Parent coaching program for children with emerging developmental disabilities while on a waitlist for services: cost analysis from a family payer perspective

Pre-school children with or at risk of developmental disabilities have diverse care needs in this critical period for neurodevelopment. Complexities in service delivery, wait times, and variable access can leave parents uncertain about how best to seek assistance for their children’s arising functional vulnerabilities. Despite higher costs, parents may resort to alternative private options to alleviate wait times for child development services. This study compared the services accessed and associated out-of-pocket (OOP) costs incurred by families in four Canadian provinces who engaged in a parent coaching intervention aimed at empowering parents in managing their child’s chronic disabilities with those who received usual care. The cost analysis was conducted alongside the BRIGHT Coaching randomized controlled trial in Quebec, British Columbia, Nova Scotia, and Manitoba. Families were randomized by a 1:1 allocation of intervention to control and clustered by provinces. Both groups could access health, education and community services. Parent-reported service utilization and costs were collected with the Resource Use Questionnaire at baseline, 8 months (post-coaching program), and 12 months (follow-up). From a family payer perspective, services were costed, encompassing OOP costs for parents and their children. No statistically significant differences were observed in the median OOP costs per family between the control and intervention groups. Quebec had the highest mean OOP costs per child, while British Columbia had the highest for parents. The two-part model estimated the mean OOP costs per family over 12 months to be $2103.14 (95% CI: 1418.79, 2787.50), with the intervention group having, on average, $679.61 (p-value > 0.05, 95% CI: -479.00, 1838.22) higher costs than the control group; province, household income and parent education level were significant covariates. The results suggest that families of children with emerging developmental disabilities incur considerable OOP expenses. The findings highlight these families’ complex needs and financial challenges and may help inform policy decisions on improving support for this population. ClinicalTrial.gov NCT03880383 https//clinicaltrials.gov/study/NCT03880383. Registration Date 2019-03-19.