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Washington State Institute for Public Policy
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Brief Strategic Family Therapy (BSFT)

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2017.  Literature review updated June 2016.
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This intervention is aimed at children and adolescents who are at risk of developing serious behavior problems, including delinquency and substance abuse. Therapy targets maladaptive interactions and problems within each family. The program is typically 12 to 16 sessions of 60 to 90 minutes in length over a three- to four-month period. Because such risk can be defined in various ways, the studies in this analysis included participants with different types and severity of problems. This treatment has been extensively tested on ethnic minorities.
More information is available at the program website.
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 $479 Benefits minus costs ($224)
Participants ($290) Benefit to cost ratio $0.59
Others $162 Chance the program will produce
Indirect ($31) benefits greater than the costs 43 %
Total benefits $320
Net program cost ($544)
Benefits minus cost ($224)
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 ($197) $0 ($394) ($98) ($690)
K-12 grade repetition $7 $0 $0 $4 $11
K-12 special education $412 $0 $0 $206 $617
Property loss associated with alcohol abuse or dependence $0 ($5) ($9) $0 ($14)
Labor market earnings associated with illicit drug abuse or dependence $0 $0 $0 $0 $0
Health care associated with disruptive behavior disorder $571 $186 $707 $285 $1,749
Costs of higher education ($313) ($471) ($141) ($156) ($1,081)
Adjustment for deadweight cost of program $0 $0 $0 ($272) ($272)
Totals $479 ($290) $162 ($31) $320
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,350 2010 Present value of net program costs (in 2016 dollars) ($544)
Comparison costs $850 2010 Cost range (+ or -) 10 %
This intervention usually takes place over a three- to four-month period. We estimated per-participant cost based on an average of 14.8 hours of therapist time, as reported in the treatment studies, multiplied by actuarial estimate of cost of hourly family therapy reported in Mercer. (2013). Behavioral Health Data Book for the State of Washington for Rates Effective January 1, 2014. Comparison cost is based on the average DSHS reimbursement for treatment of child disruptive behavior.
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
Disruptive behavior disorder symptoms 4 3 124 -0.251 0.148 14 -0.119 0.092 17 -0.500 0.002
Illicit drug use disorder 4 2 301 -0.087 0.103 13 0.000 0.187 16 -0.086 0.405
Smoking in high school 4 1 20 -1.203 0.344 17 -1.203 0.344 18 -1.203 0.001
STD risky behavior^ 4 1 20 -0.573 0.323 17 n/a n/a n/a -0.573 0.076
Youth binge drinking 4 1 20 0.344 0.319 17 0.344 0.319 17 0.344 0.280

Citations Used in the Meta-Analysis

Coatsworth, J.D., Santisteban, D.A., McBride, C.K, Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313-313

Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., Muehlbacher, M., . . . Loew, T. (2006). Bullying girls—changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy and Psychosomatics, 75(1), 47-55.

Robbins, M.S., Feaster, D.J., Horigian, V.E., Rohrbaugh, M., Shoham, V., Bachrach, K., Miller, M., ... & Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713-727.

Santisteban, D.A., Coatsworth, J.D., Perez-Vidal, A., Kurtines, W.M., Schwartz, S.J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121-133.

Szapocznik, J., Rio, A., Murray, E., Cohen, R., Scopetta, M., Rivas-Vasquez, A., . . . Kurtines, W. (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Journal of Consulting and Clinical Psychology, 57(5), 571-578.