Prevention Science

, Volume 20, Issue 8, pp 1219–1232 | Cite as

Comprehensive Cost Analysis of First Step Next for Preschoolers with Disruptive Behavior Disorder: Using Real-World Intervention Data to Estimate Costs at Scale

  • Andy J. FreyEmail author
  • Margaret R. Kuklinski
  • Kiersten Bills
  • Jason W. Small
  • Steven R. Forness
  • Hill M. Walker
  • Edward G. Feil
  • John R. Seeley


While the long-term societal costs for youth with disruptive behavior disorders are well documented, there is a dearth of information about the comprehensive costs of implementing even the most well-regarded early intervention programs, and the costs of scaling effective interventions are even less well understood. This study estimated the costs of delivering and disseminating First Step Next (FSN), an established tier two school-based early intervention, in preschool and kindergarten settings, including the training and ongoing technical assistance that support sustained, high-quality implementation. Using the Ingredients Method, we estimated (a) the per student costs of implementation, (b) the incremental cost of offering FSN to an additional student, and (c) the cost to disseminate FSN to 40 preschool and kindergarten students, including a sensitivity analysis to examine potential areas of cost savings. The per child cost to implement the FSN intervention with 29 triads in two cohorts was $4330. The incremental cost per additional student was only $2970, highlighting efficiencies gained once intervention infrastructure had been established. The cost of disseminating the intervention to a single cohort of 40 students was $170,106, or $4253 per student. The range in sensitivity analysis was $3141–$7829 per student, with variability in personnel wages having the greatest impact on cost estimates. This research expands on existing literature by providing a more comprehensive understanding of the cost of effective disruptive behavior interventions based on real-world implementation data, using these data to estimate dissemination costs, and showing how dissemination costs are particularly sensitive to personnel wages.


Cost analysis Behavior disorders Preschool Early intervention 


Availability of Data and Material

In addition to the tables presented in this manuscript, we have several tables that contain the raw data used to create the cost analysis. These are available upon request.


This study is funded by the Institute for Education Sciences #R324A150221.

Compliance with Ethical Standards

Conflict of Interest

Ed Feil and Hill Walker are two of the authors of the First Step Next intervention. The other authors declare that they have no competing interests.

Research Involving Human Participants: Statement of Human Rights

The study has been approved by the appropriate institutional and/or national research ethics committee (i.e., Oregon Research Institute and University of Louisville, and Jefferson County Public Schools) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Research Involving Human Participants: Informed Consent

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

Consent for Publication

This manuscript contains no individual data requiring consent for publication.


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Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  • Andy J. Frey
    • 1
    Email author
  • Margaret R. Kuklinski
    • 2
  • Kiersten Bills
    • 1
  • Jason W. Small
    • 3
  • Steven R. Forness
    • 4
  • Hill M. Walker
    • 3
    • 5
  • Edward G. Feil
    • 3
  • John R. Seeley
    • 3
    • 5
  1. 1.Kent School of Social WorkUniversity of LouisvilleLouisvilleUSA
  2. 2.Social Development Research Group, School of Social WorkUniversity of WashingtonSeattleUSA
  3. 3.Oregon Research InstituteEugeneUSA
  4. 4.University of CaliforniaLos AngelesUSA
  5. 5.College of EducationUniversity of OregonEugeneUSA

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