The role of incentives in the improvement of health

Cost-effectiveness of childcare discounts on parent participation in preventive parent training in low-income communities

We tested the cost-effectiveness of giving low-income parents childcare discounts contingent on their participation in the Chicago Parent Program, a 12-session preventive parent training (PT) program offered at their child's daycare center. Eight centers were matched and randomized to an experimental condition in which parents received a discount on their childcare bill (M = $8.92 per session attended) or a control group with no financial incentive. Participants (n = 174) consisted mostly of African American (55%) or Latino (42%) mothers, 62% reporting annual household incomes less than $20,000. Parents in the discount condition were 15.4% more likely to enroll than control parents, though this difference was not significant. There were no differences in PT attendance, parents' motivations for enrolling, or the degree to which parents were actively engaged in PT sessions by condition. Despite the added cost of the discounts, there was no difference in group costs by condition. Parent interviews revealed important challenges in implementing financial incentive programs in community-based agencies serving low-income families. Cost simulations show how low parent enrollment or low attendance negatively affect the economic efficiency of group-based PT. Implications for policies guiding financial incentive programs targeting low-income families and their participation in prevention programs are discussed.