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Washington State Institute for Public Policy
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Child-Parent Psychotherapy

Children's Mental Health: Trauma
Benefit-cost methods last updated December 2018.  Literature review updated June 2018.
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Child-Parent Psychotherapy is an intervention for parents and young children that aims to strengthen the relationship between parent and child, thereby increasing the child’s sense of safety and security. In one of the two studies in the review, children had witnessed domestic violence. In the other, mothers had diagnoses of depression. The intervention consists of weekly psychotherapy sessions where both child and parent are present. The program is designed to consist of 50 weekly sessions. Among studies included in this analysis, participants received an average of 39 therapeutic hours over a period of 12 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 $23,252 Benefits minus costs $64,396
Participants $34,165 Benefit to cost ratio $15.59
Others $9,160 Chance the program will produce
Indirect $2,233 benefits greater than the costs 95 %
Total benefits $68,810
Net program cost ($4,414)
Benefits minus cost $64,396
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
K-12 grade repetition $0 $0 $0 $0 $0
Labor market earnings associated with PTSD $4,438 $9,774 $0 $0 $14,212
Health care associated with PTSD $3,793 $1,072 $3,914 $1,880 $10,660
Mortality associated with depression $0 $0 $0 $0 ($1)
Subtotals $8,231 $10,846 $3,914 $1,880 $24,872
From secondary participant
Labor market earnings associated with PTSD $9,936 $21,879 $0 $0 $31,815
Health care associated with PTSD $5,083 $1,437 $5,245 $2,519 $14,284
Mortality associated with depression $1 $3 $0 $35 $40
Subtotals $15,020 $23,319 $5,245 $2,554 $46,138
Adjustment for deadweight cost of program $0 $0 $0 ($2,200) ($2,200)
Totals $23,252 $34,165 $9,160 $2,233 $68,810
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $5,406 2015 Present value of net program costs (in 2017 dollars) ($4,414)
Comparison costs $1,035 2010 Cost range (+ or -) 20 %
On average, participants received 39 therapeutic hours. Per-participant cost estimates 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). For comparison group costs, we use 2010 Washington State DSHS data to estimate the average reimbursement rate for treatment of post-traumatic stress disorder (PTSD) or trauma in children and adolescents.
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
Major depressive disorder 3 Primary 1 42 -0.385 0.238 3 0.000 0.310 5 -0.385 0.106
Post-traumatic stress 3 Primary 1 42 -0.629 0.239 3 -0.629 0.239 4 -0.629 0.008
Preschool test scores^ 3 Primary 1 43 0.242 0.205 3 n/a n/a n/a 0.484 0.020
Major depressive disorder 31 Secondary 1 42 -0.433 0.236 31 -0.225 0.289 33 -0.433 0.066
Post-traumatic stress 31 Secondary 1 42 -0.440 0.237 31 -0.440 0.237 32 -0.440 0.063

Citations Used in the Meta-Analysis

Cicchetti, D., Rogosch, F.A., & Toth, S. L. (2000). The Efficacy of Toddler-Parent Psychotherapy for Fostering Cognitive Development in Offspring of Depressed Mothers. Journal of Abnormal Child Psychology, 28(2), 135-148.

Ghosh Ippen, C., Harris, W.W., Van, H.P., & Lieberman, A.F. (2011). Traumatic and stressful events in early childhood: Can treatment help those at highest risk? Child Abuse & Neglect, 35(7), 504-513.