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Washington State Institute for Public Policy
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Seeking Safety (during incarceration)

Adult Criminal Justice
Benefit-cost methods last updated December 2024.  Literature review updated May 2024.
Seeking Safety is a cognitive-behavioral therapeutic program for individuals with co-occurring post-traumatic stress disorder (PTSD) and substance use disorder. The program is intended to improve participants’ mental health (reduce PTSD and depression) and to improve interpersonal and coping skills. The Seeking Safety curriculum includes psychoeducation regarding the consequences of trauma and the links between trauma and substance use; addresses cognitive, behavioral, and interpersonal topics; and teaches specific coping skills. Small groups meet with a trained facilitator for 24 two-hour sessions over 6-12 weeks. Studies in this meta-analysis include evaluations of Seeking Safety implemented during incarceration; we exclude evaluations implemented in a community setting or with other populations.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2023).  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 $6,820 Benefits minus costs $21,514
Participants $9,239 Benefit to cost ratio $81.88
Others $3,399 Chance the program will produce
Indirect $2,322 benefits greater than the costs 97%
Total benefits $21,780
Net program cost ($266)
Benefits minus cost $21,514

^^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 to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on 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. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change 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. 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 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^^
Clinical diagnosis of alcohol use disorder or symptoms measured on a validated scale.  
 38 1 23 -0.279 0.303 38 0.000 0.187 41 -0.279 0.357
Illicit drug use disorder^^
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 38 1 23 0.187 0.302 38 0.000 0.187 41 0.187 0.537
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 38 2 74 -0.694 0.170 38 -0.361 0.208 40 -0.694 0.001
Post-traumatic stress
Clinical diagnosis of post-traumatic stress disorder (PTSD) or symptoms measured on a validated scale.
 38 5 240 -0.358 0.093 38 -0.358 0.093 39 -0.358 0.001
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Major depressive disorder Labor market earnings associated with major depression $3,518 $8,288 $0 $0 $11,806
Mortality associated with depression $9 $20 $0 $808 $837
Post-traumatic stress Health care associated with PTSD $3,294 $931 $3,399 $1,647 $9,271
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($133) ($133)
Totals $6,820 $9,239 $3,399 $2,322 $21,780
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $266 2023 Present value of net program costs (in 2023 dollars) ($266)
Comparison costs $0 2023 Cost range (+ or -) 10%
The per-participant cost estimate is based on delivering a 48-hour program at a rate of $77 per hour (salary and benefits) for DOC Psychology Associate staff delivering this program and assumes a typical group size of ten participants. Hourly rate was provided by DOC; typical program hours and group size are based on studies included in the analysis. We also include a $1.75 per-participant cost for facilitator materials (this cost assumes ten participants per group and four groups per year).
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

Citations Used in the Meta-Analysis

Heath, N.M. (2009). An evaluation of Seeking Safety for incarcerated women with PTSD: The roles of self-efficacy and emotion regulation. Doctoral Dissertation, Idaho State University. ProQuest.

Lynch, S., Heath, N., Mathews, K., & Cepeda, G. (2012). Seeking Safety: An intervention for trauma-exposed incarcerated women. Journal of Trauma & Dissociation, 13, 1, 88-101.

Tripodi, S. J., Mennicke, A. M., McCarter, S. A., & Ropes, K. (2019). Evaluating seeking safety for women in prison: A randomized controlled trial. Research on Social Work Practice, 29(3), 281-290.

Wolff, N., Huening, J., Shi, J., Frueh, B.C., Hoover, D.R., & McHugo, G. (2015). Implementation and effectiveness of integrated trauma and addiction treatment for incarcerated men. Journal of Anxiety Disorders, 30, 66-80.

Zlotnick, C., Johnson, J., & Najavits, L.M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-336.