Long-Term Cost-Benefit Outcomes of an Evidence-Based Practice for Juvenile Offending Females

Adolescents referred to out-of-home congregate care due to involvement in the juvenile justice system are at risk-for ongoing adult system involvement, including criminal justice and child welfare. Multidimensional Treatment Foster Care (MTFC) is an evidence-based practice to treat youth involved in the juvenile justice system. MTFC is a comprehensive, and therefore costly, preventive intervention. Rather than congregate care such as Group Care (GC), youth are placed in highly skilled and supported foster homes, attend regular schools, and receive well-coordinated individual and family therapy, and community skills training.  Previous costing of the MTFC program, 24-months post baseline, suggests that MTFC costs $7,363 (2008 dollars) more than GC. To date, the long-term cost-benefit of MTFC for adolescent girls regarding ongoing criminal justice and child welfare (for their own children) involvement has been unknown.

 Methods: This presentation will focus on long-term cost-benefit outcomes of the MTFC effectiveness trials for girls (MTFC n = 81; GC n = 85). Because of the 6-year recruitment span of the original intervention trials, this long-term follow-up included data for all participants within 4.25 years post-baseline, and on 49% of participants out to 8 years post-baseline. Cost-benefit analyses will be conducted at both of these time-points, from the state payer perspective.

 Adult and juvenile criminal justice records including arrests, incarceration, probation, and parole were obtained from administrative records. Included were data about pre-hearings, hearings, trials, and legal representation. Records were verified against self-report. Additional variables included crime victim, crime career, victim pain-and-suffering, and corrected risk of homicide costs. Child welfare involvement (for their own children) costs are being collected and also will be included.

 Results: MTFC demonstrated a significant cost-benefit for women 4.25 years post baseline, with the criminal related costs for those randomized to GC costing $26,589 (2011 dollars) more than MTFC.  The adjusted 2011 cost of MTFC over GC is $7,686, with a benefit-cost ratio indicating that for every dollar spent on MTFC, there is a return in avoided expenditures of $3.46. Analysis of data available at 8-year follow-up suggested a continued positive cost-benefit of MTFC. 

Child welfare system costs also will be included. Of the 63.5% of women in the GC condition, and 59.3% of women in the MTFC condition who have children, 41% of those who received GC have their own children now involved in the child welfare system compared to 31% of the women who received MTFC.

Conclusions: Despite the expense of MTFC, the intervention appears to show positive long-term cost-benefit to the state payer.