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Multisystemic Therapy (MST) for court-involved/post-release youth

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated May 2019.
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Multisystemic Therapy (MST) is an intensive family- and community-based therapy for youth with antisocial behaviors that combines aspects of cognitive, behavioral, and family therapies. In the juvenile justice setting, MST is designed for youth with violent and chronic criminal behavior. The goal of MST is to identify problems and assess how those problems fit within the context of the youth’s life. The program targets and delivers its curriculum in the environments a youth navigates (i.e., home, school, the community). MST therapists meet weekly with the youth and their family members for three to six months. MST relies on the compliance of the family to design and implement the treatment plan to adjust to the individual strengths and needs of each family.

In the included studies, participants received an average of 4.1 months of treatment. Youth were classified as moderate- or high-risk per scores on a validated risk instrument and were either on probation following adjudication or following their release from confinement. In the studies in the analysis that reported demographic information, 80% of participants were youth of color and 23% were female.

We exclude evaluations of Multisystemic Therapy-Substance Abuse, 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 $7,118 Benefits minus costs $16,847
Participants $1,400 Benefit to cost ratio $3.02
Others $17,649 Chance the program will produce
Indirect ($966) benefits greater than the costs 99 %
Total benefits $25,201
Net program cost ($8,354)
Benefits minus cost $16,847
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 $6,576 $0 $16,815 $3,288 $26,679
Labor market earnings associated with high school graduation $695 $1,633 $904 $0 $3,232
Costs of higher education ($154) ($233) ($70) ($77) ($533)
Adjustment for deadweight cost of program $0 $0 $0 ($4,177) ($4,177)
Totals $7,118 $1,400 $17,649 ($966) $25,201
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $8,041 2016 Present value of net program costs (in 2018 dollars) ($8,354)
Comparison costs $0 2016 Cost range (+ or -) 20 %
The per-participant cost estimate is the average cost of providing Multisystemic Therapy (MST), as implemented in the studies included in this analysis. We estimate a monthly cost for MST using the average length of the program in Washington (four months) and the cost of MST in Washington, provided by C. Redman (personal communication, Washington State Juvenile Rehabilitation, April 16, 2019). 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 this monthly cost estimate and the average length of MST in the included studies, approximately 4.1 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’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
Crime 15 6 1072 -0.314 0.069 16 -0.314 0.069 24 -0.314 0.001
Externalizing behavior symptoms^^ 15 1 53 0.034 0.197 15 n/a n/a n/a 0.034 0.864
Internalizing symptoms^^ 15 1 53 0.254 0.197 15 n/a n/a n/a 0.254 0.198
Technical violations^ 15 1 43 0.832 0.691 16 n/a n/a n/a 0.832 0.228

Citations Used in the Meta-Analysis

Butler, S., Fonagy, P., Baruch, G., & Hickey, N. (2011). A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50 (12), 1220-1235.

Fain, T., & Greathouse, S.M. (2014). Effectiveness of multisystemic therapy for minority youth: Outcomes over 8 years in Los Angeles County, Journal of Juvenile Justice, 3 (2), 24-38.

Henggeler, S.W., Melton, G.B., Smith, L.A., Schoenwald, S.K., & Hanley, J.H. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953 – 961.

Henggeler, S.W., Melton, G.B., Brondino, M.J., Scherer, D.G., & Hanley, J.H. (1997). Multisystemic therapy with violent and chronic juvenile offenders and their families: The role of treatment fidelity in successful dissemination. Journal of Consulting and Clinical Psychology, 65 (5), 821-833.

Leschied, A.W., & Cunningham, A.J., London Family Court Clinic. (2002). Seeking effective interventions for serious young offenders: Interim results of a four-year randomized study of multisystemic therapy in Ontario, Canada. London, ON: Centre for Children and Families in the Justice System.

Schaeffer, C.M., & Borduin, C.M. (2005). Long-term follow-up to a randomized clinical trial of Multisystemic Therapy with serious and violent juvenile offenders. Journal of Consulting and Clinical Psychology, 73 (3), 445-453.