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Functional Family Therapy (FFT) for youth in state institutions

Juvenile Justice
Benefit-cost methods last updated December 2018.  Literature review updated July 2017.
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Functional Family Therapy (FFT) is a structured family-based intervention that uses a multi-step approach to enhance protective factors and reduce risk factors in the family. The five major components of FFT include 1) engagement, 2) motivation, 3) identifying patterns of interaction within the family, 4) behavior change, and 5) generalizing positive interactions to new situations. FFT can be provided in a variety of settings, including institutions, clinics, homes, and schools. The intervention involves 12 to 14 visits over a three to five month period. In included studies, participants included youth who were arrested, referred by courts, or known to have committed status offenses such as running away from home. Studies in this meta-analysis compared FFT to treatment as usual, which included various services such as group therapy or probation.
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 $8,399 Benefits minus costs $36,027
Participants $791 Benefit to cost ratio $11.21
Others $28,159 Chance the program will produce
Indirect $2,208 benefits greater than the costs 96 %
Total benefits $39,557
Net program cost ($3,530)
Benefits minus cost $36,027
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 $7,844 $0 $27,965 $3,917 $39,725
Labor market earnings associated with high school graduation $450 $991 $458 $0 $1,899
Health care associated with educational attainment $201 ($55) ($220) $101 $27
Costs of higher education ($96) ($146) ($44) ($48) ($333)
Adjustment for deadweight cost of program $0 $0 $0 ($1,761) ($1,761)
Totals $8,399 $791 $28,159 $2,208 $39,557
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $3,134 2008 Present value of net program costs (in 2017 dollars) ($3,530)
Comparison costs $0 2008 Cost range (+ or -) 10 %
WSIPP per-participant cost estimates are based on 12 weeks of FFT, as described in Barnoski, R. (2009). Providing evidence-based programs with fidelity in Washington State juvenile courts: Cost analysis (Doc. No. 09-12-1201). Olympia: Washington State Institute for Public Policy.
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.

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

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 disorder^^ 15 1 30 -0.160 0.259 15 n/a n/a n/a -0.160 0.538
Cannabis use^ 15 1 30 0.325 0.338 15 n/a n/a n/a 0.325 0.336
Crime 15 10 1114 -0.247 0.120 17 -0.247 0.120 27 -0.415 0.005
Externalizing behavior symptoms^^ 15 1 40 0.040 0.221 15 n/a n/a n/a 0.040 0.855
Illicit drug use disorder^^ 15 1 30 -0.793 0.268 15 n/a n/a n/a -0.793 0.003
Internalizing symptoms^^ 15 1 40 0.058 0.221 15 n/a n/a n/a 0.058 0.795
Major depressive disorder^^ 15 1 40 -0.251 0.222 15 n/a n/a n/a -0.251 0.258

Citations Used in the Meta-Analysis

Alexander, J.F., & Parsons, B.V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219-225.

Barnoski, R. (2004). Outcome evaluation of Washington State's research-based programs for juvenile offenders (Document No. 04-01-1201). Olympia: Washington State Institute for Public Policy.

Barton, C., Alexander, J.F., Waldron, H., Turner, C W., & Warburton, J. (1985). Generalizing treatment effects of functional family therapy: Three replications. American Journal of Family Therapy, 13(3), 16-26.

Erickson, C.J. (2008). The effectiveness of functional family therapy in the treatment of juvenile sexual offenders. Dissertation Abstracts International, 69-10(B), 6409.

Gordon, D.A. (1995). Functional Family Therapy for delinquents. In R. R. Ross, D. H. Antonowicz, & G. K. Dhaliwal (Eds.), Going straight: Effective delinquency prevention & offender rehabilitation (pp. 163-178). Ottawa, Ontario, Canada: AIR Training Publications.

Hannson, K. (1998). Functional Family Therapy Replication in Sweden: Treatment Outcome with Juvenile Delinquents. Paper presented to the Eighth International Conference on treating addictive behaviors. Santa Fe, NM, February 1998, as reported in: Alexander, J., Barton, C., Gordon, D., Grotpeter, J., Hansson, K., Harrison, R., Mears, S., Mihalic, S., Parsons, B., Pugh, C., Schulman, S., Waldron, H., and Sexton, T. (1998). Blueprints for Violence Prevention, Book Three: Functional Family Therapy. Boulder, CO: Center for the Study and Prevention of Violence.

Humayun, S., Herlitz, L., Chesnokov, M., Doolan, M., Landau, S., & Scott, S. (2017). Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth. Journal of Child Psychology and Psychiatry, 5.

Lantz, B.L. (1982). Preventing adolescent placement through Functional Family Therapy and tracking. Utah Department of Social Services, West Valley Social Services, District 2K, Kearns, UT 84118. As reported in: Alexander, J., Barton, C., Gordon, D., Grotpeter, J., Hansson, K., Harrison, R., Mears, S., Mihalic, S., Parsons, B., Pugh, C., Schulman, S., Waldron, H., and Sexton, T. (1998). Blueprints for Violence Prevention, Book Three: Functional Family Therapy. Boulder, CO: Center for the Study and Prevention of Violence.

Peterson, A. (2017). Functional Family Therapy in a probation setting: outcomes for youths starting treatment January 2010 - September 2012. Olympia, WA: Center for Court Research, Administrative Office of the Courts.

Slesnick, N., & Prestopnik, J.L. (2009). Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital and Family Therapy, 35(3), 255-277.

Waldron, H.B., Slesnick, N., Brody, J.L., Turner, C.W., & Peterson, T.R. (2001). Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology, 69(5), 802-813.