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Parent-Child Interaction Therapy (PCIT) for children with disruptive behavior

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2018.  Literature review updated June 2018.
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Parent-Child Interaction Therapy (PCIT) is a type of behavioral parent training that aims to build the skills of the parent to more positively interact with the child and manage the child’s behavior. PCIT is a manualized, multi-session program that relies on “in vivo” coaching, in which therapists observe parents and children interacting through a one-way mirror and provide direct feedback to the parent through an earpiece. This analysis includes standard PCIT provided to families of children with disruptive behavior, as well as PCIT adapted for parents of atypically developing children with disruptive behavior. On average, families received 14 therapeutic hours over three months. Therapies were provided in individual, group, and remote modalities.
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 $807 Benefits minus costs ($865)
Participants $407 Benefit to cost ratio $0.57
Others $638 Chance the program will produce
Indirect ($685) benefits greater than the costs 29 %
Total benefits $1,167
Net program cost ($2,032)
Benefits minus cost ($865)
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 $20 $0 $44 $10 $74
Labor market earnings associated with high school graduation $143 $314 $144 $0 $601
K-12 grade repetition $3 $0 $0 $1 $4
K-12 special education $218 $0 $0 $109 $327
Health care associated with disruptive behavior disorder $446 $126 $460 $224 $1,256
Costs of higher education ($22) ($34) ($10) ($11) ($77)
Adjustment for deadweight cost of program $0 $0 $0 ($1,019) ($1,019)
Totals $807 $407 $638 ($685) $1,167
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,993 2017 Present value of net program costs (in 2017 dollars) ($2,032)
Comparison costs $868 2010 Cost range (+ or -) 20 %
Parent-Child Interaction Therapy (PCIT) costs are the average per-family cost for families receiving PCIT in Washington in fiscal year 2018, provided by Tim Kelly (8/23/2018), Washington State Department of Children Youth and Families. For 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.

^WSIPP’s benefit-cost model does not monetize this outcome.

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

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 5 87 -0.123 0.175 4 0.000 0.141 5 -0.670 0.001
Disruptive behavior disorder symptoms 4 Primary 12 340 -0.166 0.093 4 -0.091 0.068 7 -0.792 0.001
Internalizing symptoms 4 Primary 4 183 -0.087 0.138 4 -0.087 0.138 6 -0.383 0.010
Major depressive disorder^^ 37 Secondary 2 27 -0.114 0.304 37 n/a n/a n/a -0.426 0.320
Parental stress^ 37 Secondary 8 308 -0.168 0.101 37 n/a n/a n/a -0.470 0.001

Citations Used in the Meta-Analysis

Bagner, D. M., Sheinkopf, S. J., Vohr, B. R., & Lester, B. M. (2010). Parenting intervention for externalizing behavior problems in children born premature: An initial examination. Journal of Developmental and Behavioral Pediatrics, 31(3), 209-216.

Danko, C.M. (2014). The effect of parent-child interaction therapy on strengthening the attachment relationship with foster parents and children in foster care.

Leung, C., Tsang, S., Heung, K., & Yiu, I. (2009). Effectiveness of Parent-Child Interaction Therapy (PCIT) among Chinese families. Research on Social Work Practice, 19(3), 304-313.

Matos, M., Bauermeister, J. J., & Bernal, G. (2009). Parent-Child Interaction Therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Family Process, 48(2), 232-252.

McCabe, K., & Yeh, M. (2009). Parent-Child Interaction Therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child and Adolescent Psychology, 38(5), 753-759.

Mersky, J.P., Topitzes, J., Grant-Savela, S.D., Brondino, M.J., & McNeil, C.B. (2014). Adapting Parent-Child Interaction Therapy to foster care: outcomes from a randomized trial. Research on Social Work Practice, 26(2), 157-167.

Mersky, J.P., Topitzes, J., Janczewski, C.E., & McNeil, C.B. (2015). Enhancing foster parent training with Parent-Child Interaction Therapy: evidence from a randomized field experiment. Journal of the Society for Social Work and Research, 6(4), 591-616.

Nixon, R. D. V. (2001). Changes in hyperactivity and temperament in behaviourally disturbed preschoolers after parent-child interaction therapy (PCIT). Behaviour Change, 18(3), 168-176.

Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of Parent-Child Interaction Therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38(9), 1767-1776.

Webb, H.J., Thomas, R., McGregor, L., Avdagic, E., & Zimmer-Gembeck, M.J. (2017). An evaluation of Parent-Child Interaction Therapy with and without motivational enhancement to reduce attrition. Journal of Clinical Child and Adolescent Psychology : the Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 46(4).