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Child Parent Relationship Therapy

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2019.  Literature review updated May 2018.
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Child Parent Relationship Therapy is a manualized play-based therapy for families whose children have social, emotional, or behavioral problems. In group sessions parents are taught relationship skills grounded in child-centered play therapy, limit-setting for children’s misbehavior, and attitudes of empathy and respect for their child. Parents practice new skills in videotaped play sessions which are later reviewed in the group for supervision and feedback to parents. This program is typically administered in ten weekly small group sessions, with an average of 20 therapist contact hours. Children in the included studies were diagnosed with, or met a clinical threshold for, disruptive behavior disorder.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2018). 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 $669 Benefits minus costs $1,893
Participants $338 Benefit to cost ratio n/a
Others $555 Chance the program will produce
Indirect $297 benefits greater than the costs 79 %
Total benefits $1,858
Net program cost $35
Benefits minus cost $1,893
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 $18 $0 $40 $9 $66
Labor market earnings associated with high school graduation $110 $259 $141 $0 $511
K-12 grade repetition $4 $0 $0 $2 $6
K-12 special education $183 $0 $0 $92 $275
Health care associated with disruptive behavior disorder $370 $105 $382 $185 $1,043
Costs of higher education ($17) ($26) ($8) ($9) ($60)
Adjustment for deadweight cost of program $0 $0 $0 $18 $18
Totals $669 $338 $555 $297 $1,858
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $901 2015 Present value of net program costs (in 2018 dollars) $35
Comparison costs $868 2010 Cost range (+ or -) 20 %
On average, participants received 20 therapeutic hours over ten weeks. 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
Disruptive behavior disorder symptoms 5 Primary 5 104 -0.130 0.145 5 -0.072 0.092 8 -0.849 0.001
Internalizing symptoms 5 Primary 3 55 -0.256 0.200 5 -0.256 0.200 7 -0.871 0.106
Parental stress^ 35 Secondary 2 49 -0.417 0.211 35 n/a n/a n/a -1.301 0.013

Citations Used in the Meta-Analysis

Carnes-Holt, K., & Bratton, S.C. (2014). The efficacy of Child Parent Relationship Therapy for adopted children with attachment disruptions. Journal of Counseling & Development, 92(3), 328-337.

Ceballos, P.L., & Bratton, S.C. (2010). Empowering Latino families: Effects of a culturally responsive intervention for low-income immigrant Latino parents on children's behaviors and parental stress. Psychology in the Schools, 47(8), 761-775.

Johnson-Clark, K.A. (1997). The effect of filial therapy on child conduct behavior problems and the quality of the parent-child relationship. (Unpublished doctoral dissertation). California School of Professional Psychology, San Diego, CA.

Opiola, K.K., & Bratton, S.C. (2018). The efficacy of Child Parent Relationship Therapy for adoptive families: A replication study. Journal of Counseling & Development, 96(2), 155-166.

Villarreal, C.E. (2008). School-based child parent relationship therapy (CPRT) with Hispanic parents. (Unpublished doctoral dissertation). Regent University, Virginia Beach, Virginia.