Washington State Institute for Public Policy

Multidimensional Treatment Foster Care
Juvenile Justice
Benefit-cost estimates updated May 2017. Literature review updated June 2014.

Multidimensional Treatment Foster Care (MTFC) is an intensive therapeutic foster care alternative to institutional placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. MTFC activities include skills training and therapy for youth as well as behavioral parent training and support for foster parents and biological parents. The length of the program varies for each youth depending on their age, when they obtain a permanent placement or are reunited with the biological family, or are no longer under the jurisdiction of the Juvenile Rehabilitation Administration.

In our analysis, we only include effect sizes from programs that were delivered competently and with fidelity to the program model.

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	$4,575	Benefits minus costs	$9,054
	Participants	$881	Benefit to cost ratio	$2.08
	Others	$14,092	Chance the program will produce
	Indirect	($2,116)	benefits greater than the costs	62 %
	Total benefits	$17,432
	Net program cost	($8,379)
	Benefits minus cost	$9,054

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	$4,012	$0	$13,592	$2,014	$19,618
Labor market earnings associated with high school graduation	$420	$924	$430	$0	$1,774
K-12 grade repetition	$22	$0	$0	$11	$33
K-12 special education	$94	$0	$0	$47	$142
Property loss associated with alcohol abuse or dependence	$0	$1	$2	$0	$3
Health care associated with disruptive behavior disorder	$72	$23	$89	$36	$221
Costs of higher education	($45)	($68)	($20)	($23)	($156)
Adjustment for deadweight cost of program	$0	$0	$0	($4,202)	($4,202)

Totals	$4,575	$881	$14,092	($2,116)	$17,432

Detailed Annual Cost Estimates Per Participant
Annual cost		Year dollars	Summary
Program costs	$31,883	2007	Present value of net program costs (in 2016 dollars)	($8,379)
Comparison costs	$24,536	2007	Cost range (+ or -)	10 %

The per-participant cost estimate provided by the Juvenile Rehabilitation Administration is based on an average length in the program during 2010 and includes oversight, coordination, and administration of the program. Aftercare programming for MTFC is discretionary and the additional associated cost calculation formulas are currently in development. The MTFC cost estimate is compared with alternative cost for youth in group homes.

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.
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			Unadjusted effect size (random effects model)
				ES	SE	Age	ES	SE	Age	ES	p-value
Alcohol use in high school	Primary	1	32	-0.045	0.240	17	-0.045	0.240	19	-0.126	0.601
Cannabis use in high school	Primary	1	32	-0.083	0.240	17	-0.083	0.240	19	-0.230	0.340
Crime	Primary	3	134	-0.110	0.126	17	-0.110	0.126	27	-0.544	0.091
Externalizing behavior symptoms	Primary	1	20	-0.627	0.350	17	-0.299	0.221	20	-0.627	0.073
Illicit drug use in high school	Primary	1	32	-0.094	0.240	17	-0.094	0.240	19	-0.261	0.279
Internalizing symptoms	Primary	1	20	-0.428	0.346	17	-0.312	0.295	20	-0.428	0.216
Smoking in high school	Primary	1	32	-0.068	0.240	17	-0.068	0.240	19	-0.190	0.429
Teen pregnancy (under age 18)^{^}	Primary	1	81	-0.538	0.187	16	-0.538	0.187	18	-0.538	0.004

Citations Used in the Meta-Analysis

Chamberlain, P., Fisher, P.A., & Moore, K. (2002). Multidimensional treatment foster care: Applications of the OSLC intervention model to high-risk youth and their families. In J.B. Reid, G.R. Patterson, & J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention (pp. 203-218). Washington DC: American Psychological Association.

Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care, 2(2), 21-36.

Kerr, D. C., Leve, L. D., & Chamberlain, P. (2009). Pregnancy rates among juvenile justice girls in two randomized controlled trials of multidimensional treatment foster care. Journal of Consulting and Clinical Psychology, 77(3), 588-593.

Smith, D.K., Chamberlain, P., & Eddy, J.M. (2010). Preliminary support for multidimensional treatment foster care in reducing substance use in delinquent boys. Journal of Child & Adolescent Substance Abuse, 19(4), 343-358.

Van Ryzin, M.J., & Leve, L.D. (2012). Affiliation with delinquent peers as a mediator of the effects of multidimensional treatment foster care for delinquent girls. Journal of Consulting and Clinical Psychology, 80(4), 588-96.

Westermark, P.K., Hansson, K., & Olsson, M. (2011). Multidimensional treatment foster care (MTFC): Results from an independent replication. Journal of Family Therapy, 33(1), 20-41.