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Multisystemic Therapy-Substance Abuse (MST-SA) for court-involved youth

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated May 2019.
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Multisystemic Therapy—Substance Abuse (MST-SA) is an adaptation of Multisystemic Therapy (MST) that targets youth who engage in disordered use of drugs or alcohol. MST-SA is intended to reduce drug use and abuse, as well as related delinquent or criminal behavior. Referrals to MST-SA typically come from juvenile drug court or as a condition to probation. Therapists deliver MST-SA in the participants’ home, school, and community. MST-SA includes a written plan, intensive family-focused therapy, job training, and inclusion in positive activities (e.g., sports or clubs). This program also includes random drug testing and rewards for positive behavior (e.g., rewarding a clean urinalysis with monetary compensation).

This analysis includes adolescents identified and diagnosed as substance-abusing or dependent. In the included studies, the average MST-SA treatment lasted four months, with several therapist visits with the youth and their family visits per week. In the studies in our analysis that reported demographic information, 65% of participants were youth of color and 21% were female.

We exclude evaluations of Multisystemic Therapy, Multisystemic Therapy-Family Integrated Transitions, and Multisystemic Therapy-Problem Sexual Behavior from this analysis and analyze them separately.

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.

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 (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 $4,412 Benefits minus costs $4,873
Participants $5 Benefit to cost ratio $1.58
Others $10,939 Chance the program will produce
Indirect ($2,023) benefits greater than the costs 58 %
Total benefits $13,332
Net program cost ($8,459)
Benefits minus cost $4,873
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 $4,390 $0 $10,915 $2,195 $17,500
Labor market earnings associated with cannabis abuse or dependence $0 $0 $0 $0 $0
Health care associated with cannabis abuse or dependence $22 $4 $24 $11 $61
Adjustment for deadweight cost of program $0 $0 $0 ($4,229) ($4,229)
Totals $4,412 $5 $10,939 ($2,023) $13,332
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $8,142 2016 Present value of net program costs (in 2018 dollars) ($8,459)
Comparison costs $0 2016 Cost range (+ or -) 20 %
We estimate the per-participant cost by applying an average monthly cost of Multisystemic Therapy-Substance Abuse (MST-SA) to the average length of treatment in the included studies. We estimate a monthly cost for MST-SA using the cost of a similar program, Multisystemic Therapy (MST). We use the cost and average length of MST in Washington, provided by C. Redman (personal communication, Washington State Juvenile Rehabilitation, April 16, 2019), to estimate a monthly cost. This cost reflects estimates from 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. We multiply the monthly cost estimate and the average length of MST-SA in the included studies, approximately 4.2 months.
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 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 37 -0.352 0.286 15 n/a n/a n/a -0.352 0.219
Cannabis use disorder 15 2 80 -0.345 0.223 15 0.000 0.187 18 -0.345 0.121
Crime 15 2 86 -0.217 0.209 16 -0.217 0.209 24 -0.217 0.300
Externalizing behavior symptoms^^ 15 1 43 0.162 0.264 16 n/a n/a n/a 0.162 0.540
Illicit drug use disorder^^ 15 1 43 -0.315 0.323 16 n/a n/a n/a -0.315 0.329
Internalizing symptoms^^ 15 1 43 0.114 0.264 16 n/a n/a n/a 0.114 0.665
Problem alcohol use^^ 15 1 37 -0.363 0.286 15 n/a n/a n/a -0.363 0.204

Citations Used in the Meta-Analysis

Henggeler, S.W., Clingempeel, W.G., Brondino, M.J., & Pickrel, S.G. (2002). Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41(7), 868-874.

Henggeler, S.W., Halliday-Boykins, C.A., Cunningham, P.B., Randall, J., Shapiro, S.B, & Chapman, J.E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42-54.