A new report from PSSRU suggests that adapted parenting programmes for people with learning disabilities might be a cost-effective way of providing support for this group. The authors – Annette Bauer (Research Fellow) and Gemma Williams (Research Officer) – discuss their findings.
People with learning difficulties face a number of challenges when they become parents; it is often difficult for them to learn the necessary skills to ensure their children grow up healthy and safe. Without additional support, parents are likely to lose their children into care, which presents a substantial economic burden for local authorities. Various interventions exist in the UK to avoid this outcome, but not much is known about their (cost-) effectiveness.
One such intervention is the Mellow Futures parenting programme funded by the Department of Health. The programme was piloted in 2014 in two localities in England: the Borough of Islington in London and Northumberland in the North-East. Mellow Futures (piloted as part of the Parents Pioneers programme), is an adapted version of the Mellow Bumps and Babies programme, run by Mellow Parenting. The programme is provided at this early stage which is a particularly challenging time for mothers (to be). It is also the time when concerns are commonly raised by professionals about the child’s safety and children are most likely to be removed from home.
Data for our research were collected as part of an evaluation led by Norah Fry Research Centre at Bristol University which is known for its work in this area and the charity Mencap. The aim was to explore the (cost-) effectiveness and acceptability of the two programmes. Between 2012 and 2015, information on resource use (transformed later into costs of care package) were collected in interviews with mothers. In addition, a number of child outcomes (including those that related to child’s safeguarding) and a wide range of information about the family situations were collected (further details are available from the full report. Local budget and activity data were also collected to estimate the costs of the programmes.
We determined that the pilot programmes were likely to offset the costs of delivery and lead to government savings in the short-term. Costs of the programmes, which were £2,347 per mother in the London borough (Islington) and £1,973 in the North East (Northumberland), were offset by potential cost reductions of £4,237 (Islington) and £1,287 (Northumberland). These cost reductions refer to reduced spending for child safeguarding, care proceedings and provision.
The costs of the parenting programme were a small proportion (under a fifth) of the overall costs of care package in Islington (£12,591) but represented almost half of the costs of care package in Northumberland (£4,005). This indicates that much more intensive support was provided in the London borough. The higher level of support appeared to be linked to a higher chance of the child remaining with the mother.
We were not able to examine the cost-effectiveness of a mentoring scheme that was run by volunteers alongside the parenting programme; however, the costs for building up the Scheme were high (£47,932) and volunteers’ outcomes unclear. Funders and providers who plan to incorporate a volunteering component should carefully plan and monitor the outcomes they hope to get out of such schemes.
Our economic study had a number of limitations. There were a range of challenges typical for research in this area: it is possible that outcomes were achieved not because of the parenting programmes but due to other services taking place at the same time, the mother’s characteristics or other factors in the mother’s environment, such as increased familial support. In addition, the study only investigated short-term outcomes and cost consequences. In the future, it will be important to understand the long-term support that might be required for mothers and families.
Despite these limitations, findings from our study add to an important evidence gap. At present, little evidence is available on the cost-effectiveness of adapted parenting programmes for people with learning disabilities. The one study we identified (carried out in Belgium) found that an adapted version of the mainstream Triple P parenting programme provided when the child was already an adolescent reduced psychological stress, improved parenting and reduced child conduct problems. Costs were not evaluated in that study.
Together with questions over whether such programmes can be implemented (feasibility) and achieve positive outcomes (effectiveness), there is a question as to whether they represent value for money (cost-effectiveness). If an intervention is achieving positive outcomes and adverse effects are unlikely, then the question of cost-effectiveness can be simplified to those of short-term savings. The findings from our study thus indicate that parenting programmes can be a cost-effective support option for parents with a learning disability.
Parents with learning disabilities are at a particular high risk if losing their children into care; providing additional support, such as parenting programmes, is not only important for the family but should, as suggested by our research, also be a Government priority. More research is needed to understand what support is feasible, effective and cost-effective for this group.
Bauer A, Williams G (2015) Costs and Economic Consequences of Parent Pioneers, A Pilot Mellow Futures Programme for Mothers with Learning Difficulties, PSSRU Discussion Paper 2903, Personal Social Services Research Unit, London.
About the authors
Annette Bauer is Research Fellow within the Personal Social Services Research Unit (PSSRU) at LSE.
Gemma Williams is a Ph.D. candidate in health economics at the Department of Social Policy, LSE and a global health researcher within LSE Health.