COST-EFFECTIVENESS OF PARENT-CHILD INTERACTION THERAPY (PCIT) IN CLINICS VERSUS HOMES FROM FOUR PERSPECTIVES

Parent-Child Interaction Therapy (PCIT) has been shown to be effective in decreasing negative child behaviors when delivered in the traditional setting of clinics. Emerging research suggests that delivering PCIT in clinics and homes can produce similar outcomes. Some providers believe that home PCIT improves the generalization of parenting skills and reduces barriers that may prevent families from engaging in services. Funders may be less likely to invest in home PCIT, however, as they could more concerned about the resources used by providers than parents. Given that different perspectives may not value resources in the same way, we assessed effectiveness and costs of clinic and home PCIT from the Client, Provider, Administrative, and Overall perspectives using multivariate analysis of covariance on listwise deletion and imputed datasets. Previous investigators found that clinic and home PCIT produced similar rates of decrease in the number and intensity of negative behaviors, but that home PCIT had a higher rate of treatment completion. The current study found significant differences in costs for three of the four perspectives, with home PCIT yielding higher costs from the Provider and Overall perspectives, and clinic PCIT yielding higher costs from the Administrative perspective. No significant differences were found in costs from the Client perspective, but this is due to the greater number of sessions, and better treatment completion rate, associated with home PCIT as compared to clinic PCIT. Analyses of the cost-effectiveness ratios (CERs) only indicated significant differences between treatment groups from the Overall and Provider perspectives. All CERs indicated that clinic PCIT cost less per point decrease in the number or intensity of negative behaviors than home PCIT. We conclude that although home PCIT may be more expensive, it is an important option for those families who are unable to travel to and from the clinic due to their child's severe behavior problems and logistical barriers.