Incredible Years: Parent training and child training

Children's Mental Health: Disruptive Behavior
Benefit-cost estimates updated December 2017. Literature review updated April 2012.

Incredible Years Parent Training (www.incredibleyears.com) is a group, skills-based behavioral intervention for parents of children with behavior problems. The curriculum focuses on strengthening parenting skills (monitoring, positive discipline, confidence) and fostering parents' involvement in children's school experiences in order to promote children's academic, social, and emotional competencies and reduce conduct problems. Training classes include child care, a family meal, and transportation. Studies in this category included a child skills training component as well as parent training. Children with behavioral problems are taught social, emotional and academic skills, such as understanding and communicating feelings, using effective problem solving strategies, managing anger, practicing friendship and conversational skills, as well as appropriate classroom behaviors.

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 (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.

Benefits to:

Taxpayers	$357	Benefits minus costs	($1,413)
Participants	$388	Benefit to cost ratio	$0.18
Others	$335	Chance the program will produce
Indirect	($763)	benefits greater than the costs	12 %
Total benefits	$316
Net program cost	($1,729)
Benefits minus cost	($1,413)

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.
Benefits from changes to:¹	Benefits to:
Detailed Monetary Benefit Estimates Per Participant
	Taxpayers	Participants	Others²	Indirect³	Total

Crime	$15	$0	$35	$8	$58
Labor market earnings associated with high school graduation	$172	$378	$173	$0	$723
K-12 grade repetition	$2	$0	$0	$1	$3
K-12 special education	$76	$0	$0	$37	$113
Health care associated with disruptive behavior disorder	$109	$35	$135	$54	$333
Costs of higher education	($17)	($26)	($8)	($8)	($60)
Adjustment for deadweight cost of program	$0	$0	$0	($854)	($854)

Totals	$357	$388	$335	($763)	$316

Annual cost		Year dollars	Summary
Detailed Annual Cost Estimates Per Participant
Program costs	$2,610	2013	Present value of net program costs (in 2016 dollars)	($1,729)
Comparison costs	$881	2010	Cost range (+ or -)	10 %

Cost of parent training class per family provided by Washington State DSHS Children's Administration, 2012. WSIPP also added costs of practitioner training and curriculum for the parent classes and child classes, based on the findings of Foster et al., 2007 (training and curricula costs are low on a per-family basis, as curricula are shared between practitioners and distributed across many families who receive the intervention). Based on conversations with Lisa St. George from Incredible Years (June 2014), we assumed that a practitioner team might use their purchased training and curricula to serve 24 families per year on average, for about five years (120 families served per team). In addition, we estimated an implementation cost (per child) for the child training component, based on the staff time and cost reported in Foster et al. (2007), and assuming each practitioner serves 120 children over five years. Foster, E.M., Olchowski, A.E., & Webster-Stratton, C.H. (2007). Is stacking intervention components cost-effective? An analysis of the Incredible Years program. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11).

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.
Outcomes measured	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)
Meta-Analysis of Program Effects
				First time ES is estimated			Second time ES is estimated			Unadjusted effect size (random effects model)
				ES	SE	Age	ES	SE	Age	ES	p-value
Attention-deficit/hyperactivity disorder symptoms	Primary	2	106	-0.170	0.140	7	-0.001	0.011	8	-0.566	0.001
Disruptive behavior disorder symptoms	Primary	5	319	-0.105	0.084	7	-0.050	0.048	10	-0.584	0.007
Internalizing symptoms	Primary	2	193	-0.067	0.106	7	-0.049	0.085	9	-0.245	0.200
Parental stress^{^}	Secondary	1	20	-0.412	0.312	26	-0.214	0.382	27	-0.737	0.021

Citations Used in the Meta-Analysis

Barrera, M., Biglan, A., Taylor, T.K., Gunn, B.K., Smolkowski, K., Black, C., . . . Fowler, R.C. (2002). Early elementary school intervention to reduce conduct problems: A randomized trial with Hispanic and non-Hispanic children. Prevention Science, 3(2), 83-94.

Larsson, B., Fossum, S., Clifford, G., Drugli, M.B., Handegard, B.H., & Morch, W.T. (2009). Treatment of oppositional defiant and conduct problems in young Norwegian children: Results of a randomized controlled trial. European Child & Adolescent Psychiatry, 18(1), 42-52.

Scott, S., Sylva, K., Doolan, M., Price, J., Jacobs, B., Crook, C., & Landau, S. (2010). Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: The SPOKES project. Journal of Child Psychology and Psychiatry, 51(1), 48-57.

Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65(1), 93-100.

Webster-Stratton, C., Reid, M.J., & Beauchaine, T.P. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child and Adolescent Psychology, 40(2), 191-203.