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Parent Management Training - Oregon Model (Prevention population)

Public Health & Prevention: Home- or Family-based
Benefit-cost methods last updated December 2017.  Literature review updated May 2015.
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Parent Management Training—Oregon Model (PMTO) is a family-based program that teaches parents to apply five parenting practices: skill encouragement, appropriate discipline, monitoring, problem solving, and positive involvement. This program can be delivered in a group format or an individual family therapy format; our analysis included both types. This analysis focuses on the use of PMTO to prevent behavior problems. In the evaluations we reviewed, the program was tested in two populations: 1) elementary school aged boys being raised by single mothers and 2) Latino boys and girls in middle school.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). 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 $1,762 Benefits minus costs $5,587
Participants $2,274 Benefit to cost ratio $9.50
Others $2,171 Chance the program will produce
Indirect $37 benefits greater than the costs 61 %
Total benefits $6,244
Net program cost ($657)
Benefits minus cost $5,587
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 $629 $0 $1,431 $317 $2,377
Labor market earnings associated with high school graduation $592 $1,304 $601 $0 $2,497
K-12 grade repetition ($1) $0 $0 ($1) ($2)
K-12 special education $6 $0 $0 $3 $10
Health care associated with disruptive behavior disorder $11 $4 $13 $5 $33
Costs of higher education ($60) ($90) ($27) ($30) ($208)
Subtotals $1,177 $1,217 $2,018 $295 $4,708
From secondary participant
Labor market earnings associated with major depression $462 $1,016 $0 $9 $1,487
Health care associated with major depression $123 $40 $153 $62 $378
Subtotals $585 $1,057 $153 $71 $1,866
Adjustment for deadweight cost of program $0 $0 $0 ($329) ($329)
Totals $1,762 $2,274 $2,171 $37 $6,244
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $619 2011 Present value of net program costs (in 2016 dollars) ($657)
Comparison costs $0 2011 Cost range (+ or -) 10 %
This program was delivered in a group format and an individual family therapy format. An average of 5.7 staff hours were required to deliver the program to the families in the evaluations that we reviewed. The families in the comparison groups received no services. The type of provider varied widely depending on the delivery format and specific setting. We estimated the hourly staff costs from the reimbursement rates of therapeutic psychoeducation in the community for a non-disabled population, based on actuarial tables reported for disabled adults in Mercer (2013) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2014.
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 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
Crime 8 Primary 1 147 -0.099 0.146 18 -0.099 0.146 28 -0.177 0.225
Externalizing behavior symptoms 8 Primary 2 140 -0.062 0.156 9 -0.030 0.082 12 -0.123 0.521
Internalizing symptoms 8 Primary 2 134 0.029 0.162 9 0.021 0.127 11 0.056 0.712
Major depressive disorder 35 Secondary 1 133 -0.132 0.151 35 -0.069 0.476 37 -0.236 0.118

Citations Used in the Meta-Analysis

DeGarmo, D.S., Patterson, G.R., & Forgatch, M.S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5(2), 73-89.

Forgatch, M.S., & DeGarmo. D.S. (1999). Parenting through change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67,(5), 711-24.

Forgatch, M.S., & DeGarmo, D.S. (2007). Accelerating recovery from poverty: Prevention effects for recently separated mothers. Journal of Early and Intensive Behavior Intervention, 4(4), 681-702.

Martinez, C.R., & Eddy, J.M. (2005). Effects of culturally adapted parent management training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psycology, 73(4), 841-51.

Patterson, G.R., Forgatch, M.S., & Degarmo, D.S. (2010). Cascading effects following intervention. Development and Psychopathology, 22(4), 949-70.