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Residential Women’s Treatment: Cost-Benefit and Outcome Findings from a CSAT Cross- Site Evaluation Ken Burgdorf, Ph.D. Xiaowu Chen, M.D., M.S.P.H. CSAT.

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Presentation on theme: "Residential Women’s Treatment: Cost-Benefit and Outcome Findings from a CSAT Cross- Site Evaluation Ken Burgdorf, Ph.D. Xiaowu Chen, M.D., M.S.P.H. CSAT."— Presentation transcript:

1 Residential Women’s Treatment: Cost-Benefit and Outcome Findings from a CSAT Cross- Site Evaluation Ken Burgdorf, Ph.D. Xiaowu Chen, M.D., M.S.P.H. CSAT Women’s Conference, July 12, 2004 *Study conducted under Contract 270-97-7030 funded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. Center for Substance Abuse Treatment, 5600 Fishers Lane, Rockwall II, Suite 740, Rockville, Maryland 20857, 301/443-5052. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency.

2 The RWC/PPW Program and Cross-Site Evaluation The Residential Women and Children (RWC)/Pregnant and Postpartum Women (PPW) programs were funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment The cross-site evaluation encompassed 50 5-year RWC/PPW projects that were funded in two cohorts: 39 in FY 1993 11 in FY 1995 Each project was required to develop a comprehensive, long-term (6- or 12-month) residential treatment program for pregnant and parenting women with serious substance abuse problems, including on-site care of clients’ infants and young children

3 RWC/PPW Projects Provided: Outreach services to promote Tx entry & retention Screening/assessment for women, infants, & children Medical testing for substance abuse related diseases/conditions Medical care for clients & children Individual and group therapy/counseling for clients & children

4 RWC/PPW Projects Provided (con’t) Educational & vocational services for clients & children Other support services for clients & children Individualized case management, w/ active involvement of clients Family member involvement in children’s Tx Full continuum of care in residential setting




8 The RWC/PPW Cross-Site Evaluation Cross-site evaluation collected data from October 1, 1996 to March 31, 2001 50 RWC/PPW projects submitted a standardized set of quantitative data on a quarterly basis including admission, treatment services, discharge, and 6- month follow-up data Outcome data set represents 1,768 former clients from 32 projects that met minimal requirements for follow-up data collection (50% follow-up rate or better) Follow-up data are available for 1,181 women Nonresponse adjustments made to account for underrepresentation of short- stay clients

9 Project Characteristics (n=32)

10 Client Characteristics (n = 1,768)

11 Client Characteristics (continued)

12 Child Characteristics (n=4,048) Male 49.0% Mean age 3.8  3.4 years Child Placement before treatment Legal custody (%) Living situation (%) Mother67.145.8 Father0.94.1 Mother & Father12.89.0 Grandparent2.113.3 Other relative0.86.0 State13.815.9 Other2.55.7

13 Client, Pregnancy, and Project Outcomes

14 Outcome Dimensions Covered Abstinence vs. Relapse Arrests for Illegal Activities Economic/Social Outcomes Physical and Mental Health Pregnancy Outcomes Project Sustainability

15 Client Substance Use, Pre-Post Change

16 Client Arrests for Illegal Activities p <.0001 in all 3 comparisons

17 Economic/Social Outcomes

18 Client Physical and Mental Health Problems, Pre-Post Change

19 Pregnancy Outcomes * n = 2,837 from 12 recent hospital-based studies of outcomes for cocaine-using women **n = 9,737 from 10 recent hospital-based studies of outcomes for cocaine-using women *** n = 10,816 previous pregnancies of RWC/PPW clients, as reported at treatment admission

20 Percentage of Clients Abstinent Post Discharge, by LOS and Study

21 Key Client Outcomes, Broken Out By Length of Stay


23 Sustainability Status of RWC/PPW Projects at End of CSAT Grant (n = 36)

24 Outcome Study Conclusions This type of residential treatment accrues substantial benefits to clients in many areas of life Benefits are most widespread and pronounced for clients who remain in treatment 3 months or more, who are especially successful in achieving lasting abstinence

