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Cognitive behavioral therapy (CBT) for youth in state institutions

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated July 2019.
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Cognitive behavioral therapy (CBT) uses cognitive restructuring, self-talk, skill-building, and other strategies to treat mental illness or address problem behaviors. In a juvenile justice setting, CBT emphasizes individual accountability and teaches participants that cognitive deficits, distortions, and flawed thinking processes can cause criminal behavior. The studies included in this meta-analysis evaluated name brand programs including Coping Course, Corrective Thinking, and Situational-Decision Making.

In this meta-analysis, CBT is delivered to youth serving sentences in state institutions. We include evaluations of CBT programs that target criminal behavior, rather than specific mental health problems. In the included studies, participants were in treatment for two or three months, for a total of 16 to 122 hours of group-based therapy. In the included studies that report demographic information, 50% of participants were youth of color and 29% were female.

Evaluations on CBT for court-involved youth 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 $3,547 Benefits minus costs $15,993
Participants $464 Benefit to cost ratio $52.59
Others $10,789 Chance the program will produce
Indirect $1,503 benefits greater than the costs 68 %
Total benefits $16,303
Net program cost ($310)
Benefits minus cost $15,993
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 $3,368 $0 $10,512 $1,684 $15,564
Labor market earnings associated with high school graduation $231 $542 $300 $0 $1,073
Costs of higher education ($52) ($78) ($23) ($26) ($179)
Adjustment for deadweight cost of program $0 $0 $0 ($155) ($155)
Totals $3,547 $464 $10,789 $1,503 $16,303
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $310 2018 Present value of net program costs (in 2018 dollars) ($310)
Comparison costs $0 2018 Cost range (+ or -) 50 %
The per-participant cost estimate is based on provider wages for the average implementation of cognitive behavioral therapy (CBT) in the included studies. We estimate that participants receive an average of 57 hours of group therapy, as reported in the included studies. We use hourly wage information for Corrections Mental Health Counselors from the Office of Financial Management (https://ofm.wa.gov/state-human-resources/compensation-job-classes/ClassifiedJobListing/SalaryRange/1208) and multiply this by 1.44 to account for benefits. We assume that there are eight participants in the average CBT group.
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 16 2 105 -0.118 0.236 17 -0.118 0.236 25 -0.118 0.617
Externalizing behavior symptoms^^ 16 1 46 -0.542 0.268 16 n/a n/a n/a -0.542 0.029
Internalizing symptoms^^ 16 1 46 -0.378 0.246 16 n/a n/a n/a -0.378 0.124
Suicidal ideation^ 16 1 46 -0.339 0.246 16 n/a n/a n/a -0.339 0.168

Citations Used in the Meta-Analysis

Bottcher, J. (1985). The Athena Program: An evaluation of a girl’s treatment program at the Fresno County Probation Department’s Juvenile Hall. Sacramento: California Youth Authority.

Hubbard, D.J., & Latessa, E.J. (2004). Evaluation of cognitive-behavioral programs for offenders: A look at outcome and responsivity in five treatment programs (Final report). Cincinnati: University of Cincinnati, Division of Criminal Justice, Center for Criminal Justice Research.

Rohde, P., Jorgensen, J.S., Seeley, J.R., & Mace, D.E. (2004). Pilot evaluation of the coping course: A cognitive-behavioral intervention to enhance coping skills in incarcerated youth. Journal of the American Academy of Child & Adolescent Psychiatry, 43 (6), 669-676.