Washington State Institute for Public Policy
Triple-P Positive Parenting Program: Level 4, group
Children's Mental Health: Disruptive Behavior
Benefit-cost estimates updated May 2017.  Literature review updated April 2012.
Triple P—Positive Parenting Program (Level 4, group) is an intensive class-based parenting program for families of children with more challenging behavior problems. The focus is learning skills and role-playing strategies to cope with and correct behavior problems.
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.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $410 Benefits minus costs $2,201
Participants $468 Benefit to cost ratio n/a
Others $383 Chance the program will produce
Indirect $380 benefits greater than the costs 100 %
Total benefits $1,641
Net program cost $560
Benefits minus cost $2,201
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 $19 $0 $43 $9 $72
Labor market earnings associated with high school graduation $211 $464 $211 $0 $886
K-12 grade repetition $3 $0 $0 $1 $4
K-12 special education $87 $0 $0 $44 $131
Health care associated with disruptive behavior disorder $112 $36 $138 $56 $342
Costs of higher education ($21) ($32) ($10) ($11) ($73)
Adjustment for deadweight cost of program $0 $0 $0 $281 $281
Totals $410 $468 $383 $380 $1,641
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $367 2010 Present value of net program costs (in 2016 dollars) $560
Comparison costs $881 2010 Cost range (+ or -) 20 %
This program typically consists of 10-16 sessions over a period of three to four months. Per-family costs are based on current Washington expenditures per family for individual behavioral treatment with Triple P, under the assumption that with group training, eight families could receive training at the same time from the same therapist. We also added an estimated cost for venue rental (a cost that is unnecessary when conducting the program with individual families).
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
Disruptive behavior disorder symptoms 8 1154 -0.170 0.043 5 -0.081 0.041 8 -0.491 0.001
Internalizing symptoms 1 186 -0.025 0.127 5 -0.018 0.099 7 -0.066 0.602
Citations Used in the Meta-Analysis

Hahlweg, K., Heinrichs, N., Kuschel, A., Bertram, H., & Naumann, S. (2010). Long-term outcome of a randomized controlled universal prevention trial through a positive parenting program: Is it worth the effort? Child and Adolescent Psychiatry and Mental Health, 4, 14-27.

Leung, C., Sanders, M. R., Leung, S., Mak, R., & Lau, J. (2003). An outcome evaluation of the implementation of the Triple P-Positive Parenting Program in Hong Kong. Family Process, 42(4), 531-544.

Matsumoto, Y., Sofronoff, K., & Sanders, M.R. (2007). The efficacy and acceptability of the Triple P-Positive Parenting Program with Japanese parents. Behaviour Change, 24(4), 205-218.

Matsumoto, Y., Sofronoff, K., & Sanders, M.R. (2010). Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society. Journal of Family Psychology, 24(1), 87-91.

Morawska, A., & Sanders, M. (2009). An evaluation of a behavioural parenting intervention for parents of gifted children. Behaviour Research and Therapy, 47(6), 463-470.

Turner, K. M. T., Richards, M., & Sanders, M. R. (2007). Randomised clinical trial of a group parent education programme for Australian indigenous families. Journal of Paediatrics and Child Health, 43(6), 429-437.

Whittingham, K., Sofronoff, K., Sheffield, J., & Sanders, M. R. (2009). Stepping stones Triple P: An RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. Journal of Abnormal Child Psychology, 37(4), 469-480.

Zubrick, S. R., Ward, K. A., Silburn, S. R., Lawrence, D., Williams, A. A., Blair, E., et al. (2005). Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prevention Science, 6(4), 287-304.

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