A cost/effectiveness evaluation of lay therapy treatment for child abusing and high risk parents

This longitudinal investigation tested the effectiveness and cost-efficiency of a lay therapy treatment program in comparison with a standard social work treatment approach. A pretest-extended posttest research design was used to follow a group of child abusing and high risk mothers who received lay therapy (N = 27) and a randomized control group of similar clients (N = 28) over a 12-month period. Outcome data were obtained through interview and direct observation of the parents and children at six-month intervals. A variety of standardized instruments were used including Cattell's 16 Personality Factor Test, Coopersmith's Self-Opinion Form, and the Nurturance and Parent Observation Scales, adapted from Baumrind. Treatment success was defined as progression toward the mean scores of a matched comparison group (N = 21) obtained from the general population of the community during the pretest. The results indicated a trend toward improvement on the outcome measures for both treatment groups. The group receiving lay therapy treatment improved only slightly more than the group receiving standard treatment; however, there was also significantly less attrition with the lay therapy group. Analysis of time budget study data indicated that the lay therapists spent an average of 17.46 hours per month with each of their clients thus permitting the social workers to spend considerably less time with lay therapy clients. Analysis of the direct costs of the programs, based on time budget information, indicated that the lay therapy treatment involved more direct client contact than the standard treatment approach and was also substantially more costly. The high cost of the program was attributed to low caseloads and redundancy in supervision. This study presents several practical program and research recommendations.