Washington State Institute for Public Policy
Multisystemic Therapy (MST) for youth with serious emotional disturbance (SED)
Children's Mental Health: Serious Emotional Disturbance
Benefit-cost estimates updated December 2016.  Literature review updated April 2012.
Multisystemic Therapy (MST) is an intensive family-focused treatment, which combines aspects of cognitive, behavioral, and family therapies. Therapists work in the child’s home, school, and community to modify his or her environment. Although MST is often conducted with juvenile offenders, the studies included here focused on children with externalizing problems who were not involved with the juvenile justice system at the time of intervention.
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 (2015). 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 $3,502 Benefits minus costs $2,185
Participants $4,192 Benefit to cost ratio $1.32
Others $3,066 Chance the program will produce
Indirect ($1,751) benefits greater than the costs 61 %
Total benefits $9,009
Net program cost ($6,823)
Benefits minus cost $2,185
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 $426 $0 $1,194 $214 $1,835
Labor market earnings associated with high school graduation $1,518 $3,342 $1,539 $667 $7,065
Child abuse and neglect $0 $1,012 $0 $0 $1,012
Out-of-home placement $922 $0 $0 $462 $1,385
K-12 grade repetition $29 $0 $0 $14 $43
K-12 special education $451 $0 $0 $226 $678
Health care associated with disruptive behavior disorder $336 $109 $416 $169 $1,030
Costs of higher education ($180) ($271) ($84) ($90) ($625)
Adjustment for deadweight cost of program $0 $0 $0 ($3,414) ($3,413)
Totals $3,502 $4,192 $3,066 ($1,751) $9,009
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $7,076 2008 Present value of net program costs (in 2015 dollars) ($6,823)
Comparison costs $850 2010 Cost range (+ or -) 10 %
MST-SED is typically provided for four to five months. Per-participant costs from Barnoski, R. (2009). Providing evidence-based programs with fidelity in Washington state juvenile courts: Cost analysis. Olympia: Washington State Institute for Public Policy, http://www.wsipp.wa.gov/rptfiles/09-12-1201.pdf.
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 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
Crime 5 341 -0.062 0.081 16 -0.062 0.081 26 -0.060 0.502
Out-of-home placement 4 451 -0.279 0.124 16 -0.279 0.124 17 -0.459 0.009
Disruptive behavior disorder symptoms 6 443 -0.311 0.127 16 -0.148 0.091 19 -0.311 0.015
Substance abuse 2 72 -0.044 0.167 16 0.000 0.187 19 -0.051 0.762
Internalizing symptoms 2 72 -0.026 0.167 16 -0.019 0.130 18 -0.046 0.789
Suicidal ideation 1 78 -0.017 0.160 16 -0.008 0.083 19 -0.031 0.877
Hospitalization (psychiatric) 2 136 -0.415 0.344 16 -0.198 0.196 19 -0.719 0.256
Citations Used in the Meta-Analysis

Asscher, J.J., Deković, M., Manders, W.A., Laan, P.H., & Prins, P.J.M. (2013). A randomized controlled trial of the effectiveness of multisystemic therapy in the Netherlands: post-treatment changes and moderator effects. Journal of Experimental Criminology, 9, 169-187

Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550.

Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P. B., . . . Santos, A. B. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1331-1339.

Henggeler, S. W., Rowland, M. D., Halliday-Boykins, C., Sheidow, A. J., Ward, D. M., Randall, J., . . . Edwards, J. (2003). One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 543-551.

Ogden, T., & Halliday-Boykins, C. A. (2004). Multisystemic treatment of antisocial adolescents in Norway: Replication of clinical outcomes outside of the US. Child and Adolescent Mental Health, 9(2), 77-83.

Rowland, M. D., Halliday-Boykins, C. A., Henggeler, S. W., Cunningham, P. B., Lee, T. G., Kruesi, M. J. P., & Shapiro, S. B. (2005). A randomized trial of multisystemic therapy with Hawaii's Felix Class youths. Journal of Emotional and Behavioral Disorders, 13(1), 13- 23.

Sundell, K., Hansson, K., Lofholm, C. A., Olsson, T., Gustle, L. H., & Kadesjo, C. (2008). The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths. Journal of Family Psychology, 22(4), 550-560.

Weiss, B., Han, S., Harris, V., Castron, T., Ngo, V. K., & Caron, A. (n.d.). An independent evaluation of the MST treatment program. Unpublished manuscript emailed to M. Miller by S. Henggeler on May 4, 2010.

For more information on the methods
used please see our Technical Documentation.
360.664.9800
institute@wsipp.wa.gov