Journal of Child and Family Studies

, Volume 27, Issue 6, pp 1950–1956 | Cite as

Cost Effectiveness of Strategies for Recruiting Low-Income Families for Behavioral Parent Training

  • Olga A. KhavjouEmail author
  • Patrick Turner
  • Deborah J. Jones
Original Paper


The goal of this study was to assess cost, effectiveness, and cost-effectiveness of recruitment strategies used to engage low-income families of young children with disruptive behavior disorder to participate in a Behavioral Parent Training (BPT) program. For this analysis, we used data on labor and non-labor resources associated with 13 recruitment strategies implemented in February 2014 through February 2016. We assessed the effectiveness of each strategy as the number of families that enrolled into the study. Cost-effectiveness of each recruitment strategy was expressed as cost per family enrolled; analysis was conducted in 2016. We calculated the cost of total recruitment effort for 13 strategies during the 2-year period to be $11,496 with an average cost of $885 per recruitment strategy or $255 per enrolled family. Across strategies, total costs ranged from $25 to $2540. “University mass e-mail” and “school flyers” resulted in the most phone screens (34 each); however, only 10% of these families enrolled in the study (three and four families, respectively). “Craigslist” was the most effective strategy with 30 families screened and 11 of them enrolling. Three strategies did not yield any participants. The four strategies with the lowest cost per family enrolled were “Facebook page,” “Craigslist,” “university mass e-mail,” and “organization/agency” (<$90). In conclusion, we found that some recruitment strategies were more successful at engaging low-income families to participate in a BPT program than others. Our results indicate that using a combination of recruitment strategies may be the optimal approach for recruiting low-income families.


Behavioral parent training Disruptive behavior disorder Recruitment strategies Cost-effectiveness 


Author Contributions

All co-authors contributed substantively to the research questions, hypotheses, and writing of the manuscript. In addition, OAK developed and implemented the cost data collection approach and assisted with the data analyses and interpretation; PT completed data management and analyses; and DJJ is principal investigator of the parent study upon which this study is based.


This report was prepared with support from the National Institute of Mental Health (grant 1-R01-MH100377).

