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Washington State Institute for Public Policy
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Therapeutic communities (vs. group homes) for court-involved youth with substance use disorder

Juvenile Justice
Benefit-cost methods last updated December 2019.  Literature review updated August 2017.
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Therapeutic communities (TCs) are a form of intensive substance use disorder treatment. This analysis is on TCs within the community that serve youth who are ordered to chemical dependency diversion or following adjudication. These residential living units are highly structured and utilize a hierarchical model among peers to promote both personal and group accountability in regards to achieving and maintaining substance abstinence. Youth earn responsibility as they progress through the stages of long-term treatment.

Participants in the included study were court-involved youth with substance use disorders. TCs were implemented within a group home-type setting; youth in the comparison group were typically placed in group homes. The average length of treatment was 5.4 months. In the included study, 79% of participants were youth of color and 18% were female.

We exclude evaluations of other (non-TC) substance use disorder treatments and TCs for youth in state institutions from this analysis and analyze them separately.

Key Terms

Court-involved youth: Youth who are processed through the juvenile justice system but who are not ordered to a period of confinement in a residential or correctional facility. This includes populations of arrested youth, diverted youth, charged youth, adjudicated youth, and youth on probation or formal supervision.

Youth in state institutions: Youth who are confined in a residential or correctional facility when they participate in the program.

Youth post-release: Youth who are returning to the community following a period of confinement in a residential or correctional facility and who participate in the program after release to the community.
 
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 (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 $502 Benefits minus costs ($1,681)
Participants $1,067 Benefit to cost ratio $0.24
Others $660 Chance the program will produce
Indirect ($1,691) benefits greater than the costs 47 %
Total benefits $538
Net program cost ($2,219)
Benefits minus cost ($1,681)

^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. See Estimating Program Effects Using Effect Sizes for additional information.

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
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 16 1 160 -0.030 0.101 17 -0.030 0.101 25 -0.030 0.768
Regular smoking
Smoking tobacco on a regular basis.
 16 1 160 0.200 0.102 16 0.200 0.102 26 0.200 0.049
Substance use disorder^
A non-specified alcohol or drug use disorder. Typically, a collection of different types of disorders reported by study authors. 
 16 1 160 -0.270 0.102 16 n/a n/a n/a -0.270 0.008
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 16 1 160 -0.220 0.102 16 0.000 0.310 18 -0.220 0.031
Anxiety disorder
Clinical diagnosis of an anxiety disorder (e.g., general anxiety, panic, social anxiety, obsessive compulsive disorder) or symptoms measured on a validated scale.
 16 1 160 -0.289 0.102 16 -0.114 0.094 17 -0.289 0.004
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
Crime Criminal justice system $559 $0 $1,276 $280 $2,115
Regular smoking Labor market earnings associated with smoking ($1,979) ($4,648) $0 $989 ($5,637)
Health care associated with smoking ($916) ($259) ($945) ($458) ($2,577)
Mortality associated with smoking ($7) ($16) $0 ($304) ($327)
Major depressive disorder Mortality associated with depression $0 $0 $0 $1 $1
Anxiety disorder K-12 grade repetition $14 $0 $0 $7 $21
Labor market earnings associated with anxiety disorder $2,511 $5,899 $0 ($1,256) $7,155
Health care associated with anxiety disorder $319 $90 $329 $159 $897
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($1,109) ($1,109)
Totals $502 $1,067 $660 ($1,691) $538
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,020 2012 Present value of net program costs (in 2018 dollars) ($2,219)
Comparison costs $0 2012 Cost range (+ or -) 20 %
The treatment group cost represented the cost of therapeutic communities (TCs) beyond the cost of usual group homes. We estimate the per-participant cost by applying an average monthly cost to the average length of treatment in the included studies. We use an estimated cost of treatment provided by Washington State Juvenile Rehabilitation and assume 12 months of treatment to calculate a typical cost of treatment per month. We multiply this per-month cost by the weighted average length of treatment for the included studies (5.4 months).
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

Morral, A.R., McCaffrey, D.F., & Ridgeway, G. (2004). Effectiveness of community-based treatment for substance-abusing adolescents: 12-month outcomes of youths entering Phoenix Academy or alternative probation dispositions. Psychology of Addictive Behaviors, 18(3), 257-68.