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Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC)

Children's Mental Health: Other
Benefit-cost methods last updated December 2018.  Literature review updated July 2018.
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Modular treatment (MATCH) consists of a collection of 33 modules from three standard treatment types for child anxiety (Coping Cat), depression (Primary and Secondary Control Enhancement Training), and disruptive behavior (Behavioral Parent Training/Defiant Child). Modular treatment uses a “guiding algorithm” that allows the therapies to vary based on treatment response. For example, the MATCH therapist could jump ahead in the treatment protocol, could omit modules, or could use procedures from multiple programs. MATCH is typically delivered in an individual modality but may include one or more family members for some modules. This analysis includes MATCH provided to children with depression, anxiety, conduct disorders, or trauma.

On average, children in MATCH received 19 therapeutic hours over seven months. Children in the comparison group received standard therapy, which may consist of models such as Coping Cat, Primary and Secondary Control Enhancement Training, or Behavioral Parent Training/Defiant Child but did not include a guiding algorithm or flexible modules of these treatments. Comparison group children received an average of 24 therapeutic hours over a period of eight months.
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 $1,351 Benefits minus costs $4,917
Participants $710 Benefit to cost ratio n/a
Others $1,176 Chance the program will produce
Indirect $1,097 benefits greater than the costs 98 %
Total benefits $4,335
Net program cost $582
Benefits minus cost $4,917
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 $85 $0 $206 $42 $333
Labor market earnings associated with high school graduation $261 $574 $263 $263 $1,361
K-12 grade repetition $20 $0 $0 $10 $30
K-12 special education $324 $0 $0 $162 $485
Health care associated with internalizing symptoms $703 $199 $726 $350 $1,978
Costs of higher education ($41) ($62) ($19) ($21) ($142)
Adjustment for deadweight cost of program $0 $0 $0 $290 $290
Totals $1,351 $710 $1,176 $1,097 $4,335
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,709 2015 Present value of net program costs (in 2017 dollars) $582
Comparison costs $3,276 2015 Cost range (+ or -) 20 %
On average, children in MATCH received 19 therapeutic hours over seven months. Comparison group children received an average of 24 therapeutic hours over a period of eight months. Per-participant costs for both groups are based on weighted average therapist time, as reported in the included studies. Hourly therapist cost is based on the actuarial estimates of reimbursement for family treatment (Mercer. (2016). Mental health and substance use disorder services data book for the state of Washington).
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.

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 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
Externalizing behavior symptoms 10 2 140 -0.280 0.128 10 -0.154 0.102 13 -0.537 0.001
Internalizing symptoms 10 2 140 -0.260 0.128 10 -0.260 0.128 12 -0.501 0.001

Citations Used in the Meta-Analysis

Chorpita, B.F., Park, A.L., Levy, M.C., Krull, J.L., Daleiden, E.L., Cromley, T., Ward, . . . Tsai, K.H. (2017). Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Journal of Consulting and Clinical Psychology, 85(1), 13-25.

Weisz, J.R., Chorpita, B.F., Palinkas, L.A., Schoenwald, S.K., Miranda,J, Bearman, S.K…(2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth. Archives of General Psychiatry 69(3), 274-282