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54. Schoenwald, S.K., Ward, D.M., Henggeler, S.W., Pickrel, S.G., Patel, H. (1996). Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient and residential placement. Journal of Child and Family Studies, 5, 431-444.

62. Washington State Institute for Public Policy.(Jan.1998). Watching the bottom line: Cost-Effective interventions for reducing crime in Washington. Olympia, WA: Seminar 3162 (pp. 1-6), The Evergreen State College.

64. Schoenwald, S.K., Ward, D.M., Henggeler, S.W., & Rowland, M.D. (2000). MST vs. hospitalization for crisis stabilization of youth: Placement outcomes 4 months post-referral. Mental Health Services Research, 2, (1), 3-12.

253. Sheidow, A.J., Bradford , W.D., Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C., Schoenwald, S.K., Ward, D.M. (May 2004). Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis. Psychiatric Services, 55, 548-554.

278. Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M.D., Cakan, N. (2005).  Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization.  Journal of Pediatric Psychology, 30(8), 656-666.

313. Surace, C. (2008). Medicaid coverage of multisystemic therapy. National Alliance on Mental Illness, 10, 5-8.

339.  McCollister, K.E., French, M.T., Sheidow, A.J., Henggeler, S.W., & Halliday-Boykins, C.A. (2009). Estimating the differential costs of criminal activity for juvenile drug court participants: Challenges and recommendations. The Journal of Behavioral Health Services & Research, 36(1), 111–126.

383.  Klietz, S. J., Borduin, C. M., Schaeffer, C. M. (2010). Cost-Benefit analysis of multisystemic therapy with serious and violent juvenile offenders. Journal of Family Psychology, 24(5), 657-666.

417.  Olsson, T. M. (2009). Intervening in youth problem behavior in Sweden: A pragmatic cost analysis of MST from a randomized trial with conduct disordered youth. International Journal of Social Welfare, 19, 194-205.  

 418.  Olsson, T. M. (2010). MST with conduct disordered youth in Sweden: Costs and benefits after 2 years. Research on Social Work Practice, 20(6), 561-571.

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Cost Savings and Economics Abstracts

54. Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Cost of reducing incarceration, inpatient, and residential placement

The development of more effective and less costly family- and community based services to serve as alternatives to out-of-home placements of children is an important priority in the reform of mental health services for children and adolescents. Within the context of a randomized trial with 118 substance abusing or dependent juvenile offenders, we examined the incremental costs of multisystemic therapy (MST) and related these costs to observed reductions in days of incarceration, hospitalization, and residential treatment at approximately 1-year postreferral. Results showed that the incremental costs of MST were nearly offset by the savings incurred as a result of reductions in days of out-of-home placement during the year. The need to validate effective treatments for youth with serious clinical problems and to link the cost of treatments.

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62.  Watching the bottom line:  Cost-effective interventions for reducing crime in Washington

The Washington State Legislature directed the Washington State Institute for Public
Policy to evaluate the costs and benefits of certain criminal justice policies, violence
prevention programs, and other efforts to decrease criminal recidivism and at-risk behaviors of youth. This progress report contains information on several interventions that have been shown to work, some that have not, and some that are promising but
not yet fully evaluated. Similar to the home insulation example, this analysis focuses
on the “bottom-line” economics of different programs that try to reduce criminal
behavior, by comparing up-from program costs paid by taxpayers to any further benefits that a program produces.

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64.  Multisystemic therapy versus hospitalization for crisis stabilization of youth: Placement outcomes 4 months postreferral

Hospitalization and out-of-home placement data for 113 youth participating in a randomized trial comparing home-based multisystemic therapy (MST; n = 57) with hospitalization (n = 56) for psychiatric crisis stabilization were analyzed following the completion of MST treatment – approximately 4 months post approval for emergency hospitalization. Analyses showed that MST prevented any hospitalization for 57% of the participants in the MST condition and reduced the overall number of days hospitalized by 72%. Importantly, the reduction in use and length of hospitalization was not offset by increased use of other placement options, as MST reduced days in other out-of-home placements by 49%. The cost implications for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed.