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. University of North Carolina at Chapel Hill provided IRB approval for the study.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Addy, S., Anglehart, W., & Skinner, C. (2013). Fact sheet: Basic facts about low income children: children under 18 years—2011. National Center for Children in Poverty.
  2. American Psychological Association (2016). About the office on socioeconomic status. Scholar
  3. August, G. J., Realmuto, G. M., MacDonald, A. W., Nugent, S. M., & Crosby, R. (1996). Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. Journal of Abnormal Child Psychology, 24(5), 571–595. Scholar
  4. Bureau of Labor Statistics, US Department of Labor (2015). Occupational outlook handbook, 2016–17 Edition, Mental health counselors and marriage and family therapists. Scholar
  5. Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., & Starace, N. (2011). Evidence-based treatmentsfor children and adolescents: an updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18(2), 154–172. Scholar
  6. Conger, R. D., & Donnellan, M. B. (2007). An interactionist perspective on the socioeconomic context of human development. Annual Review of Psychology, 58, 175–199. Scholar
  7. Costello, E. J., Egger, H., SpringerAmpamp; Angold, A. (2005). 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry, 44(10), 972–986. Scholar
  8. Dodge, K. A., Malone, P. S., Lansford, J. E., Miller, S., Pettit, G. S., & Bates, J. E. (2009). A dynamic cascade model of the development of substance-use onset. Monographs of the Society for Research in Child Development, 74(3), 119. vii-.CrossRefGoogle Scholar
  9. Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37(1), 215–237. Scholar
  10. Eyberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory & Sutter-Eyberg student behavior inventory-revised: professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
  11. Forehand, R., Jones, D. J., & Parent, J. (2013). Behavioral parenting interventions for child disruptive behaviors and anxiety: what’s different and what’s the same. Clinical Psychology Review, 33(1), 133–145. Scholar
  12. Gardner, F., Connell, A., Trentacosta, C. J., Shaw, D. S., Dishion, T. J., & Wilson, M. N. (2009). Moderators of outcome in a brief family-centered intervention for preventing early problem behavior. The Journal of Consulting and Clinical Psychology, 77(3), 543–553. Scholar
  13. Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. M. (2010). Engaging families into child mental health treatment: updates and special considerations. Journal of the American Academy of Child and Adolescent Psychiatry, 19(3), 182–196.Google Scholar
  14. Jiang, Y., Ekono, M., & Skinner, C. (2016). Basic facts about low-income children: children under 18 years, 2014. New York, NY: National Center for Children in Poverty, Mailman School of Public Health, Columbia University.Google Scholar
  15. Jones, D. J., Anton, M., Zachary, C., Pittman, S., Turner, P., Forehand, R., & Khavjou, O. (2016). A review of the key considerations in mental health services research: a focus on low-income children and families. Couple and Family Psychology: Research and Practice, 5(4), 240–257. Scholar
  16. Jones, D. J., Forehand, R., Cuellar, J., Kincaid, C., Parent, J., Fenton, N., & Goodrum, N. (2013). Harnessing innovative technologies to advance children’s mental health: behavioral parent training as an example. Clinical Psychology Review, 33(2), 241–252. Scholar
  17. Jones, D. J., Forehand, R., Cuellar, J., Parent, J., Honeycutt, A., Khavjou, O., & Newey, G. A. (2014). Technology-enhanced program for child disruptive behavior disorders: development and pilot randomized control trial. Journal of Clinical Child & Adolescent Psychology, 43(1), 88–101. Scholar
  18. Kaehler, L. A., Jacobs, M., & Jones, D. J. (2016). Distilling common history and practice elements to inform dissemination: Hanf-model BPT programs as an example. Clinical Child and Family Psychology Review, 19(3), 236–258. Scholar
  19. Larson, K., Russ, S. A., Kahn, R. S., & Halfon, N. (2011). Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics, 127(3), 462–470. Scholar
  20. Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., & Sheehan, K. H., et al. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231. 10.1016/S0924-9338(97)83296-8.CrossRefGoogle Scholar
  21. Leijten, P., Raaijmakers, M. A., de Castro, B. O., & Matthys, W. (2013). Does socioeconomic status matter? A meta-analysis on parent training effectiveness for disruptive child behavior. Journal of Clinical Child & Adolescent Psychology, 42(3), 384–392. Scholar
  22. McMahon, R. J., & Forehand, R. (2003). Helping the noncompliant child: family-based treatment for oppositional behavior (2nd ed.). New York, NY: Guilford Press.Google Scholar
  23. Mendez-Luck, C. A., Trejo, L., Miranda, J., Jimenez, E., Quiter, E. S., & Mangione, C. M. (2011). Recruitment strategies and costs associated with community-based research in a Mexican-origin population. The Gerontologist, 51(Suppl 1), S94–S105. Scholar
  24. Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20.PubMedPubMedCentralGoogle Scholar
  25. Moffitt, T. E., Arseneault, L., Jaffee, S. R., Kim-Cohen, J., Koenen, K. C., & Odgers, C. L., et al. (2008). Research review: DSM-V conduct disorder: research needs for an evidence base. Journal of Child Psychology and Psychiatry, 49(1), 3–33. Scholar
  26. National Institute of Mental Health (2016). Transforming and understanding the treatment of mental illnesses: Division of Services and Intervention Research (DSIR).
  27. Reitman, D., & McMahon, R. J. (2012). The mentor and the model. Cognitive and Behavioral Practice, 20, 106–116. Scholar
  28. Rodriguez, M. D., Rodriguez, J., & Davis, M. (2006). Recruitment of first-generation Latinos in a rural community: the essential nature of personal contact. Family Process, 45(1), 87–100. Scholar
  29. Schnirer, L., & Stack-Cutler, H. (2012). Recruitment and engagement of low-income populations: Service provider and researcher perspectives. Community-University Partnership for the Study of Children, Youth, and Families.Google Scholar
  30. Shaw, D. S., & Bell, R. Q. (1993). Developmental theories of parental contributors to antisocial behavior. The Journal of Abnormal Child Psychology, 21(5), 493–518. Scholar
  31. Southern Education Foundation (2015). Low income children now a majority in the nation’s public schools. Scholar
  32. Thomas, R., & Zimmer-Gembeck, M. J. (2007). Behavioral outcomes of parent-child interaction therapy and triple P-positive parenting program: a review and meta-analysis. The Journal of Abnormal Child Psychology, 35(3), 475–495. Scholar
  33. Xue, Y., Leventhal, T., Brooks-Gunn, J., & Earls, F. J. (2005). Neighborhood residence and mental health problems of 5- to 11-year-olds. Archives of General Psychiatry, 62(5), 554–563. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.RTI InternationalResearch Triangle ParkUSA
  2. 2.University of North Carolina at Chapel HillChapel HillUSA

Personalised recommendations