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

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2018.  Literature review updated July 2018.
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Behavioral parent training (BPT) programs target parents of youth with disruptive behavior disorders. BPT programs teach parents self-regulation, behavior management skills, positive reinforcement methods, and communication techniques either individually or in conjunction with their children. BPT programs aim to change parenting behaviors and instruct parents in the use of positive reinforcement methods through individual, group, or family therapies. Interventions occurred either in family homes, or in mental health/community clinics. Interventions in our review varied in both intensity (weekly to bi-weekly meetings) and duration (two months to six months). Typical dosage for BPT is weekly for three months.
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 $889 Benefits minus costs $2,314
Participants $490 Benefit to cost ratio $31.97
Others $693 Chance the program will produce
Indirect $316 benefits greater than the costs 96 %
Total benefits $2,389
Net program cost ($75)
Benefits minus cost $2,314
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 $25 $0 $58 $12 $95
Labor market earnings associated with high school graduation $184 $405 $186 $0 $776
K-12 grade repetition $4 $0 $0 $2 $6
K-12 special education $258 $0 $0 $129 $387
Health care associated with disruptive behavior disorder $447 $126 $461 $224 $1,258
Costs of higher education ($27) ($41) ($12) ($14) ($95)
Adjustment for deadweight cost of program $0 $0 $0 ($37) ($37)
Totals $889 $490 $693 $316 $2,389
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,008 2015 Present value of net program costs (in 2017 dollars) ($75)
Comparison costs $868 2010 Cost range (+ or -) 20 %
On average, participants received 22 therapeutic hours over three months. Per-participant costs are based on weighted average therapist time, as reported in the included studies. Hourly therapist cost is based on the actuarial estimates of reimbursement for group treatment (Mercer. (2016). Mental health and substance use disorder services data book for the state of Washington). 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.

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 7 Primary 4 158 -0.072 0.119 7 0.000 0.141 8 -0.310 0.035
Disruptive behavior disorder symptoms 7 Primary 13 754 -0.149 0.057 7 -0.082 0.049 10 -0.526 0.001
Internalizing symptoms 7 Primary 6 355 -0.194 0.078 7 -0.194 0.078 9 -0.334 0.009
Parental stress^ 38 Secondary 3 126 -0.134 0.139 38 n/a n/a n/a -0.291 0.038

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.

Chacko, A., Gopalan, G., Franco, L., Dean-Assael, K., Jackson, J., Marcus, S., Hoagwood, K., ... McKay, M. (2015). Multiple family group service model for children with disruptive behavior disorders: Child outcomes at post-treatment. Journal of Emotional and Behavioral Disorders, 23(2), 67-77.

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.

Day, C., Michelson, D., Thomson, S., Penney, C., & Draper, L. (2012). Evaluation of a peer led parenting intervention for disruptive behaviour problems in children: Community based randomised controlled trial. BMJ (Clinical Research Ed.), 344.

Enebrink, P., Hogstrom, J., Forster, M., & Ghaderi, A. (2012). Internet-based parent management training: A randomized controlled study. Behaviour Research and Therapy, 50, 240-249.

Gavita, O.A., David, D., Bujoreanu, S., Tiba, A., & Ionutiu, D.R. (2012). The efficacy of a short cognitive-behavioral parent program in the treatment of externalizing behavior disorders in Romanian foster care children: Building parental emotion-regulation through unconditional self- and child-acceptance strategies. Children and Youth Services Review, 34(7), 1290-1297.

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.

Kierfeld, F., Ise, E., Hanisch, C., Görtz-Dorten, A., & Döpfner, M. (2013). Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: A randomized controlled trial. European Child & Adolescent Psychiatry, 22(9), 553-565.

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.

Sourander, A., McGrath, P. J., Ristkari, T., Cunningham, C., Huttunen, J., Lingley-Pottie, P., Hinkka-Yli-Salomäki, S., ... Unruh, A. (2016). Internet-assisted parent training intervention for disruptive behavior in 4-year-old children: A randomized clinical trial. JAMA Psychiatry, 73(4), 378.

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