This purpose of this paper is to provide a summary of the cost-effectiveness research for the profession and practice of marriage and family therapy. Studies based on four sources of data were considered: (1) a western United States HMO covering 180,000 subscribers; (2) the Kansas State Medicaid system with over 300,000 beneficiaries; (3) Cigna, a large Unites States health insurance benefits management company with more than nine million subscribers; and (4) a marriage and family therapy training clinic in the western United States serving approximately 300 individuals and families a year. Results from the studies support the potential for a medical offset effect after couple or family therapy, with the largest reduction occurring for high utilizers of health care. The studies also show that covering family therapy as a treatment option and marriage and family therapists as a provider group is not associated with significantly higher treatment costs. An application of cost-effectiveness methodology to medical family therapy is also considered.

This purpose of this paper is to review the literature on the treatment of Oppositional Defiant Disorder, with a specific focus on cost analyses. In general the literature shows that while there has been substantial research on Oppositional Defiant Disorder there has been little focus on the costs involved. A search of the major databases in psychology and the social sciences yielded only seven articles even marginally appropriate for a review of costs associated with Oppositional Defiant Disorder and related disruptive behavior. Interestingly, only two of these studies investigated treatment costs specifically associated with Oppositional Defiant Disorder. These studies showed that the treatment of Oppositional Defiant Disorder is much less expensive than the treatment of Conduct Disorder and family therapy is the most cost effective approach. Overall, the review showed that there is a dearth of literature related to treatment costs, which leads to the conclusion that much more research is needed on the cost of treating Oppositional Defiant Disorder.

Psychosocial intervention has been found to be related to subsequent reductions in health care use. Studies generally measure this ''offset effect'' by combining medical use categories into one outcome variable, such as outpatient doctor visits. However, using a general outcome variable may obscure more specific patterns of reduction. In an effort to identify potential ''targets'' for mental health intervention, outpatient care for health screening, illness visits, laboratory/X-ray, and urgent care were considered. Health care use reductions were most prominent for high utilizers and were found across a number of different types of outpatient care. With high utilizers, those who participated in MFT showed significant reductions of 68% for health screening visits, 38% for illness visits, 56% for laboratory/X-ray visits, and 78% for urgent care visits. Keywords Family therapy effectiveness Á Health care Á High utilizers of health care Á Cost eccectiveness Á Effectiveness research Á Cost effectiveness of marital/couple and family therapy Á Outpatient health care Á Ambulatory care The Medical Offset Effect: Patterns in Medical Utilization Reductions for High Utilizers of Health Care The United States spends more money per person on health care than any other nation in the world (Agency for Health Care Research and Quality [AHRQ] 2002). Due in part to a number of factors beyond immediate health concerns (Crane 1995; Nichols 2003), health care costs in the US continued to grow from $1,106 per person in 1980 to about $6,280 per person in 2004 (Stanton and Rutherford 2005) While the implementation of managed care slowed the growth of health care costs for a time (Cockerham 1998), costs are again on the rise and may be expected to continue rising in the foreseeable future (AHRQ 2002).

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In the academic literature, including the field of positive psychology, there have been articles advocating how leisure activities can be used within a behavioral activation framework. To this end, differing academic writers advocate the use of scheduling leisure activities to increase enjoyable behavioral activity (e.g., Mazzucchelli et al. 2010), but do not elaborate on how leisure can be used within a behavioral activation framework. This paper fills this void by explaining (1) how the serious leisure perspective (SLP) can help mental health counselors and other applied human service professionals structure potential activation targets based on differentiating between pleasure-based casual leisure and mastery-based serious leisure, and (2) how the SLP can be used as a potential structure for grading activation assignments. The last part of this paper provides a mental health counseling case report of a middleaged man who had stage four renal disease, severe depression, and mild anxiety who became healthier by intervention that linked the SLP, behavioral activation, and positive psychology.