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253.  Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis

Objectives: The authors conducted a cost analysis for Multisystemic therapy, an evidence-based treatment that is used as an intensive community-based alternative to the hospitalization of youths presenting with psychiatric emergencies. Methods: Data from a randomized clinical trial that compared Multisystemic therapy with usual inpatient services followed by community aftercare were used to compare Medicaid costs and clinical outcomes during a four-month period post referral and a 12-month follow-up period. Data were from 115 families receiving Medicaid (out of 156 families in the clinical trial). Results During the four months postreferral, Multisystemic therapy demonstrated better short-term cost-effectiveness for each of the clinical outcomes (externalizing behavior, internalizing behavior, and global severity of symptoms) than did usual inpatient care and community aftercare. The tow treatments demonstrated equivalent long-term cost-effectives. Conclusions: Among youths presenting with psychiatric emergencies, Multisystemic therapy was associated with better outcomes at a lower cost during the initial postreferral period and with equivalent cost and outcomes during the 12-month follow-up period.

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278.  Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization

Objective  To determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease rates of hospital utilization and related costs of care among adolescents with poorly controlled type diabetes.  Methods  Thirty-one adolescents were randomly assigned to receive either MST or standard care.  MST lasted approximately 6 months, and all participants were followed for 9 months.  Rates of inpatient admissions and emergency room (ER) visits were calculated for a nine-month prestudy period and during the 9 months of study participation.  The relationship between changes in inpatient admissions and changes in metabolic control was also investigated.  Results  Intervention participants had a decreasing number of inpatient admissions from the baseline period to the end of the study, whereas the number of inpatient admissions increased for controls.  Use of the emergency room did not differ.  Related medical charges and direct care costs were significantly lower for adolescents receiving MST.  Correlational analysis conducted with a subset of participants indicated that decreases in inpatient admissions were associated with improved metabolic control for MST but not control participants.  Conclusions  Findings suggest that MST has the potential to decrease inpatient admissions among adolescents with poorly controlled type 1 diabetes.

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313.  Medicaid coverage of multisystemic therapy

Medicaid funding has emerged as an important factor in the growth of Multisystemic Therapy (MST) programs nationally. MST is a highly touted evidence-based practice for delinquent youth and Medicaid funding is playing a critical role in its financial sustainability in approximately half of the 32 states that currently have licensed MST programs. While advocacy is recommended to ensure MST, as well as other evidence-based practices, are included in a state's Medicaid service array, Medicaid should not be viewed as a "silver bullet" that will cover the full cost of providing MST services for youth. Based on the experience of many states and localities, additional funding streams are necessary to fully support a state's MST program. Given the proven cost effectiveness of MST, state legislators and officials presented with the facts should be willing to appropriate funds and develop programs to support this evidence-based practice that helps children and their families and produces cost-savings to taxpayers on the order of five dollars for every one dollar invested."

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339. Estimating the differential costs of criminal activity for juvenile drug court participants: Challenges and recommendations

Juvenile drug court (JDC) programs have expanded rapidly over the past 20 years and are an increasingly popular option for rehabilitating juvenile offenders with substance use problems. Given the hgih cost of crime to society, an important economic question is whether and to what extent JDC programs reduce criminal activity among juvenile offenders. To address this question, the present study added an economic cost analysis to an ongoing randomized trial of JDC conducted in Charleston, South Carolina. Four treatment conditions were included in the parent study: Family court with usual community-based treatment (FC, the comparison group), Drug Court with usual community-based treatment (DC), DC with Multisystemic Therapy (DC/MST), and DC/MST enhanced with Contingency Management (DC/MST/CM). The economic study estimated the cost of criminal activity for nine specific crimes at baseline (pretreatment) and 4 and 12 months thereafter. A number of methodological challenges were encountered, suggesting that it may be more difficult to economically quantify frequency and type of criminal activity for adolescents than for adults. The present paper addresses methodological approaches and challenges, and proposes guidelines for future economic evaluations of adolescents substance abuse and crime prevention programs.

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