Table 1.

Promoting First Relationships Population and Sources of Benefit in the Benefit-Cost Analysis

	BCA Scenario a
Population and Benefit Source b	1	2	3
Population c	√	√	√
Treatment, because a precondition for trial participation was a CPS allegation
Avoided system costs: CPS, CWS, and court costs through age 17, as reductions in the present decreased risk for subsequent victimizations and placements d	√	√	√
CPS: Referrals, police involvement, juvenile court dependency, case involvement, in-home services
CWS: Protective custody placement, adoption
Court: Juvenile court termination case involvement
Avoided victim costs from the present through 30 years into the future, as victim costs are experienced over long periods of time e
Tangible: Medical and mental health (anxiety, depression, PTSD, disruptive behavior disorder, disordered alcohol, illicit drug use, and smoking, obesity)f		√	√
Intangible: Pain, suffering, psychological distress, diminished quality of life g			√
Improved earnings and human capital through age 65, due to reductions in CAN h,i		√	√
Other long-term avoided costs causally linked to CAN h,i		√	√
Education: Special education placement, grade retention through age 18
Crime
Premature mortality through age 17

^aBCA=Benefit-cost analysis. CPS=Child Protective Services. CWS=Child welfare system. PTSD=post-traumatic stress disorder. OOHP=Out-of-home-placement. CAN=Child abuse and neglect.

^bBenefits in the Washington State Institute for Public Policy (WSIPP) model reflect avoided costs and increased revenues estimated to accrue over the lifecycle of Promoting First Relationships participants because of impacts on out-of-home placements (OOHP) and implicitly on CAN. Refer to WSIPP’s technical documentation for detailed information about computational routines, unit costs, causal relationship magnitudes, and the like (Washington State Institute for Public Policy, 2018).

^cThis is a conservative assumption as 98% of Supporting Parents Project sample did not have a prior OOHP, the strongest indicator of prior CAN, and most CPS allegations are neither substantiated nor investigated.

^dAvoided costs (i.e., benefits) in each year through age 17 are the product of the likelihood of OOHP occurring in that year, expected CPS, CWS, and court costs per case, and the unit change in OOHP indicated by the intervention effect size.

^eAvoided victim costs in each year through 30 years into the future are the product of the likelihood of CAN occurring in that year, expected direct and indirect costs per case, and the unit change in CAN indicated by the implicit intervention effect size.

^fTangible medical costs are from Miller, Fisher, and Cohen (2001). Tangible mental health, substance use, and obesity costs are from WSIPP’s meta-analyses of the causal relationships between each condition and CAN.

^gIntangible quality-of-life costs are also from Miller et al. (2001).

^hImproved earnings and human capital and other long-term avoided costs avoided reflect WSIPP’s meta-analyses of the causal relationships between each of these outcomes and CAN.

ⁱWSIPP conservatively halves the causal relationship between CAN and each of these indirect benefits areas in BCAs involving treatment populations because some of the indirect cost may already have been incurred prior to intervention. We have not altered this assumption in our analyses.