Do Parent Training Services Result in Lowered Child Mental Health Expenditures? a Study of Medicaid Data from 36 States

Background and Purpose: Interventions designed to improve the quality of parenting of caregivers of children with histories of maltreatment are a mainstay of child welfare services. While these services are designed to support parents, their intermediate goal is to reduce repeat maltreatment, and ultimately reduce emotional burdens among children of these parents. We examined whether receipt of parent training services is associated with reduced mental health expenditures among a national cohort of children coming into contact with child protective services.

Methods: We obtained social security numbers and other identifiers for child participants in the first National Survey of Child and Adolescent Well-Being (NSCAW) - the nation’s first national probability sample of children coming into contact with child protective services. Using deterministic and probabilistic approaches, we linked these data to Medicaid claims from 36 states for the years 2000-2003. These claims were used to construct the outcome variable of the child’s annual expenditure on psychotropic drugs. From NSCAW’s caregiver interviews we obtained information on whether the respondent received “any special instruction or training” in parenting skills, or any “parent classes.” This variable, and other child demographic, need, caregiver, and caseworker variables were used to estimate a 2-part model to quantity calendar-year expenditures on psychotropic drugs by child participants. All expenditures were adjusted to 2013 dollars.  

Results: A total of 1046 (24%) of children had caregivers who reported receiving special instruction or training, and 1646 (37%) of children had caregivers who had received parenting classes. There were no significant differences in the child’s mean annual psychotropic drug expenditures between those who received and did not receive training ($578 and $443, respectively), and between those who received and did not receive parenting classes ($418 and $437, respectively).

Conclusions and Implications: Receipt of parent training or parenting classes does not seem to reduce mental health expenditures on psychotropic drugs for children with histories of maltreatment. It is unclear if this is because of heterogeneity in the nature of parent training, in variations in effectiveness of parent training, or because psychotropic drug expenditures are too distal of an outcome on which to exert effects. From a mental health services perspective, current parent training programs do not seem to exert significant effects upon child mental health expenditures.