Washington State Institute for Public Policy
Eye Movement Desensitization and Reprocessing (EMDR) for child trauma
Children's Mental Health: Trauma
Benefit-cost estimates updated December 2016.  Literature review updated April 2012.
During this individual-based treatment, clients focus on a traumatic memory for 30 seconds at a time while the therapist provides a stimulus. For most clients, the therapist moves his hand slowly back and forth in front of the client (eye movement); for younger children, the therapist may, instead, tap the child's hand. The client reports on what thoughts come to mind and clients are guided to refocus on that thought in the next stimulus session. During therapy visits, clients report on the level of distress they feel. In later phases, a positive thought is emphasized during the stimulus sessions. Afterward, clients are asked to focus on residual physical tensions they may feel in order to enhance relaxation. The intervention is brief, typically one to two months of weekly or biweekly sessions. A more complete description of this therapy is available at: http://www.emdrnetwork.org/description.html.
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 (2015). 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 $2,776 Benefits minus costs $8,979
Participants $5,058 Benefit to cost ratio n/a
Others $631 Chance the program will produce
Indirect $351 benefits greater than the costs 81 %
Total benefits $8,816
Net program cost $163
Benefits minus cost $8,979
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 $17 $0 $41 $9 $67
K-12 grade repetition $6 $0 $0 $3 $8
K-12 special education $51 $0 $0 $25 $76
Labor market earnings associated with anxiety disorder $2,235 $4,922 $0 $0 $7,158
Health care associated with PTSD $482 $157 $596 $240 $1,475
Costs of higher education ($14) ($22) ($7) ($7) ($50)
Adjustment for deadweight cost of program $0 $0 $0 $81 $82
Totals $2,776 $5,058 $631 $351 $8,816
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $886 2009 Present value of net program costs (in 2015 dollars) $163
Comparison costs $1,035 2009 Cost range (+ or -) 10 %
This intervention typically takes place over one to two months. We estimated the per-participant cost by computing the average hours of therapy reported in the studies multiplied by the average Regional Support Network costs (for 2009) for individual therapy for child PTSD.
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 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
Major depressive disorder 2 29 -0.228 0.269 11 0.000 0.029 12 -0.192 0.476
Anxiety disorder 2 29 -0.226 0.269 11 -0.104 0.129 12 -0.184 0.521
Externalizing behavior symptoms 1 14 -0.512 0.378 11 -0.244 0.221 14 -0.512 0.175
Post-traumatic stress 4 60 -0.356 0.277 11 -0.356 0.277 12 -0.510 0.134
Citations Used in the Meta-Analysis

Ahmad, A., Larsson, B., & Sundelin-Wahlsten, V. (2007). EMDR treatment for children with PTSD: results of a randomized controlled trial. Nordic Journal of Psychiatry, 6(5), 349-54.

Chemtob, C.M., Nakashima, J., & Carlson, J G. (2002). Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: A field study. Journal of Clinical Psychology, 58(1), 99-112.

Kemp, M., Drummond, P., & McDermott, B. (2010). A wait-list controlled pilot study of eye movement desensitization and reprocessing (EMDR) for children with post-traumatic stress disorder (PTSD) symptoms from motor vehicle accidents. Clinical Child Psychology and Psychiatry, 15(1), 5-25.

Soberman, G.B., Greenwald, R., & Rule, D.M. (2002). A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment, and Trauma 6(1), 217-236.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov