Stanford University, Department of Medicine, Centers for Health Policy and Primary Care and Outcomes Research, CA 94305-6019, USA.
Child Abuse Negl. 2011 Sep;35(9):722-40. doi: 10.1016/j.chiabu.2011.05.012. Epub 2011 Sep 23.
With over 1 million children served by the US Child Welfare system at a cost of $20 billion annually, this study examines the economic evaluation literature on interventions to improve outcomes for children at risk for and currently involved with the system, identifies areas where additional research is needed, and discusses the use of decision-analytic modeling to advance Child Welfare policy and practice.
The review included 19 repositories of peer-reviewed and non-peer-reviewed "gray" literatures, including items in English published before November, 2009. Original research articles were included if they evaluated interventions based on costs and outcomes. Review articles were included to assess the relevance of these techniques over time and to highlight the increasing discussion of methods needed to undertake such research. Items were categorized by their focus on: interventions for the US Child Welfare system; primary prevention of entry into the system; and use of models to make long-term projections of costs and outcomes.
Searches identified 2,640 articles, with 49 ultimately included (19 reviews and 30 original research articles). Between 1988 and 2009, reviews consistently advocated economic evaluation and increasingly provided methodological guidance. 21 of the original research articles focused on Child Welfare, while 9 focused on child mental health. Of the 21 Child Welfare articles, 81% (17) focused on the US system. 47% (8/17) focused exclusively on primary prevention, though 83% of the US system, peer-reviewed articles focused exclusively on prevention (5/6). 9 of the 17 articles included empirical follow-up (mean sample size: 264 individuals; mean follow-up: 3.8 years). 10 of the 17 articles used modeling to project longer-term outcomes, but 80% of the articles using modeling were not peer-reviewed. Although 60% of modeling studies included interventions for children in the system, all peer-reviewed modeling articles focused on prevention.
Methodological guidance for economic evaluations in Child Welfare is increasingly available. Such analyses are feasible given the availability of nationally representative data on children involved with Child Welfare and evidence-based interventions.
Policy analyses considering the long-term costs and effects of interventions to improve Child Welfare outcomes are scarce, feasible, and urgently needed.
在美国儿童福利系统中，每年有超过 100 万名儿童得到服务，耗资 200 亿美元。本研究考察了干预措施的经济评估文献，这些干预措施旨在改善有风险和已经参与该系统的儿童的结果，确定了需要进一步研究的领域，并讨论了使用决策分析模型来推进儿童福利政策和实践。
综述包括 19 个同行评议和非同行评议的“灰色”文献库，其中包括 2009 年 11 月前发表的英文文献。如果研究评估了基于成本和结果的干预措施，则纳入原始研究文章。综述文章的纳入是为了评估这些技术随时间的相关性，并强调为进行此类研究所需的方法的讨论日益增加。根据其重点，将项目分为以下几类：美国儿童福利系统的干预措施；系统进入的初步预防；以及使用模型对成本和结果进行长期预测。
搜索确定了 2640 篇文章，最终纳入了 49 篇（19 篇综述和 30 篇原始研究文章）。1988 年至 2009 年期间，综述文章一直倡导经济评估，并越来越多地提供方法指导。30 篇原始研究文章中有 21 篇关注儿童福利，9 篇关注儿童心理健康。在 21 篇儿童福利文章中，81%（17 篇）关注美国系统。其中 47%（8/17）专门关注初步预防，而 83%的美国系统、同行评议的文章专门关注预防（5/6）。17 篇文章中有 9 篇包括实证随访（平均样本量：264 人；平均随访：3.8 年）。17 篇文章中有 10 篇使用模型来预测更长期的结果，但使用模型的文章中只有 80%是同行评议的。虽然 60%的建模研究包括系统内儿童的干预措施，但所有同行评议的建模文章都侧重于预防。
儿童福利经济评估的方法指导越来越多。考虑到全国范围内涉及儿童福利的儿童数据和循证干预措施的可用性，这种分析是可行的。
考虑改善儿童福利结果的干预措施的长期成本和效果的政策分析很少，但是可行的，并且迫切需要。
