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Functional Family Therapy (FFT) for youth post-release

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated March 2019.
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Functional Family Therapy (FFT) is a structured family-based intervention that uses a multi-step approach to enhance protective factors and reduce risk factors in the family. The five major components of FFT include engagement, motivation, relational assessment, behavior change, and generalization.

In the included studies, FFT typically involved 12 to 14 therapist visits over a three- to seven-month period. Studies in this meta-analysis compare FFT to treatment as usual, which is often post-confinement supervision with referrals to community-based services. In the studies in our analysis that reported demographic information, 35% of participants were youth of color.

This analysis includes studies where FFT is provided to youth in the community following their release from confinement. Evaluations of FFT where youth receive the program following arrest or adjudication (and are not confined) and FFT for youth convicted of a sex offense are excluded from this analysis and analyzed 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 $33,597 Benefits minus costs $138,422
Participants $3,793 Benefit to cost ratio $18.75
Others $96,879 Chance the program will produce
Indirect $11,953 benefits greater than the costs 100 %
Total benefits $146,222
Net program cost ($7,800)
Benefits minus cost $138,422
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 $32,133 $0 $94,614 $16,067 $142,814
Labor market earnings associated with high school graduation $1,890 $4,439 $2,458 $0 $8,786
Costs of higher education ($426) ($645) ($193) ($213) ($1,478)
Adjustment for deadweight cost of program $0 $0 $0 ($3,900) ($3,900)
Totals $33,597 $3,793 $96,879 $11,953 $146,222
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $7,508 2016 Present value of net program costs (in 2018 dollars) ($7,800)
Comparison costs $0 2016 Cost range (+ or -) 20 %
The per-participant cost estimate is the weighted average cost of providing Functional Family Therapy (FFT), as implemented in the studies included in this analysis. We use the cost and average length of the program in Washington (3 months), 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 FFT in the included studies, approximately 6.5 months. The comparison group cost represents treatment-as-usual, which includes probation with referrals to community-based services and programming.
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.

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 17 2 57 -0.976 0.245 18 -0.976 0.245 26 -0.976 0.001

Citations Used in the Meta-Analysis

Barton, C., Alexander, J.F., Waldron, H., Turner, C W., & Warburton, J. (1985). Generalizing treatment effects of functional family therapy: Three replications. American Journal of Family Therapy, 13(3), 16-26.

Gordon, D.A. (1995). Functional Family Therapy for delinquents. In R. R. Ross, D. H. Antonowicz, & G. K. Dhaliwal (Eds.), Going straight: Effective delinquency prevention & offender rehabilitation (pp. 163-178). Ottawa, Ontario, Canada: AIR Training Publications.