Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior

Background and Purpose: Providing agencies with comprehensive cost estimates of evidence-based interventions is central to ensuring efficient identification and implementation of programs that are not only impactful but cost effective. As well, accurate cost estimates are needed to facilitate broader dissemination and scale-up. The purpose of this presentation is to share finding from a comprehensive cost analysis of the First Step Next (FSN) intervention. FSN is an evidence-based, Tier 2 intervention implemented with students exhibiting disruptive behavior in educational settings. During implementation, the child receives direct support from the coach during initial implementation. Then, as program implementation shift from the coach to the teacher, the coach’s role becomes consultative, providing on-going support and feedback to the teacher as needed.

Methods: This study used cost data from eight intervention sites which were part of a larger cluster-randomized controlled trial of FSN in preschool settings (Feil et al., in press; (IES; R324A150221). The study also reported on maintenance costs for providing booster support in Kindergarten the following year. The eight sites included two early childhood centers and six elementary schools in Kentucky. The number of classrooms per site ranged from two to six (M = 3.6, SD = 1.6). Across the sites, 29 teacher-child-parent triads participated in the program. Children had a mean age of 4.1 years and were predominately Black (69%) and male (70%). We used the Ingredients Method (Levin et al., 2012) to estimate total and average costs per student; the incremental cost of delivering FSN to one additional student; and the cost of disseminating FSN to 40 students within one school district. Data sources for these estimates included personnel wage and fringe benefit rates; personnel hours; supplies; and overhead. We utilized the Implicit Price Deflator for Personal Consumption Expenditures to adjust all nominal unit prices. We also conducted a sensitivity analysis to examine implementation costs associated with a variety of cost drivers.

Results: For the 29 participating triads, intervention costs (including overhead) were $125,556 for the preschool and Kindergarten year. Thus, on average, implementation costs were $4,330 per student. Most of the investment (80%) was in the preschool year. Pre-intervention activities (e.g., screening and meetings) made up 34% of costs; whereas, 55% were tied to intervention activities. Personnel costs comprised 80% of total costs with overhead accounting for an additional 16% of cost. Efficiencies were gained once FSN infrastructure was in place. The cost per additional student was 31% lower than the average per student cost.

Conclusions and Implications: The long-term societal costs for supporting youth with disruptive behavior disorders is well documented. This study provides a systematic and replicable comprehensive cost analysis of an evidence-based program designed to mitigate disruptive behavior early in a child’s academic career.