found that, because significantly more sessions were held for PCIT delivered in homes than in clinics (a mean 18 versus 11 sessions, respectively), home PCIT cost significantly more from the overall perspective ($3913 versus $1821 per child receiving home versus clinic PCIT) and the provider perspective ($3326 versus $950 per child receiving home versus clinic PCIT), significantly less from the administrator perspective ($125 versus $397 per child receiving home versus clinic PCIT), and about the same from the client perspective ($352 versus $427 per child receiving home versus clinic PCIT). Cost-effectiveness ratios (CERs) calculated for individual clients were significantly better for clinic PCIT from provider and overall perspectives but not from the administrator or client perspectives.