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Multidimensional Treatment Foster Care (MTFC) (vs. group homes) for court-involved youth

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated June 2019.
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Multidimensional Treatment Foster Care (MTFC) is an intensive therapeutic foster care alternative to institutional placement for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. MTFC activities include skills training and therapy for youth, as well as behavioral parent training and support for foster parents and biological parents. Participating youth are closely monitored by the foster parents. The length of the program varies and ranged from 5 to 15 months.

This analysis is on MTFC for adjudicated youth who are sentenced to out-of-home placement. The studies in this meta-analysis compared MTFC to treatment as usual, which typically involved placement in a group home. Treatment group youth were in MTFC for 197 days, on average, and comparison youth were typically in group homes for 189 days. In included studies that reported demographics, 23% of participants were youth of color and 58% were female.

Key Terms

Court-involved youth: Youth who are processed through the juvenile justice system but who are not ordered to a period of confinement in a residential or correctional facility. This includes populations of arrested youth, diverted youth, charged youth, adjudicated youth, and youth on probation or formal supervision.

Youth in state institutions: Youth who are confined in a residential or correctional facility when they participate in the program.

Youth post-release: Youth who are returning to the community following a period of confinement in a residential or correctional facility and who participate in the program after release to the community.

The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2018). 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 $11,278 Benefits minus costs $30,661
Participants $268 Benefit to cost ratio $4.29
Others $27,481 Chance the program will produce
Indirect $946 benefits greater than the costs 91 %
Total benefits $39,973
Net program cost ($9,311)
Benefits minus cost $30,661
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 $11,067 $0 $27,372 $5,533 $43,973
K-12 grade repetition $5 $0 $0 $3 $8
Labor market earnings associated with major depression $100 $236 $0 $0 $336
Health care associated with major depression $105 $30 $108 $52 $295
Mortality associated with depression $1 $2 $0 $13 $16
Adjustment for deadweight cost of program $0 $0 $0 ($4,656) ($4,656)
Totals $11,278 $268 $27,481 $946 $39,973
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $27,863 2017 Present value of net program costs (in 2018 dollars) ($9,311)
Comparison costs $18,232 2015 Cost range (+ or -) 20 %
We estimate the per-participant cost of Multidimensional Treatment Foster Care (MTFC) using the per-client cost of community placement (modeled after MTFC) reported by Washington State Department of Social and Health Services, Client Services (2019, We estimate the per-participant cost for youth in the comparison group using the average daily costs for group home care reported in McKay, P., Hollist, D., & Mayrer, J. (2016). Foster or group home care for youth on probation. Missoula, MT: University of Montana, Missoula. We apply this daily cost ($96.48) to the average time spent in group care by participants in the studies (189 days).
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 before end of high school^^ 15 1 32 -0.126 0.240 16 n/a n/a n/a -0.126 0.601
Cannabis use before end of high school^^ 15 1 32 -0.230 0.241 16 n/a n/a n/a -0.230 0.340
Crime 15 4 157 -0.548 0.166 16 -0.548 0.166 24 -0.548 0.001
Major depressive disorder 15 1 81 -0.378 0.157 23 0.000 0.310 25 -0.378 0.016
Psychosis symptoms (positive)^ 15 1 75 -0.364 0.216 16 n/a n/a n/a -0.364 0.091
Regular smoking^^ 15 1 32 -0.190 0.240 16 n/a n/a n/a -0.190 0.429
Substance use^ 15 1 32 -0.261 0.241 16 n/a n/a n/a -0.261 0.279
Suicidal ideation^ 15 1 81 -0.458 0.157 23 n/a n/a n/a -0.458 0.004
Suicide attempts^ 15 1 81 0.095 0.233 23 n/a n/a n/a 0.095 0.685
Teen pregnancy (under age 18)^ 15 1 78 -0.538 0.187 16 n/a n/a n/a -0.538 0.004

Citations Used in the Meta-Analysis

Biehal, N., Ellison, S., & Sinclair, I. (2012). Intensive fostering: an independent evaluation of MTFC in an English setting. Adoption & Fostering, 36(1), 13-26.

Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care, 2(2), 21-36.

Chamberlain, P., Fisher, P.A., & Moore, K. (2002). Multidimensional treatment foster care: Applications of the OSLC intervention model to high-risk youth and their families. In J. B. Reid, G. R. Patterson, & J. Snyder (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention (pp. 203-218). Washington DC: American Psychological Association.

Kerr, D.C., DeGarmo, D.S., Leve, L.D., & Chamberlain, P. (2014). Juvenile justice girls’ depressive symptoms and suicidal ideation 9 years after multidimensional treatment foster care. Journal of Consulting and Clinical Psychology, 82(4), 684-693.

Kerr, D.C., Leve, L.D., & Chamberlain, P. (2009). Pregnancy rates among juvenile justice girls in two randomized controlled trials of multidimensional treatment foster care. Journal of Consulting and Clinical Psychology, 77(3), 588-593.

Poulton, R., Van, R. M.J., Harold, G.T., Chamberlain, P., Fowler, D., Cannon, M., Arseneault, L., & Leve, L.D. (2014). Effects of Multidimensional Treatment Foster Care on Psychotic Symptoms in Girls. Journal of the American Academy of Child & Adolescent Psychiatry, 53(12), 1279-1287.

Smith, D.K., Chamberlain, P., & Eddy, J.M. (2010). Preliminary support for Multidimensional Treatment Foster Care in reducing substance use in delinquent boys. Journal of Child & Adolescent Substance Abuse, 19(4), 343-358.

Van Ryzin, M.J., & Leve, L.D. (2012). Affiliation with delinquent peers as a mediator of the effects of multidimensional treatment foster care for delinquent girls. Journal of Consulting and Clinical Psychology, 80(4), 588-96.