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Incredible Years Parent Training with Incredible Years Child Training

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2018.  Literature review updated July 2018.
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Incredible Years Parent Training is a group, skills-based behavioral intervention for parents of children with disruptive behavior. The curriculum focuses on strengthening parenting skills (monitoring, positive discipline, confidence) and fostering parents' involvement in children's school experiences in order to promote children's academic, social, and emotional competencies and reduce conduct problems. In the studies included in this review, children also received Incredible Years Child Training concurrent to the parent training. The program consists of 12 to 16 weekly two-hour sessions provided by trained therapists separately to parents and children. Parent sessions include videotape modeling of parenting skills and focused discussion of the skills portrayed in the vignettes. Training classes include child care, a family meal, and transportation. Children are taught social, emotional, and academic skills, such as understanding and communicating feelings, using effective problem solving strategies, managing anger, practicing friendship, and conversational skills, as well as appropriate classroom behaviors.
BENEFIT-COST
META-ANALYSIS
CITATIONS
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2017). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $328 Benefits minus costs ($3,779)
Participants $183 Benefit to cost ratio ($0.21)
Others $257 Chance the program will produce
Indirect ($1,431) benefits greater than the costs 2 %
Total benefits ($662)
Net program cost ($3,117)
Benefits minus cost ($3,779)
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $9 $0 $22 $5 $35
Labor market earnings associated with high school graduation $69 $152 $70 $0 $291
K-12 grade repetition $1 $0 $0 $1 $2
K-12 special education $95 $0 $0 $47 $142
Health care associated with disruptive behavior disorder $165 $47 $170 $81 $463
Costs of higher education ($10) ($16) ($5) ($5) ($36)
Adjustment for deadweight cost of program $0 $0 $0 ($1,559) ($1,559)
Totals $328 $183 $257 ($1,431) ($662)
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $3,970 2015 Present value of net program costs (in 2017 dollars) ($3,117)
Comparison costs $868 2010 Cost range (+ or -) 40 %
Incredible Years Parent Training with Incredible Years Child Training costs include both therapist time and additional program costs. Participants in the treatment studies received a weighted average of 32 hours of therapist time for parents, and 32 hours of therapist time for children. Hourly therapist cost is based on the actuarial estimates of reimbursement by modality (Mercer. (2016). Mental health and substance use disorder services data book for the state of Washington). Additional program costs include training, materials, and implementation fees (e.g., childcare or transportation) as reported in Foster, Olchowski, & Webster-Stratton (2007). Is stacking intervention components cost-effective? An analysis of the Incredible Years program. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1414-1424. We apply these costs to the average duration of the programs as reported in the studies (16 two-hour sessions for adults and 16 two-hour sessions for children) and assume that treatment groups included six families. For comparison group costs we used 2010 Washington State DSHS data to estimate the average reimbursement rate for treatment of child and adolescent disruptive behavior disorders.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Attention-deficit/hyperactivity disorder symptoms 7 Primary 1 48 -0.064 0.204 7 0.000 0.141 8 -0.517 0.019
Disruptive behavior disorder symptoms 7 Primary 4 259 -0.056 0.091 7 -0.031 0.056 10 -0.549 0.025
Internalizing symptoms 7 Primary 3 241 -0.067 0.096 7 -0.067 0.096 9 -0.197 0.098
Parental stress^ 33 Secondary 2 69 -0.258 0.197 34 n/a n/a n/a -0.780 0.001

Citations Used in the Meta-Analysis

Barrera, M., Biglan, A., Taylor, T.K., Gunn, B.K., Smolkowski, K., Black, C., . . . Fowler, R.C. (2002). Early elementary school intervention to reduce conduct problems: A randomized trial with Hispanic and non-Hispanic children. Prevention Science, 3(2), 83-94.

Larsson, B., Fossum, S., Clifford, G., Drugli, M.B., Handegard, B.H., & Morch, W.T. (2009). Treatment of oppositional defiant and conduct problems in young Norwegian children: Results of a randomized controlled trial. European Child & Adolescent Psychiatry, 18(1), 42-52.

Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65(1), 93-100.

Webster-Stratton, C., Reid, M.J., & Beauchaine, T.P. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child and Adolescent Psychology, 40(2), 191-203.