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Washington State Institute for Public Policy
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Helping the Noncompliant Child

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2017.  Literature review updated June 2015.
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In this program, a therapist directly observes a parent and child through a one-way mirror, and provides direct coaching to the parent through a radio earphone. The program is delivered in two phases. The first phase focuses on “differential attention”, when parents are taught to describe the child’s appropriate behavior to the child rather than giving commands and to give rewards through positive physical attention and verbal praise. In the second phase, parents learn the importance of clear, simple instructions and to provide positive rewards for compliance and negative consequences for noncompliance.
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 $574 Benefits minus costs $857
Participants $634 Benefit to cost ratio $2.23
Others $549 Chance the program will produce
Indirect ($203) benefits greater than the costs 65 %
Total benefits $1,555
Net program cost ($698)
Benefits minus cost $857
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 $25 $0 $57 $13 $95
Labor market earnings associated with high school graduation $280 $617 $282 $0 $1,180
K-12 grade repetition $4 $0 $0 $2 $5
K-12 special education $112 $0 $0 $56 $168
Health care associated with disruptive behavior disorder $180 $59 $223 $90 $552
Costs of higher education ($28) ($42) ($12) ($14) ($96)
Adjustment for deadweight cost of program $0 $0 $0 ($350) ($350)
Totals $574 $634 $549 ($203) $1,555
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,612 2007 Present value of net program costs (in 2016 dollars) ($698)
Comparison costs $1,000 2007 Cost range (+ or -) 10 %
This program is very similar to Parent-Child Interaction Therapy (PCIT), requiring similar equipment and therapist qualifications. In 2007, the standard PCIT expenditures provided by Children's Administration (average reimbursement rate for families receiving PCIT in Washington) was $2,240. Helping the Noncompliant Child requires ten sessions, compared to an average of 13.9 sessions in the studies we reviewed for PCIT, so we estimate the cost for HNC to be 10/13.9 multiplied by $2,240.
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 4 Primary 1 63 -0.590 0.271 4 0.000 0.001 5 -1.039 0.001
Disruptive behavior disorder symptoms 4 Primary 3 79 -0.529 0.377 4 -0.122 0.129 7 -0.811 0.030
Parental stress^ 26 Secondary 1 63 -0.375 0.269 26 -0.179 0.158 28 -0.669 0.014

Citations Used in the Meta-Analysis

Abikoff, H.B., Thompson, M., Laver-Bradbury, C., Long, N., Forehand, R.L., Miller, B.L., Klein, R.G., ... Sonuga-Barke, E. (2015). Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. Journal of Child Psychology and Psychiatry, 56(6), 618-631.

Peed, S., Roberts, M., & Forehand, R. (1977). Evaluation of the effectiveness of a standardized parent training program in altering the interaction of mothers and their noncompliant children. Behavior Modification, 1(3), 323-350.

Wells, K.C, & Egan, J. (1988). Social learning and systems family therapy for childhood oppositional disorder: Comparative treatment outcome. Comprehensive Psychiatry, 29(2), 138-146.