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Triple P—Positive Parenting Program: Level 4, individual

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2018.  Literature review updated June 2018.
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Triple P—Positive Parenting Program (Level 4, individual) is a behavioral parent training program for families of children with disruptive behavior problems. The focus is learning skills and role-playing strategies to cope with and correct behavior problems. This review includes evaluations of individually administered Triple P, either in therapist-led sessions or in a self-directed modality. In the self-directed version parents receive a full Level 4 curriculum with a workbook and exercises to complete at their own pace, as well as weekly phone calls with a therapist. We excluded evaluations of self-directed treatments with no therapist contact. Children in the included studies were diagnosed with or met a clinical threshold for disruptive behavior disorder. Families received an average of ten hours of treatment over ten weeks.
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 $2,114 Benefits minus costs $5,224
Participants $3,213 Benefit to cost ratio $7.81
Others $683 Chance the program will produce
Indirect ($20) benefits greater than the costs 60 %
Total benefits $5,991
Net program cost ($767)
Benefits minus cost $5,224
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 $17 $0 $39 $8 $64
Labor market earnings associated with high school graduation $124 $273 $125 $0 $522
K-12 grade repetition $3 $0 $0 $1 $4
K-12 special education $195 $0 $0 $98 $293
Health care associated with disruptive behavior disorder $326 $92 $336 $164 $918
Costs of higher education ($20) ($30) ($9) ($10) ($70)
Subtotals $644 $335 $490 $261 $1,730
From secondary participant
Health care associated with major depression $187 $53 $193 $94 $527
Labor market earnings associated with anxiety disorder $1,283 $2,825 $0 $0 $4,108
Mortality associated with depression $0 $1 $0 $9 $10
Subtotals $1,470 $2,878 $193 $103 $4,645
Adjustment for deadweight cost of program $0 $0 $0 ($384) ($384)
Totals $2,114 $3,213 $683 ($20) $5,991
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,730 2017 Present value of net program costs (in 2017 dollars) ($767)
Comparison costs $868 2010 Cost range (+ or -) 30 %
Triple P costs are the average per-family service cost for families receiving Triple P 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
Anxiety disorder^^ 6 Primary 1 26 -0.070 0.991 6 n/a n/a n/a -0.306 0.776
Disruptive behavior disorder symptoms 6 Primary 7 311 -0.112 0.096 6 -0.062 0.064 9 -0.761 0.001
Major depressive disorder^^ 6 Primary 1 26 -0.208 0.495 6 n/a n/a n/a -0.910 0.124
Anxiety disorder 35 Secondary 2 79 -0.100 0.201 35 -0.052 0.246 37 -0.438 0.031
Major depressive disorder 35 Secondary 2 79 -0.094 0.201 35 -0.049 0.246 37 -0.411 0.043
Parental stress^ 35 Secondary 2 171 -0.300 0.129 35 n/a n/a n/a -0.458 0.001

Citations Used in the Meta-Analysis

Day, J.J., & Sanders, M.R. (2018). Do parents benefit from help when completing a self-guided parenting program online? A randomized controlled trial comparing Triple P Online with and without telephone support. Behavior Therapy.

Connell, S., Sanders, M.R., & Markie-Dadds, C. (1997). Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas. Behavior Modification, 21(4), 379-408.

Kleefman, M., Jansen, D.E., Stewart, R.E., & Reijneveld, S.A. (2014). The effectiveness of Stepping Stones Triple P parenting support in parents of children with borderline to mild intellectual disability and psychosocial problems: A randomized controlled trial. BMC Medicine, 12, 191.

Markie-Dadds, C., & Sanders, M.R. (2006a). A controlled evaluation of an enhanced self-directed behavioural family intervention for parents of children with conduct problems in rural and remote areas. Behaviour Change, 23(1), 55-72.

Nicholson, J.M., & Sanders, M.R. (1999). Randomized controlled trial of behavioral family intervention for the treatment of child behavior problems in stepfamilies. Journal of Divorce and Remarriage, 30(3/4), 1-23.

Plant, K.M., & Sanders, M.R. (2007). Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities. Research in Developmental Disabilities, 28(4), 362-385.

Sanders, M.R., Markie-Dadds, C., Tully, L.A., & Bor, W. (2000). The Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68(4), 624-640.