Washington State Institute for Public Policy

Cognitive Behavioral Therapy (CBT)
Juvenile Justice
Benefit-cost estimates updated May 2017. Literature review updated December 2014.

Cognitive-Behavior Therapy (CBT) emphasizes individual accountability and teaches offenders that cognitive deficits, distortions, and flawed thinking processes can cause criminal behavior. All CBT programs focus on cognitive restructuring, but not all programs include skill building. In this meta-analysis, CBT is delivered to juveniles in a group setting in both the institutional and community settings ranging from 3 to 12 months. Name-brand programs, including Reasoning and Rehabilitation, Moral Reconation Therapy, and Situational-Decision Making, as well as "homegrown programs," were included in this meta-analysis.

We further examined the effectiveness of CBT using multivariate regression analysis and found little variation based upon program brand, gender of participants, treatment length, treatment setting or follow-up period (p > 0.5).

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	$3,672	Benefits minus costs	$14,562
	Participants	$805	Benefit to cost ratio	$37.87
	Others	$9,044	Chance the program will produce
	Indirect	$1,436	benefits greater than the costs	94 %
	Total benefits	$14,957
	Net program cost	($395)
	Benefits minus cost	$14,562

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	$3,212	$0	$8,757	$1,608	$13,576
Labor market earnings associated with high school graduation	$408	$899	$414	$0	$1,721
Health care associated with educational attainment	$97	($27)	($106)	$49	$13
Costs of higher education	($45)	($68)	($20)	($23)	($156)
Adjustment for deadweight cost of program	$0	$0	$0	($198)	($198)

Totals	$3,672	$805	$9,044	$1,436	$14,957

Detailed Annual Cost Estimates Per Participant
Annual cost		Year dollars	Summary
Program costs	$285	1998	Present value of net program costs (in 2016 dollars)	($395)
Comparison costs	$0	1998	Cost range (+ or -)	10 %

This program is typically delivered over a period of 3 to 12 months. Per-participant costs from Aos, S., Phipps, P. Barnoski, R. & Lieb, R. (1999). The comparative costs and benefits of programs to reduce crime: A review of national research findings with implications for Washington State (Doc. No. 99-05-1202). 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.

**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
				ES	SE	Age	ES	SE	Age	ES	p-value
Crime	Primary	8	2114	-0.122	0.077	18	-0.122	0.077	28	-0.122	0.110

Citations Used in the Meta-Analysis

Bottcher, J. (1985). The Athena Program: An evaluation of a girl’s treatment program at the Fresno County Probation Department’s Juvenile Hall. Sacramento: California Youth Authority.

Cann, J., Falshaw, L., Nugent, F., & Friendship, C. (2003). Understanding what works: Accredited cognitive skills programmes for adult men and young offenders (Research Findings No. 226). London: Home Office.

Deschamps, T. (1998). MRT: Is it effective in decreasing recidivism rates with young offenders? (Master's thesis). University of Windsor: Ontario, CA.

Gordon, J.S. (1996). An evaluation of Paint Creek Youth Center (Unpublished doctoral thesis). University of Cincinnati, OH.

Hubbard, D.J., & Latessa, E.J. (2004). Evaluation of cognitive-behavioral programs for offenders: A look at outcome and responsivity in five treatment programs (Final report). Cincinnati: University of Cincinnati, Division of Criminal Justice, Center for Criminal Justice Research.

Leeman, L.W., Gibbs, J.C., & Fuller, D. (1993). Evaluation of a multi-component group treatment program for juvenile delinquents. Aggressive Behavior, 19(4), 281-292.

Pullen, S. (1996). Evaluation of the Reasoning and Rehabilitation cognitive skills development program as implemented in juvenile ISP in Colorado. Denver: Colorado Department of Public Safety, Division of Criminal Justice.

Robertson, A.A., Grimes, P.W., & Rogers, K.E. (2001). A short-run cost-benefit analysis of community-based interventions for juvenile offenders. Crime & Delinquency 47(2), 265-285.