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Washington State Institute for Public Policy
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Brief Strategic Family Therapy (BSFT)

Children's Mental Health: Disruptive Behavior
Benefit-cost methods last updated December 2019.  Literature review updated July 2018.
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Brief Strategic Family Therapy (BSFT) is both a prevention and treatment intervention model that addresses cognitive, behavioral, and affective aspects of families for children with disruptive behavior problems. BSFT targets youth aged 8-17 years who display or are at-risk for behavioral problems, including delinquency and substance use. Youth are eligible for BSFT if they self-report substance use or are referred from an institution for substance use outpatient treatment. BSFT utilizes individual family therapy to teach tools to address specific risk factors and improve family-based interactions. Youth are commonly referred to BSFT through a school or parent recommendation. BSFT consists of 12-17 weekly sessions, each lasting for an hour- to ninety-minutes; each session is overseen by a trained BSFT therapist.
 
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 $1,137 Benefits minus costs $2,206
Participants ($831) Benefit to cost ratio $2.25
Others $3,832 Chance the program will produce
Indirect ($165) benefits greater than the costs 58 %
Total benefits $3,973
Net program cost ($1,767)
Benefits minus cost $2,206

^WSIPP’s benefit-cost model does not monetize this outcome.

^^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 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
Alcohol use before end of high school
Any use of alcohol by the end of high school, typically between ages 14 and 18.
15 1 56 0.134 0.229 15 0.134 0.229 18 0.258 0.261
STD risky behavior^
For youth, this outcome includes unprotected sex and other behaviors. For high-risk drug users, this also includes intravenous drug use.
15 1 20 -1.042 0.337 15 n/a n/a n/a -2.369 0.001
Smoking before end of high school^^
Any smoking of tobacco by the end of high school, typically between ages 14 and 18.
 15 1 20 -0.529 0.322 15 n/a n/a n/a -1.203 0.001
Cannabis use before end of high school
Any use of cannabis by the end of high school, typically between ages 14 and 18.
15 1 56 -0.123 0.229 15 -0.123 0.229 18 -0.237 0.301
Disruptive behavior disorder symptoms
Clinical diagnosis of a disruptive behavior disorder (e.g., conduct disorder, oppositional defiant disorder) or symptoms measured on a validated scale.
 15 2 93 -0.112 0.175 15 -0.062 0.108 18 -0.374 0.160
Illicit drug use before end of high school
Any use of illicit drugs by the end of high school, typically between ages 14 to 18. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 15 2 169 -0.339 0.369 15 -0.339 0.369 18 -0.864 0.310
Problem alcohol use^^
Alcohol use reflecting problem behaviors (e.g., high frequency drinking, binge drinking, or drinking that has a high impact on daily life) for individuals who do not have an alcohol use disorder.
 15 1 20 -0.829 0.330 15 n/a n/a n/a -1.884 0.001
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 15 1 140 -0.174 0.124 20 -0.174 0.124 30 -0.335 0.007
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 $1,120 $0 $2,788 $560 $4,467
Labor market earnings associated with high school graduation $535 $1,256 $688 $0 $2,479
Costs of higher education ($89) ($134) ($40) ($44) ($307)
Disruptive behavior disorder symptoms K-12 grade repetition $12 $0 $0 $6 $18
K-12 special education $46 $0 $0 $23 $69
Health care associated with disruptive behavior disorder $390 $110 $402 $195 $1,097
Alcohol use before end of high school Labor market earnings associated with alcohol abuse or dependence ($876) ($2,057) $0 $0 ($2,933)
Property loss associated with alcohol abuse or dependence $0 ($3) ($6) $0 ($10)
Mortality associated with alcohol ($1) ($3) $0 ($20) ($24)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($883) ($883)
Totals $1,137 ($831) $3,832 ($165) $3,973
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $2,595 2015 Present value of net program costs (in 2018 dollars) ($1,767)
Comparison costs $868 2010 Cost range (+ or -) 20 %
Brief Strategic Family Therapy (BSFT) lasts for three- to four-months. We estimate per-participant costs based on a weighted average of 14.8 hours of therapist time, as reported in the treatment studies, multiplied by actuarial estimate of cost of hourly family therapy (Mercer. (2016). Mental health and substance use disorder services data book for the state of Washington). For comparison group costs we use 2010 Washington State DSHS data to estimate the average reimbursement rate for treatment of child and adolescent disruptive behavior disorders.
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

Coatsworth, J.D., Santisteban, D.A., McBride, C.K, Szapocznik, J. (2001). Brief strategic family therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent symptom severity. Family Process, 40(3), 313-313

Horigian, V.E., Feaster, D.J., Brincks, A.M., Ucha, J., Szapocznik, J., Robbins, M.S., . . . Werstlein, R. (2015). A cross-sectional assessment of the long term effects of brief strategic family therapy for adolescent substance use. American Journal on Addictions, 24(7) 637-645.

Nickel, M., Luley, J., Krawczyk, J., Nickel, C., Widermann, C., Lahmann, C., Muehlbacher, M., . . . Loew, T. (2006). Bullying girls—changes after Brief Strategic Family Therapy: A randomized, prospective, controlled trial with one-year follow-up. Psychotherapy and Psychosomatics, 75(1), 47-55.

Robbins, M.S., Feaster, D.J., Horigian, V.E., Rohrbaugh, M., Shoham, V., Bachrach, K., Miller, M., ... & Szapocznik, J. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents. Journal of Consulting and Clinical Psychology, 79(6), 713-727.

Santisteban, D.A., Coatsworth, J.D., Perez-Vidal, A., Kurtines, W.M., Schwartz, S.J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121-133.