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Objective: Although there is evidence that the positive impact of multisystemic therapy for problem sexual behaviors (MST-PSB) reaches as far as young adulthood, the longer-term effects of MST-PSB into midlife are unknown. The present study examined criminal and civil court outcomes for sexually offending youths who participated on average 24.9 years earlier in a clinical trial of MST-PSB (Borduin et al., Journal of Consulting and Clinical Psychology, 2009, 77, p. 26). Method: Participants were 48 individuals who were originally randomized to MST-PSB or usual community services (UCS) and were at high risk of continued criminality. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants averaged 39.4 years of age. Results: Intent-to-treat analyses showed that MST-PSB participants had 85% fewer sexual offenses and 70% fewer nonsexual offenses than did UCS participants. In addition, MST-PSB participants were sentenced to 46% fewer days of incarceration and had 62% fewer family-related civil suits. Moreover, the favorable effects of MST-PSB on participants' crimes and civil suits were mediated by improved peer and family relations during treatment. Conclusion: The current study represents the longest and most comprehensive follow-up to date of an MST-PSB clinical trial and demonstrates that the positive effects of an evidence-based youth treatment for sexual crimes can last well into adulthood. Implications of the findings for policymakers, service providers, and researchers are discussed. What is the public health significance of this article?: This study demonstrates that a comprehensive, family-based treatment for youth sexual offending can have a lasting impact on participants' lives. The findings are useful for policymakers and service providers to consider in their selection of mental health interventions for youths who engage in sexual offenses. [ABSTRACT FROM AUTHOR]

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings. [ABSTRACT FROM AUTHOR]

This study investigated the economics of multisystemic therapy for problem sexual behaviors (MST-PSB), a family-based treatment that has shown promise with juvenile sexual offenders. We evaluated the cost and benefits of MST-PSB versus usual community services using arrest data obtained in an 8.9-year follow-up from a randomized clinical trial with 48 juvenile sexual offenders, who averaged 22.9 years of age at follow-up (Borduin, Schaeffer, & Heiblum, 2009). The net benefit of MST-PSB over usual community services was calculated in terms of (a) the value to taxpayers, which was based on measures of criminal justice system expenses (e.g., police and sheriff's offices, court processing, community supervision); and (b) the value to crime victims, which was based on measures of both tangible (e.g., property damage and loss, health care, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. Lower rates of posttreatment arrests in the MST-PSB versus usual community services conditions were associated with lasting reductions in expenses for both taxpayers and crime victims, with an estimated total benefit of $343,455 per MST-PSB participant. Stated differently, every dollar spent on MST-PSB recovered $48.81 in savings to taxpayers and crime victims over the 8.9-year follow-up. These findings demonstrate that a family-based treatment such as MST-PSB can produce lasting economic benefits with juvenile sexual offenders. Policymakers and public service agencies should consider these findings when making decisions about interventions for this challenging clinical population. [ABSTRACT FROM AUTHOR]

Purpose – Effective treatments for juvenile sexual offenders are needed to reduce the societal impact of sexual crimes. The purpose of this paper is to review the empirical literature on treatments for this clinical population. Design/methodology/approach – The authors searched PsycInfo and MEDLINE (via PubMed) for studies that evaluated outcomes of treatments with juvenile sexual offenders. Findings – There are a small but growing number of treatment studies (n=10) with juvenile sexual offenders, and all of these studies evaluated cognitive-behavioral therapy or multisystemic therapy for problem sexual behaviors. The results of these studies are promising, although conclusions about treatment effectiveness have been frequently limited by methodological problems. Originality/value – The authors provide recommendations for treatment providers and policymakers to consider in their decisions about interventions for juvenile sexual offenders. Furthermore, the authors offer suggestions for researchers who seek to develop effective interventions targeting this clinical population. [ABSTRACT FROM AUTHOR]

Objective: Family-based treatment models that have shown effectiveness with juvenile offenders may also lead to reduced criminality in siblings of those offenders. However, the lasting effects of such treatments on siblings have not been evaluated. In the present study, the authors examined criminal outcomes for siblings of serious and violent juvenile offenders who had participated on average 25.0 years earlier in a clinical trial of multisystemic therapy (MST; Borduin et al., 1995). Method: Participants were 129 closest-in-age siblings of individuals who were originally randomized to MST or individual therapy (IT) during adolescence. Arrest and incarceration data were obtained in middle adulthood when siblings were on average 38.4 years old. Results: Intent-to-treat analyses showed that arrest rates were significantly lower for siblings in the MST condition than in the IT condition (43.3% vs. 72.0%, respectively). In addition, siblings in the IT condition were about 3 times as likely to be convicted of a felony and more than twice as likely to be sentenced to incarceration and probation. Conclusion: The present study represents the longest follow-up to date of sibling participants in an MST clinical trial and demonstrates that the positive impact of an evidence-based treatment for serious and violent juvenile offenders can extend to other family members. Implications of the authors' findings for policymakers and service providers are discussed. [ABSTRACT FROM AUTHOR]

Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities. This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior – Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth. Youth (N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States. We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders. CERs (i.e., $ per SD) were $1,772 per youth for problem sexual behavior and ranged from $2,867 to $4,899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions. The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth. [ABSTRACT FROM AUTHOR]

Background: Little is known about clinician perspectives regarding the factors that support or hinder the long-term delivery (i.e., sustainment) of evidence-based treatments in community-based treatment settings.Methods: Clinical staff from 82 community-based treatment organizations that received federal grant funding to support the delivery of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment for adolescent substance use, were asked to participate in interviews focused on understanding their perspectives about the sustainment of A-CRA. Qualitative themes were identified using inductive and deductive approaches. Then the themes were dichotomized (present/absent) so that quantitative comparisons could be made between staff from organizations that sustained and did not sustain delivery of A-CRA. Administrative data about each organization in relation to federal funding support and their primary focus was also examined to explore whether these characteristics were associated with A-CRA sustainment.Results: Staff (n = 134) representing 78 organizations participated in the interviews. Staff from organizations that had received multiple federal grants to support the delivery of A-CRA and whose primary focus was substance use rather than other conditions (mental health or primary care) were more likely to report sustaining A-CRA. Staff from sustaining organizations were more likely to report positive grant experiences and success with maintaining both organizational and external support in comparison to staff from non-sustaining organizations. Staff from non-sustaining organizations were more likely to report barriers to sustaining A-CRA, including more challenges with intervention delivery, and lack of internal support and external funding.Conclusions: Our findings lend empirical support for implementation theories in that multiple factors appear to be associated with long-term delivery of an evidence-based treatment. Although A-CRA was generally perceived positively by staff from both organizations that sustained A-CRA and organizations that did not sustain A-CRA, inner setting factors (e.g., structural policies, leadership support and staff retention) along with outer setting factors (e.g., external funding support) were reported as key to A-CRA sustainment. [ABSTRACT FROM AUTHOR]