skip to main content
Washington State Institute for Public Policy
Back Button

Multisystemic Therapy (MST) for court-involved/post-release youth

Juvenile Justice
Benefit-cost methods last updated December 2024.  Literature review updated May 2019.
Multisystemic Therapy (MST) is an intensive family- and community-based therapy for youth with antisocial behaviors that combines aspects of cognitive, behavioral, and family therapies. 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 those problems fit within the context of the youth’s life. The program targets and delivers its curriculum in the environments a youth navigates (i.e., home, school, the community). MST therapists meet weekly with the youth and their family members for three to six months. MST relies on the compliance of the family to design and implement the treatment plan to adjust to the individual strengths and needs of each family.

In the included studies, participants received an average of 4.1 months of treatment. Youth were classified as moderate- or high-risk per scores on a validated risk instrument and were either on probation following adjudication or following their release from confinement. In the studies in the analysis that reported demographic information, 80% of participants were youth of color and 23% were female.

We exclude evaluations of Multisystemic Therapy-Substance Abuse, Multisystemic Therapy-Family Integrated Transitions, and Multisystemic Therapy-Problem Sexual Behavior 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 (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 $8,374 Benefits minus costs $19,768
Participants $1,626 Benefit to cost ratio $3.01
Others $20,756 Chance the program will produce
Indirect ($1,139) benefits greater than the costs 99%
Total benefits $29,617
Net program cost ($9,849)
Benefits minus cost $19,768

^^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
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 15 6 1072 -0.314 0.069 16 -0.314 0.069 24 -0.314 0.001
Externalizing behavior symptoms^^
Symptoms of externalizing behavior (e.g., aggressive, hostile, or disruptive behavior) measured on a validated scale.
 15 1 53 0.034 0.197 15 n/a n/a n/a 0.034 0.864
Internalizing symptoms^^
Symptoms of internalizing behavior (e.g., sadness, anxiety, or withdrawal) measured on a validated scale.
 15 1 53 0.254 0.197 15 n/a n/a n/a 0.254 0.198
Technical violations^^
Violations of the conditions of an individual’s terms of probation, parole, or supervision.
 15 1 43 0.832 0.691 16 n/a n/a n/a 0.832 0.228
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 $7,747 $0 $19,791 $3,874 $31,411
Labor market earnings associated with high school graduation $804 $1,893 $1,046 $0 $3,743
Costs of higher education ($177) ($267) ($80) ($88) ($612)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($4,924) ($4,924)
Totals $8,374 $1,626 $20,756 ($1,139) $29,617
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $8,041 2016 Present value of net program costs (in 2023 dollars) ($9,849)
Comparison costs $0 2016 Cost range (+ or -) 20%
The per-participant cost estimate is the average cost of providing Multisystemic Therapy (MST), as implemented in the studies included in this analysis. We estimate a monthly cost for MST using the average length of the program in Washington (four months) and the cost of MST in Washington, provided by C. Redman (personal communication, Washington State Juvenile Rehabilitation, April 16, 2019). This cost reflects estimates 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. We multiply this monthly cost estimate and the average length of MST in the included studies, approximately 4.1 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

Butler, S., Fonagy, P., Baruch, G., & Hickey, N. (2011). A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50 (12), 1220-1235.

Fain, T., & Greathouse, S.M. (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., Melton, G.B., Smith, L.A., Schoenwald, S.K., & Hanley, J.H. (1992). Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60, 953 – 961.

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.

Leschied, A.W., & Cunningham, A.J., London Family Court Clinic. (2002). Seeking effective interventions for serious young offenders: Interim results of a four-year randomized study of multisystemic therapy in Ontario, Canada. London, ON: Centre for Children and Families in the Justice System.

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.