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Washington State Institute for Public Policy
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Familias Unidas

Public Health & Prevention: Home- or Family-based
Benefit-cost methods last updated December 2018.  Literature review updated June 2016.
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Familias Unidas is a family-based prevention program for Latino youth and their families. The program involves 8 parent group meetings and 4 home visits. Group sessions are facilitated by two therapists. The sessions focus on positive parenting, family communication, parental monitoring, and adolescent risk (substance use, HIV) behaviors.
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 $137 Benefits minus costs ($1,811)
Participants $180 Benefit to cost ratio ($0.20)
Others $95 Chance the program will produce
Indirect ($711) benefits greater than the costs 41 %
Total benefits ($299)
Net program cost ($1,512)
Benefits minus cost ($1,811)
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 $21 $0 $51 $10 $82
Labor market earnings associated with smoking $76 $166 $0 $0 $242
Health care associated with smoking $41 $12 $42 $21 $115
Property loss associated with alcohol abuse or dependence $0 $1 $2 $0 $3
Mortality associated with smoking $0 $1 $0 $12 $13
Adjustment for deadweight cost of program $0 $0 $0 ($755) ($755)
Totals $137 $180 $95 ($711) ($299)
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,465 2014 Present value of net program costs (in 2017 dollars) ($1,512)
Comparison costs $0 2014 Cost range (+ or -) 25 %
We estimate per-participant cost using by multiplying 16 hours of group sessions by the hourly rate for each facilitator multiplied by 12 facilitators divided by 10 families per group. Cost of 4 home visits per family assuming 1.5 hours with facilitator travel. Training costs assume 10 facilitators can be trained at one time, 48 hours of training, with a cost of $50,000 to train 10 facilitators. We further assume that the intervention would be provided by school counselors, using average hourly rates for certificated school personnel and that each counselor would be provide one session per year for 3 years and that 3 hours of clinical supervision would be provided per week for each group. Again, cost per participant assumes 10 families per group. Costs may vary depending on whether facilitators are school district employees or independent contractors. Information on required training provided by Yessine Estrada on May 17, 2016.
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 2 186 -0.059 0.117 16 -0.059 0.117 18 -0.156 0.612
Cannabis use disorder 15 1 120 -0.056 0.140 16 -0.056 0.140 26 -0.146 0.296
Illicit drug use in high school 15 1 66 0.005 0.181 16 0.005 0.181 18 0.014 0.937
Initiation of sexual activity^ 15 2 120 -0.099 0.198 16 n/a n/a n/a -0.264 0.180
Regular smoking 15 1 66 -0.012 0.181 16 -0.012 0.181 26 -0.031 0.865
STD risky behavior^ 15 1 43 -0.129 0.309 16 n/a n/a n/a -0.339 0.293

Citations Used in the Meta-Analysis

Estrada, Y., Rosen, A., Huang, S., Tapia, M., Sutton, M., Willis, L., Quevedo, A., . . . Prado, G. (2015). Efficacy of a brief intervention to reduce substance use and Human Immunodeficiency Virus infection risk among Latino youth. Journal of Adolescent Health, 57(6), 651-657.

Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M.I., Schwartz, S.J., Sabillon, E., Brown, C.H., & Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71(9), 987-995.

Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M. I., Velazquez, M. R., Calfee, M., . . . Estrada, Y. (2012). Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 166(2), 127-33.

Prado, G., Cordova, D., Huang, S., Estrada, Y., Rosen, A., Bacio, G. A., Leon, J. G., . . . McCollister, K. (2012). The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: Main effects and interaction effects by parental stress and social support. Drug and Alcohol Dependence, 125.