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The Cost of Child Behaviour Therapy: The First Step to Demonstrating Cost-effectiveness

Published online by Cambridge University Press:  06 October 2014

Mervyn Jackson
Affiliation:
Royal Melbourne Institute of Technology
Ray Wilks
Affiliation:
Royal Melbourne Institute of Technology
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Abstract

There has been extensive debate over the last three decades about which professional groups should receive government-funded rebates in the mental health field. Cognitive-behaviour therapists appear to be in the best position to demonstrate clinical efficacy, but have failed to demonstrate cost-effectiveness of cognitive-behaviour therapy. There is a need to demonstrate the cost of behaviour therapy as the first step in determining the cost-effectiveness of behaviour therapy compared to the traditional (medical-based) interventions. Using archival data from a university-based psychology clinic specialising in cognitive-behavioural interventions with child and adolescent problems, the present research determined the cost of successful treatment programs with the clinic's major referral areas: nocturnal enuresis, behaviour management, and education-based problems. Analysing 77 cases, it was found that there were significant between group differences in the number and total duration of face-to-face interviews, in the number of other contacts between therapist and client, in total therapist time, and in the estimated average cost of cases. There emerged different treatment patterns for each clinical problem, and these were reflected in costing. A number of research and methodological issues are explored. Implications for future research on cost-effectiveness and the subsequent collection of comparative data across clinics and a variety of clinical problem areas are discussed.

