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Collaborative primary care for children with behavior disorders

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2023.  Literature review updated August 2017.
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Collaborative primary care for behavior disorders integrates behavioral health into the primary care setting to treat children and adolescents with oppositional defiance disorder, attention deficit/hyperactivity disorder, or other behavior disorders. In the collaborative care model, a care manager coordinates with a primary care provider and behavioral health care providers to develop and implement measurement-based treatment plans for individual patients. Care managers also provide psychoeducation and brief psychotherapy-based modules, such as cognitive behavioral therapy. Studies in this meta-analysis report on Doctor-Office Collaborative Care (DOCC), a specific collaborative care model. In the included studies, patients received collaborative care for six months. Patients in the comparison group received “enhanced” treatment as usual, which consisted of brief psychoeducation and referrals to usual mental health services.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). 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 $459 Benefits minus costs $779
Participants $254 Benefit to cost ratio $3.41
Others $366 Chance the program will produce
Indirect $23 benefits greater than the costs 60%
Total benefits $1,102
Net program cost ($323)
Benefits minus cost $779

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. See Estimating Program Effects Using Effect Sizes for additional information.

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
8 2 201 -0.149 0.141 8 0.000 0.141 9 -0.309 0.075
8 2 201 -0.064 0.141 8 -0.035 0.086 11 -0.227 0.108
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Disruptive behavior disorder symptoms Criminal justice system $13 $0 $32 $7 $52
Labor market earnings associated with high school graduation $91 $213 $116 $0 $420
K-12 grade repetition $3 $0 $0 $1 $4
K-12 special education $149 $0 $0 $74 $223
Health care associated with disruptive behavior disorder $218 $62 $225 $109 $613
Costs of higher education ($14) ($21) ($6) ($7) ($48)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($162) ($162)
Totals $459 $254 $366 $23 $1,102
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $511 2010 Present value of net program costs (in 2022 dollars) ($323)
Comparison costs $259 2010 Cost range (+ or -) 15%
Per-participant cost estimates are based on the average cost per child enrolled in the treatment group and average cost per child enrolled in the comparison group, as reported in Yu et al. (2017). These estimates include the costs of training, outreach, equipment, and provider salaries.
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

Citations Used in the Meta-Analysis

Kolko, D.J., Campo, J., Kilbourne, A.M., Hart, J., Sakolsky, D., & Wisniewski, S. (2014). Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial. Pediatrics, 133(4), 981-92.

Kolko, D.J., Campo, J.V., Kilbourne, A.M., & Kelleher, K. (2012). Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial. Archives of Pediatrics & Adolescent Medicine, 166(3), 224-31.