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Washington State Institute for Public Policy
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Multisystemic Therapy (MST)

Juvenile Justice
Benefit-cost estimates updated December 2017.  Literature review updated August 2017.
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Multisystemic Therapy (MST) is an intensive family- and community-based therapy for youth with antisocial behaviors. 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 they fit within the context of the youth’s life. MST therapists meet with family members and others in the home or directly within the environment of the youth (e.g., school). Multiple family therapist contacts are made weekly resulting in variability in treatment time among participants. The intervention typically lasts between three to six months. In the included studies, participants received an average of 44 total hours of treatment.

We exclude MST for juveniles with substance use disorder and MST for juveniles convicted of sex offenses from this analysis and report on them separately.
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 $3,434 Benefits minus costs $4,824
Participants $967 Benefit to cost ratio $1.62
Others $10,688 Chance the program will produce
Indirect ($2,434) benefits greater than the costs 73 %
Total benefits $12,655
Net program cost ($7,830)
Benefits minus cost $4,824
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 $2,848 $0 $10,153 $1,436 $14,437
Labor market earnings associated with high school graduation $468 $1,030 $472 $0 $1,970
K-12 grade repetition $9 $0 $0 $4 $13
K-12 special education $95 $0 $0 $48 $143
Health care associated with disruptive behavior disorder $72 $23 $89 $36 $220
Costs of higher education ($57) ($86) ($26) ($29) ($198)
Adjustment for deadweight cost of program $0 $0 $0 ($3,930) ($3,930)
Totals $3,434 $967 $10,688 ($2,434) $12,655
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) ($7,830)
Comparison costs $0 2008 Cost range (+ or -) 10 %
The per-participant cost estimate is based on an average program length of four months, 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.

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 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 7 1370 -0.096 0.047 17 -0.096 0.047 27 -0.251 0.027
Disruptive behavior disorder symptoms 1 147 -0.529 0.129 17 -0.252 0.125 20 -0.529 0.001
Externalizing behavior symptoms 1 147 -0.405 0.128 17 -0.193 0.105 20 -0.405 0.002

Citations Used in the Meta-Analysis

Asscher, J.J., Dekovic, M., Manders, W., van der Laan, P.H., Prins, P.J.M., van Arum, S., & Dutch MST Cost-Effectiveness Study Group. (2014). Sustainability of the effects of Multisystemic Therapy for juvenile delinquents in The Netherlands: effects on delinquency and recidivism. Journal of Experimental Criminology, 10, 227-243

Centre for Children and Families in the Justice System. (2006). Randomized study of MST in Ontario, Canada: Final results. Retrieved June 23, 2011 from">

Fain, T., & Michel Greathouse, S. (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., 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.

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.

Henggeler, S.W., Melton, G.B., Smith, L.A., Schoenwald, S.K., & Hanley, J.H. (1992). Family preservation using Multisystemic Therapy: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2(4), 283-293.

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.

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