Washington State Institute for Public Policy
Multisystemic Therapy for juveniles with substance use disorder
Juvenile Justice
Benefit-cost estimates updated May 2017.  Literature review updated September 2013.
Multisystemic Therapy–Substance Abuse (MST–SA) is a form of MST that is targeted toward youth who are abusing drugs and alcohol. MST–SA teams develop a specific written plan for the offender enforced by the juvenile’s caregiver. Random drug testing is an important aspect of the program as well as rewarding positive behavior.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2016). 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 $2,903 Benefits minus costs $1,117
Participants $7 Benefit to cost ratio $1.14
Others $8,161 Chance the program will produce
Indirect ($2,121) benefits greater than the costs 51 %
Total benefits $8,950
Net program cost ($7,833)
Benefits minus cost $1,117
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 $2,773 $0 $8,027 $1,396 $12,197
Property loss associated with alcohol abuse or dependence $0 $1 $1 $0 $2
Labor market earnings associated with illicit drug abuse or dependence $18 $40 $0 $319 $377
Health care associated with illicit drug abuse or dependence $154 $30 $151 $84 $419
Costs of higher education ($42) ($64) ($19) ($21) ($146)
Adjustment for deadweight cost of program $0 $0 $0 ($3,899) ($3,899)
Totals $2,903 $7 $8,161 ($2,121) $8,950
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $7,076 2008 Present value of net program costs (in 2016 dollars) ($7,833)
Comparison costs $0 2008 Cost range (+ or -) 10 %
The per-participant costs, based on traditional MST for four months, are 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.
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 Primary or secondary participant 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 2 66 -0.177 0.178 15 0.000 0.187 18 -0.473 0.009
Cannabis use^ 3 109 -0.200 0.155 17 -0.027 0.233 27 -0.562 0.001
Crime 2 124 -0.113 0.170 17 -0.113 0.170 27 -0.361 0.034
Illicit drug use disorder 1 43 -0.114 0.280 15 0.000 0.187 18 -0.315 0.251
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.

For more information on the methods
used please see our Technical Documentation.