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Other behavioral parent training (BPT) for children with disruptive behavior disorders

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2017.  Literature review updated April 2012.
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In addition to several brand-name parenting programs, we grouped other brief treatments in which parents were taught behavior management skills and communication either alone or with their children (in a family format). In the studies included here, treatment duration ranged from to two to six months, with weekly sessions.
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 $680 Benefits minus costs $2,383
Participants $754 Benefit to cost ratio n/a
Others $612 Chance the program will produce
Indirect $224 benefits greater than the costs 89 %
Total benefits $2,271
Net program cost $112
Benefits minus cost $2,383
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 $30 $0 $72 $15 $116
Labor market earnings associated with high school graduation $342 $753 $346 $0 $1,440
K-12 grade repetition $5 $0 $0 $2 $7
K-12 special education $169 $0 $0 $84 $254
Health care associated with disruptive behavior disorder $170 $55 $211 $85 $521
Costs of higher education ($36) ($54) ($16) ($18) ($123)
Adjustment for deadweight cost of program $0 $0 $0 $56 $56
Totals $680 $754 $612 $224 $2,271
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $778 2010 Present value of net program costs (in 2016 dollars) $112
Comparison costs $881 2010 Cost range (+ or -) 10 %
These interventions typically take place over a two- to six-month period. We estimated per-participant costs based on therapist time, as reported in the treatment studies. Hourly therapist cost was based on the latest actuarial estimates of reimbursement by modality in WA State (DSHS).
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
Disruptive behavior disorder symptoms 7 7 136 -0.186 0.139 8 -0.089 0.081 11 -0.746 0.001
Internalizing symptoms 7 2 62 -0.123 0.205 8 -0.090 0.164 10 -0.442 0.033

Citations Used in the Meta-Analysis

Behan, J., Fitzpatrick, C., Sharry, J., Carr, A., & Waldron, B. (2001). Evaluation of the Parenting Plus Programme. The Irish Journal of Psychology, 22(3-4), 238-256.

Coughlin, M., Sharry, J., Fitzpatrick, C., Guerin, S., & Drumm, M. (2009). A controlled clinical evaluation of the parents plus children's programme: A video-based programme for parents of children aged 6 to 11 with behavioural and developmental problems. Clinical Child Psychology and Psychiatry, 14(4), 541-558.

Hamilton, S.B., & MacQuiddy, S.L. (1984). Self-administered behavioral parent training: Enhancement of treatment efficacy using a time-out signal seat. Journal of Clinical Child & Adolescent Psychology, 13(1), 61-69.

Landy, S., & Menna, R. (2006). An evaluation of a group intervention for parents with aggressive young children: Improvements in child functioning, maternal confidence, parenting knowledge and attitudes. Early Child Development and Care, 176(6), 605-620.

Luk, E.S.L., Staiger, P., Mathai, J., Field, D., & Adler, R. (1998). Comparison of treatments of persistent conduct problems in primary school children: A preliminary evaluation of a modified cognitive-behavioural approach. Australian and New Zealand Journal of Psychiatry, 32(3), 379-386.

Sayger, T.V., Horne, A.M., Walker, J.M., & Passmore, J.L. (1988). Social learning family therapy with aggressive children: Treatment outcome and maintenance. Journal of Family Psychology, 1(3), 261-285.

Zangwill, W.M. (1983). An evaluation of a parent training program. Child and Family Behavior Therapy, 5(4), 1-16.