Type
Research Article
Copyright
Copyright © The Author(s) 1996

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References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Bergan, J. (1995). Behavioral training and the new mental health. The Behavior Therapist, 18, 161164.Google Scholar
Booz-Allen, & Hamilton, . (1990). Operational restructuring: The patient-focused hospital. Altanta: Author.Google Scholar
Clinton, M., & Scheiwe, D. (1995). Management in the Australian health care industry. Sydney: Harper Collins.Google Scholar
Cumming, N. (1986). The dismantling of our health system: Strategies for the survival of psychological practice. American Psychologist, 41, 426431.Google Scholar
DeLeon, G., & Mandell, W. (1966). A comparison of conditioning and psychotherapy in the treatment of functional enuresis. Journal of Personality, 48, 449472.Google Scholar
Dickey, B., & Cohen, M. (1993). Changing the financing of state mental health programs: Using carrots, not sticks to improve care. Administration and Policy in Mental Health, 20, 343355.Google Scholar
Durlack, J. (1995). Understanding meta-analysis. In Grim, L. & Yarnold, P.. (Eds.), Reading and understanding multivariate statistics. Washington: American Psychological Association.Google Scholar
Durlack, J., Fuhrman, T., & Lampman, C. (1991). Effectiveness of cognitive-behavior for maladapting children: A meta analysis. Psychological Bulletin, 110, 204214.Google Scholar
Fisch, R., Weakland, J., & Segal, L. (1982). The tactics of change: Doing therapy briefly. San Francisco: Jossey-Bass.Google Scholar
Fisher, S. (1984). Time-limited brief therapy with families: A one-year follow-up study. Family Process, 21, 101106.Google Scholar
Gardner, J. (1972). Teaching behavior modification to nonprofessionals. Journal of Applied Behavior Analysis, 5, 517521.Google Scholar
Garfield, S. (Ed.). (1983). Special section: Meta-analysis and psychotherapy. Journal of Consulting and Clinical Psychology, 51, 375.Google Scholar
Giles, T., Prail, E., & Neims, D. (1993). Evaluating psychotherapies: A comparison of effectiveness. International Journal of Mental Health, 22(2), 4365.Google Scholar
Hayes, S. (1995). Working with managed care: Lessons from the acceptance and commitment therapy training project. The Behavior Therapist, 18, 184186.Google Scholar
Hersch, L. (1995). Adapting to health care reform and managed care: Three strategies for survival and growth. Professional Psychology: Research and Practice, 26, 1626.CrossRefGoogle Scholar
Hudson, A., Wilken, P., Jauernig, R., & Radler, G. (1995). Regionally based teams for the treatment of challenging behaviour: A three year outcome study. Behaviour Change, 12, 209215.Google Scholar
Katon, W., & Schulberg, H. (1993). Epidemiology of depression in primary care. General Hospital Psychiatry, 14, 237247.Google Scholar
Kiresuk, T., & Sherman, R. (1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443453.Google Scholar
Kirkby, R., & Smyrnios, K. (1992). The psychological health of children, cost-effectiveness, and brief therapy. Australian Psychologist, 27, 7892.Google Scholar
McGrath, P., Humphreys, P., Keene, D., Goodman, J., Lascelles, M., Cunningham, S., & Firestone, P. (1992). The efficacy and efficiency of a self-administered treatment of adolescent migraine. Pain, 49, 321324.Google Scholar
Mechanic, D., & Aiken, L. (Eds.). (1989). Paying for services: Promises and pitfalls of capitation. San Fransisco: Jossey-Bass.Google Scholar
Michelson, L. (Ed.). (1985). Special issue: Meta-analysis and clinical psychology. Clinical Psychology Review, 5, 1.Google Scholar
Mordoch, J. (1993). Hidden cost of children's outpatient mental health services: Lessons from New York State. Administration and Policy in Mental Health, 20, 215229.Google Scholar
Narrow, W., Regier, D., Rae, D., Manderscheid, R., & Locke, B. (1993). Use of services by persons with mental and addictive disorders: Findings from the National Institute of Mental Health Epidemiological Catchment Area Program. Archives of General Psychiatry, 50, 95107.Google Scholar
Ollendick, T. (1995). AABT and empirically validated treatments. The Behavior Therapist, 18, 8189.Google Scholar
Olmsted, M., Davis, R., & Garner, D. (1991). Efficacy of a brief group psychoeducational intervention for bulimia nervosa. Behaviour Research and Therapy, 29, 7183.Google Scholar
Parsons, B., & Alexander, J. (1973). Short-term family intervention: A therapy outcome study. Journal of Consulting and Clinical Psychology, 41, 195201.CrossRefGoogle ScholarPubMed
Pekarik, G. (1993). Beyond effectiveness: Uses of consumer-oriented criteria in defining treatment success. In Giles, T. (Ed.), Handbook of effective psychotherapy (pp. 409436). New York: Plenum.Google Scholar
Pike, C., & Piercy, F. (1990). Cost effectiveness research in family therapy. Journal of Marital and Family Therapy, 16, 375388.CrossRefGoogle Scholar
Piotrowski, N. (1995). The importance of precisely defining study populations. The Behavior Therapist, 18, 157158.Google Scholar
Realmuto, G., Bernstein, G., Maglothin, M., & Pandey, R. (1992). Patterns of utilization of outpatient mental health services by children and adolescents. Hospital and Community Psychiatry, 43, 12181223.Google Scholar
Robinson, P. (1995). New territory for the behavior therapist: Hello depressed patients in primary care. The Behavior Therapist, 18, 149153.Google Scholar
Sanders, M., & Dadds, M. (1995). Behavioral family intervention. Needham Heights, MA: Allyn & Bacon.Google Scholar
Saxe, L., Cross, T., & Silverman, N. (1988). Children's mental health: The gap between what we know and what we do. American Psychologist, 43, 800807.Google Scholar
Schmitz, C., & Gilchrist, L. (1991). Developing a community-based care system for seriously emotionally disabled children and youth. Child and Adolescent Social Work Journal, 8, 417430.Google Scholar
Schurman, R., Kramer, P., & Mitchel, J. (1985). The hidden mental health network: Treatment of mental illness by nonpsychiatrist physicians. Archives of General Psychiatry, 42, 8994.Google Scholar
Schuster, J. (1991). Ensuring highest quality care for the cost: Coping strategies for mental health providers. Hospital and Community Psychiatry, 42, 774776.Google Scholar
Schwartz, S. (1995, 12). Should the government pay for psychotherapy?The Bulletin of the Australian Psychological Society, 59.Google Scholar
Smyrnios, K., & Kirkby, R. (1989). A review of brief child-oriented family therapy outcome research: Descriptive reports and single group studies. Australian and New Zealand Journal of Family Therapy, 10, 151159.Google Scholar
Strosahl, K. (1995). Behavior therapy 2000: A perilous journey. The Beliavior Therapist, 18, 130133.Google Scholar
Suls, J., & Wan, C. (1989). Effects of sensory and procedural information on coping with stressful medical procedures and pain: A meta-analysis. Journal of Consulting and Clinical Psychology, 57, 372379.Google Scholar
Trull, T., Nietzel, M., & Main, A. (1988). The use of metaanalysis to assess the clinical significance of behavior therapy for agoraphobia. Behavior Therapy, 19, 527538.Google Scholar
Turner, S., Beidel, D., Cooley, M., Woody, S., & Messer, S. (1994). A multi-component behavior treatment for social phobia: Social effectiveness therapy. Behaviour Research and Therapy, 32, 381390.Google Scholar
Turner, S., Beidel, D., Spaulding, S., & Brown, J. (1995a). The practice of behavior therapy: A national survey of cost and methods. The Behavior Therapist, 18, 14.Google Scholar
Turner, S., Beidel, D., Spaulding, S., & Brown, J. (1995b). Response Piotrowski. The Behavior Therapist, 18, 158.Google Scholar