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Multisystemic Therapy (MST) for juveniles convicted of sex offenses

Juvenile Justice
Benefit-cost methods last updated December 2018.  Literature review updated August 2017.
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Multisystemic Therapy for Youth with Problem Sexual Behaviors (MST–PSB) is an adaptation of MST for juveniles who have committed sexual offenses. Juveniles are referred from juvenile court following diversion or adjudication.

MST-PSB emphasizes intensive family therapy, as well as identifying and solving potential triggers and environmental factors that lead to problem sexual behaviors. MST-PSB therapists visit three or more times a week over the course of the average length of treatment, approximately seven months. MST-PSB therapists’ work with the youth, their families, and others identified in the youth’s community to establish and promote healthy relationships.

This meta-analysis includes adolescents with a problem sexual behavior (i.e., officially identified as a juvenile with a sex offense). We present analyses for other types of MST separately from this analysis.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2017). 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 $3,823 Benefits minus costs $5,404
Participants $692 Benefit to cost ratio $1.60
Others $12,735 Chance the program will produce
Indirect ($2,790) benefits greater than the costs 63 %
Total benefits $14,459
Net program cost ($9,056)
Benefits minus cost $5,404
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 $3,481 $0 $12,350 $1,739 $17,570
Labor market earnings associated with high school graduation $359 $791 $367 $0 $1,518
K-12 grade repetition $1 $0 $0 $1 $2
K-12 special education $7 $0 $0 $4 $10
Property loss associated with alcohol abuse or dependence $0 $1 $1 $0 $2
Health care associated with externalizing behavior symptoms $50 $14 $52 $25 $140
Costs of higher education ($76) ($115) ($34) ($38) ($263)
Mortality associated with alcohol $0 $0 $0 $3 $4
Adjustment for deadweight cost of program $0 $0 $0 ($4,523) ($4,523)
Totals $3,823 $692 $12,735 ($2,790) $14,459
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $8,905 2016 Present value of net program costs (in 2017 dollars) ($9,056)
Comparison costs $0 2016 Cost range (+ or -) 10 %
The per-participant costs, based on MST-PSB for four months, are sourced from Blueprints for Healthy Youth Development. (2016). Multisystemic Therapy-Problem Sexual Behavior (MST-PSB) Program Costs. Retrieved from These costs reflect Bureau of Labor Statistics reported salaries for eight master-level therapists who each utilize a caseload of four families per four months of service. This represents a total of 96 families served per year. Also reflected are supervisor salary which requires a 0.5 FTE supervisor per four therapists. Additionally, licensing costs, program support fees, Test Analysis Modules using R (TAM-R) collection, and general overhead costs are included in the estimate.
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 Treatment age 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
Alcohol use in high school 15 1 66 -0.025 0.239 17 -0.025 0.239 18 -0.066 0.783
Cannabis use in high school 15 1 66 0.000 0.246 17 0.000 0.246 18 0.000 1.000
Crime 15 4 164 -0.163 0.138 17 -0.163 0.138 27 -0.553 0.028
Externalizing behavior symptoms 15 1 67 -0.024 0.178 17 -0.013 0.107 20 -0.065 0.715
Grade point average^ 15 1 24 0.521 0.294 17 n/a n/a n/a 1.409 0.001
Internalizing symptoms 15 1 67 -0.040 0.178 17 -0.040 0.178 19 -0.107 0.546
Sex offense^ 15 2 32 -0.509 0.327 21 n/a n/a n/a -1.391 0.001

Citations Used in the Meta-Analysis

Borduin, C.M., Henggeler, S.W., Blaske, D.M., & Stein, R. (1990). Multisystemic treatment of adolescent sexual offenders. International Journal of Offender Therapy and Comparative Criminology, 35(2), 105-113.

Borduin, C.M., Schaeffer, C.M., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77(1), 26-37.

Letourneau, E.J., Henggeler, S.W., Borduin, C.M., Schewe, P.A., McCart, M.R., Chapman, J E., et al. (2009). Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. Journal of Family Psychology, 23(1), 89-102.

Letourneau, E.J., Henggeler, S.W., McCart, M.R., Borduin, C.M., Schewe, P.A., & Armstrong, K.S. (2013). Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend. Journal of Family Psychology, 27(6), 978-985.