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Familias Unidas

Public Health & Prevention: Home- or Family-based
Benefit-cost methods last updated December 2019.  Literature review updated February 2019.
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Familias Unidas is a family-based prevention program for Hispanic and Latino adolescents, designed to prevent substance abuse, risky sexual behavior, and behavior problems. The program typically involves eight parent group meetings and four family visits, either in homes or schools. Group sessions are facilitated by two therapists or counselors. The sessions focus on positive parenting, family communication, parental monitoring, and adolescent risk (substance use, HIV) behaviors. Studies in this analysis included both a general population as well as adolescents with behavior or delinquency problems. One study tested an online version of the program. Program duration ranges from six weeks to six months, with most included studies evaluating the three-month version.
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 $1,898 Benefits minus costs $3,874
Participants $3,780 Benefit to cost ratio $3.50
Others $325 Chance the program will produce
Indirect ($581) benefits greater than the costs 67 %
Total benefits $5,422
Net program cost ($1,548)
Benefits minus cost $3,874
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 $47 $0 $123 $24 $194
K-12 grade repetition $2 $0 $0 $1 $3
K-12 special education $79 $0 $0 $39 $118
Labor market earnings associated with alcohol abuse or dependence $1,582 $3,717 $0 $0 $5,299
Property loss associated with alcohol abuse or dependence $0 $6 $10 $0 $16
Health care associated with externalizing behavior symptoms $186 $52 $192 $93 $522
Mortality associated with alcohol $2 $5 $0 $36 $43
Adjustment for deadweight cost of program $0 $0 $0 ($774) ($774)
Totals $1,898 $3,780 $325 ($581) $5,422
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,548 2018 Present value of net program costs (in 2018 dollars) ($1,548)
Comparison costs $0 2018 Cost range (+ or -) 20 %
We estimate the per-participant cost for the three-month program by multiplying the hours of group and family sessions by the hourly rate for a facilitator (school counselor). We assume that there are ten families and two facilitators per group therapy session. We also include the cost to train facilitators, assuming ten facilitators are trained in a 48-hour session that costs $50,000. We include the cost of three hours per week of supervision. Information on training and supervision was provided by Yannine Estrada of Familias Unidas on May 17, 2016. We estimate the value of counselor time using average Washington State compensation costs (including benefits) for the 2017-18 school year as reported by the Office of the Superintendent of Public Instruction (http://www.k12.wa.us/safs/PUB/PER/1718/ps.asp).
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.

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 14 4 668 -0.001 0.058 15 -0.001 0.058 18 0.002 0.977
Alcohol use disorder 14 1 113 -0.116 0.144 14 -0.116 0.144 24 -0.305 0.035
Cannabis use before end of high school 14 1 113 -0.037 0.129 14 -0.037 0.129 18 -0.098 0.456
Cannabis use disorder 14 1 113 -0.057 0.144 14 -0.057 0.144 24 -0.150 0.297
Externalizing behavior symptoms 14 2 238 -0.107 0.123 14 -0.059 0.078 17 -0.320 0.008
Illicit drug use before end of high school 14 4 668 -0.073 0.058 15 -0.073 0.058 18 -0.197 0.001
Initiation of sexual activity^ 14 2 192 -0.065 0.145 14 n/a n/a n/a -0.173 0.237
Internalizing symptoms 14 2 222 -0.079 0.103 15 -0.079 0.103 18 -0.207 0.090
Smoking before end of high school 14 2 179 -0.045 0.108 14 -0.045 0.108 18 -0.113 0.288
STD risky behavior^ 14 2 186 -0.002 0.149 14 n/a n/a n/a -0.065 0.823
Substance use^ 14 1 109 -0.093 0.149 16 n/a n/a n/a -0.246 0.100
Suicidal ideation^ 14 1 376 -0.042 0.073 16 n/a n/a n/a -0.111 0.131
Suicide attempts^ 14 1 376 -0.009 0.073 16 n/a n/a n/a -0.024 0.744

Citations Used in the Meta-Analysis

Estrada, Y., Rosen, A., Huang, S., Tapia, M., Sutton, M., Willis, L., . . . Prado, G. (2015). Efficacy of a brief intervention to reduce substance use and Human Immunodeficiency Virus infection risk among Latino youth. Journal of Adolescent Health, 57(6), 651-657.

Estrada, Y., Lee, T.K., Huang, S., Tapia, M.I., Velázquez, M.R., Martinez, M.J., . . . Prado, G. (2017). Parent-centered prevention of risky behaviors among Hispanic youths in Florida. American Journal of Public Health, 107(4), 607-613.

Estrada, Y., Lee, T. K., Wagstaff, R., M, R.L., Tapia, M.I., Velázquez, M.R., Sardinas, K., ... Prado, G. (2019). eHealth Familias Unidas: Efficacy trial of an evidence-based intervention adapted for use on the Internet with Hispanic families. Prevention Science : the Official Journal of the Society for Prevention Research, 20(1), 68-77.

Molleda, L., Estrada, Y., Lee, T.K., Poma, S., Bahamon, M., Tapia, M.I., . . . Tamayo, C.C. (2017). Short-term effects on family communication and adolescent conduct problems: Familias Unidas in Ecuador. Prevention Science, 18(7), 783-792.

Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M.I., Schwartz, S.J., . . . Branchini, J. (2009). A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine, 71(9), 987-995.

Perrino, T., Pantin, H., Huang, S., Brincks, A., Brown, C.H., & Prado, G. (2016). Reducing the risk of internalizing symptoms among high‐risk Hispanic youth through a family intervention: A randomized controlled trial. Family Process, 55(1), 91-106.

Perrino, T., Brincks, A., Howe, G., Brown, C.H., Prado, G., & Pantin, H. (2016). Reducing internalizing symptoms among high-risk, Hispanic adolescents: Mediators of a preventive family intervention. Prevention Science, 17(5), 595-605.

Prado, G., Cordova, D., Huang, S., Estrada, Y., Rosen, A., Bacio, G.A., . . . McCollister, K. (2012). The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: Main effects and interaction effects by parental stress and social support. Drug and Alcohol Dependence, 125.

Prado, G., Pantin, H., Huang, S., Cordova, D., Tapia, M.I., Velazquez, M.R., . . . Estrada, Y. (2012). Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 166(2), 127-33.

Vidot, D.C., Huang, S., Poma, S., Estrada, Y., Lee, T.K., & Prado, G. (2016). Familias Unidas’ crossover effects on suicidal behaviors among Hispanic adolescents: Results from an effectiveness trial. Suicide and Life-Threatening Behavior, 46.