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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 2017.  Literature review updated April 2012.
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Parent Child Interaction Therapy (PCIT) is a program where a therapist directly observes a parent and child through a one-way mirror while providing direct coaching to the parent through a radio earphone. The focus is on building the skills of the parent to more positively interact with the child and manage his or her behavior. Therapists aim to ultimately restructure the parent-child relationship and provide the child with a more secure attachment to the parent.
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 $1,154 Benefits minus costs $1,704
Participants $1,286 Benefit to cost ratio $2.21
Others $1,092 Chance the program will produce
Indirect ($414) benefits greater than the costs 78 %
Total benefits $3,118
Net program cost ($1,414)
Benefits minus cost $1,704
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 $51 $0 $117 $25 $194
Labor market earnings associated with high school graduation $573 $1,261 $576 $0 $2,410
K-12 grade repetition $8 $0 $0 $4 $11
K-12 special education $238 $0 $0 $118 $356
Health care associated with disruptive behavior disorder $343 $112 $425 $171 $1,050
Costs of higher education ($58) ($87) ($26) ($29) ($200)
Adjustment for deadweight cost of program $0 $0 $0 ($703) ($703)
Totals $1,154 $1,286 $1,092 ($414) $3,118
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,240 2007 Present value of net program costs (in 2016 dollars) ($1,414)
Comparison costs $1,000 2007 Cost range (+ or -) 10 %
This program is typically delivered over a three- to four-month period. Standard per-family PCIT expenditures provided by Washington State DSHS Children's Administration (average reimbursement rate for families receiving PCIT in Washington in 2007).
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 5 Primary 4 87 -0.273 0.175 6 -0.001 0.016 7 -0.720 0.001
Disruptive behavior disorder symptoms 5 Primary 10 213 -0.392 0.102 6 -0.187 0.095 9 -1.045 0.001
Parental stress^ 0 Secondary 5 145 -0.860 0.129 31 -0.447 0.158 32 -0.860 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.

Bagner, D. M. & Eyberg, S. M. (2007). Parent-child interaction therapy for disruptive behavior in children with mental retardation: a randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36,418-429.

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.

McNeil, C. B., Capage, L. C., Bahl, A., & Blanc, H. (1999). Importance of early intervention for disruptive behavior problems: Comparison of treatment and waitlist-control groups. Early Education and Development, 10(4), 445-454.

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.

Nixon, R. D., Sweeney, L., Erickson, D. B., & Touyz, S. W. (2003). Parent-child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71(2), 251-260.

Schuhmann, E.M., Foote, R.C., Eyberg, S.M., Boggs, S.R., & Algina, J. (1998). Efficacy of Parent-Child Interaction Therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child & Adolescent Psychology, 27(1), 34-45.

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.