Cost-Effectiveness Analysis of First Step Next for Preschoolers with Social-Emotional Needs

Background and Purpose: Few cost-effectiveness studies have been conducted on social-emotional interventions for students in preschool settings. The current study is a cost-effectiveness analysis (CEA) of the First Step Next (FSN) intervention for preschool students.

Methods: One hundred-sixty triads (i.e., student, teacher, and parent) participated in the efficacy study to assess the impact of the FSN intervention on student outcomes in the home and preschool setting. We conducted the CEA from the provider’s perspective utilizing effect sizes across outcomes in home and preschool setting and a comprehensive analysis using the ingredients method to estimate costs. We calculated incremental cost-effectiveness ratios (ICERs) by dividing the incremental cost estimate for implementing FSN by the effect size (ES) for each outcome, which yields an ICER for each outcome equivalent to the cost per student to generate a one standard deviation change in a student’s score on an outcome. To understand uncertainty in ICER estimates, we conducted a simulation to evaluate a potential variation of ICER estimates for behavioral outcome measures as a sensitivity check.

Results: Effect sizes in the classroom setting ranged from .73 to .93 for improvements in prosocial behavior and from .33 to .80 for problem behavior, relational aggression, and child-teacher conflict. Parent- and caregiver-reported effect sizes for social skills and problem behavior in the home setting were .34. The incremental cost, or cost of providing the FSN intervention to an additional student within a preschool center or school after staff are trained and FSN has been implemented, in 2021 dollars was $2,575 when including overhead and $2,152 when excluding overhead costs. ICERs ranged from $2,830 to $7,803 in the preschool setting and were $7,574 for both home setting outcomes. FSN was more cost-effective for improving behavior in the preschool setting than in the home setting, with an average cost per 1 SD improvement of $3,833 and $6,329, respectively.

Conclusions and Implications FSN had greater cost-effectiveness for social skill-related outcomes than problem behavior-related outcomes among preschool students. Our findings also demonstrate the FSN intervention was more cost-effective for improving children's prosocial behaviors (i.e., social skills and adaptive behaviors) and child-teacher relationships than for reducing problem behavior (e.g., maladaptive behavior, aggression). Findings suggest that in the preschool years, the FSN intervention is relatively stronger at promoting social competency than reducing problem behavior, although there is benefit in both domains. This study advances our understanding of the costs and outcomes of practices designed to improve the school success of our youngest learners. Economic evaluations of evidence-based practices are critical for school leaders, administrators, and program planners who want to understand the impact of the available interventions and determine whether they have the resources to implement them. From a policy perspective, understanding associations between costs and outcomes can also bolster knowledge that contributes to or sustains early childhood funding priorities, federal and state investments, and legislative decisions. By distilling the relationships between costs and social-emotional improvements in early childhood, CEA studies can serve as advocacy platforms for investing in Pre-K and Head Start settings.