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Stop Now and Plan (SNAP)

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2018.  Literature review updated July 2018.
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Stop Now and Plan (SNAP) is a cognitive behavioral model for teaching children with disruptive behavior disorders and their parents effective emotional regulation, self-control, and problem-solving skills. SNAP offers separate programs for girls and boys aged 6-11. Children are recruited through referrals by either schools or juvenile courts. The SNAP model consists of 12 weekly group sessions conducted in local clinics designed to teach children to stop and think before acting, keep them involved in school, and avoid delinquent and criminal conduct. In separate group sessions, parents learn parenting skills and strategies to cope with their own emotions related to their children’s behavior. In addition to the group sessions, SNAP provides services to meet the needs of individual families. These services may include booster sessions, family counseling, academic tutoring, school advocacy, and mentoring.
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 $5,286 Benefits minus costs $12,968
Participants $3,565 Benefit to cost ratio $4.13
Others $8,548 Chance the program will produce
Indirect ($282) benefits greater than the costs 86 %
Total benefits $17,117
Net program cost ($4,149)
Benefits minus cost $12,968
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 $2,709 $0 $6,180 $1,358 $10,247
Labor market earnings associated with high school graduation $1,701 $3,745 $1,720 $0 $7,166
K-12 grade repetition $8 $0 $0 $4 $12
K-12 special education $384 $0 $0 $192 $576
Health care associated with disruptive behavior disorder $742 $210 $766 $373 $2,090
Costs of higher education ($258) ($390) ($117) ($129) ($893)
Adjustment for deadweight cost of program $0 $0 $0 ($2,080) ($2,080)
Totals $5,286 $3,565 $8,548 ($282) $17,117
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $4,817 2012 Present value of net program costs (in 2017 dollars) ($4,149)
Comparison costs $868 2010 Cost range (+ or -) 30 %
SNAP is a 12-week program. We estimated the cost of the treatment group using cost estimates in Farrington and Koegl, 2015 (as recommended by Leena Augimeri via personal communication, August 2018). All treatment group costs were converted from Canadian dollars to US dollars using the average exchange rate from the year the costs were measured. (http://www.canadianforex.ca/forex-tools/historical-rate-tools/yearly-average-rates). Farrington, D.P., & Koegl, C.J. (2015). Monetary benefits and costs of the Stop Now And Plan Program for boys aged 6–11, based on the prevention of later offending. Journal of Quantitative Criminology, 31(2), 263-287. For the comparison group costs we use 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.

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
Attention-deficit/hyperactivity disorder symptoms 9 1 40 -0.062 0.237 9 0.000 0.141 10 -0.141 0.556
Crime 9 1 80 -0.441 0.273 10 -0.441 0.273 20 -0.441 0.106
Disruptive behavior disorder symptoms 9 3 166 -0.233 0.114 9 -0.128 0.088 12 -0.479 0.001
Internalizing symptoms 9 2 150 -0.284 0.120 9 -0.284 0.120 11 -0.319 0.008

Citations Used in the Meta-Analysis

Augimeri, L.K., Farrington, D.P., Koegl, C.J., & Day, D.M. (2007). The SNAP™ Under 12 Outreach Project: Effects of a community based program for children with conduct problems. Journal of Child and Family Studies, 16(6), 799-807.

Burke, J.D., & Loeber, R. (2015). The Effectiveness of the Stop Now and Plan (SNAP) program for boys at risk for violence and delinquency. Prevention Science, 16(2), 242-253.

Pepler, D., Walsh, M., Yuile, A., Levene, K., Jiang, D., Vaughan, A., & Webber, J. (2010). Bridging the gender gap: interventions with aggressive girls and their parents. Prevention Science: the Official Journal of the Society for Prevention Research, 11(3), 229-38.