25 Treatment Cost

26 Treatment Cost Data Collected on-site by professional accounting firm (CCC) in 1997; 39 sites Used CSAT-developed cost accounting system (SATCAAT) Comprehensive, based on full market value of project facilities, goods, and services (incl. donated)

27 Site Variation in RWC/PPW Unit Costs Mean  SD Annual cost per site $928,190  305,114 Episode cost per client $25,744  13,440 Daily cost per client, total $159  62 Housing $51  30 Client services $60  28 Child services $48  26

28 Average Treatment Episode Costs by Group Statistics Group Total1-3031-9091-180181+PregntNot pre N (clients)17683683623816574571311 Mean LOS (days)151.815.658.2140.2286.5143.2154.8 Clinical intensity12.91.60.9 varies Episode cost by component Intake $834 Resid. Care $11,686$1,201$4,480$10,793$22,055$11,024$11,917 Clin. Care $11,670$3,478$7,159$9,701$19,824$11,130$11,859 Total, per client $24,190$5,513$12,473$21,327$42,712$22,988$24,610

29 Monetizing Benefits

30 Benefit Types Included Only benefits to society Only benefits that can be quantified from study data and then monetized based on outside literature Include both in-treatment and post-treatment (PT) benefits Include both client- and child-related benefits Estimate PT benefits for at least 1 year

31 Benefits to be Estimated In-treatment: reduced crime, reduced TANF, reduced foster care Post-treatment: reduced crime (1 yr), reduced TANF (1 yr), reduced Foster Care (33 mos), reduced LBW (lifetime)

32 Crime Reduction, by Type of OffenseUnit cost ($) In-txPost-tx (1 yr) Units avert (total) Units avert (mn) Saving (mn) Units avert (total) Units avert (mn) Saving (mn) Drug sale, dist., manfr.2651502.9$7691625.2$135 DWI, DUI5812920.7$4219731.1$65 Forgery, fraud69025051.4$97855043.1$2148 Fencing stolen propty12425401.4$17842912.4$301 Gambling, bookmaking811640.7$513600.8$6 Prostitution5434652.0$10660833.4$186 Burglary/auto theft163716440.9$152235342.0$3272 Other theft91521531.2$111432951.9$1705 Robbery59445110.3$171810740.6$3611 Aggravated assault54409830.6$302514690.8$4520 Vandalism588360.5$2715720.9$52 Total22243$879139317 $16000

33 Benefit type and amountUnit cost ($) Total N=1,768 Mean per client ($) Crime In-tx: N crimes averted22,243 Savingsvaries$15,543,283$8,791 Yr post-tx: N crimes avrt.39,317 Savingsvaries$28,288,327$16,000 Crime total$43,831,610$24,792 TANF (& Food Stamps) In-tx: N sup. days averted121,071 Savings$31/day$3,753,201$2,123 Yr post-tx: N sup. yrs avrtd349 Savings$11,300/yr$3,943,700$2,231 TANF total$7,696,901$4,353

34 Benefit type and amount (continued) Unit cost ($)Total N=1,768 Mean per client ($) LBW Deliveries N LBWs averted55 1 st year med cost saving$25,413$1,397,715$791 Lifetime med/edu saving$423,760$23,306,800$13,183 LBW total$449,173$24,704,515$13,973 Foster Care (FC) In-tx: N days for FC kids48,432 Saving$64/day$3,099,648$1,753 Post-tx: FC plmts averted1,217 Saving$64,218/plmt$78,153,306$44,204 FC total$81,252,954$45,958

35 RWC/PPW Benefit Summary Benefit type and period Savings Quantity Total ( $M) Mean ($thou) % Total (n=1,768)157.589.1100 In-tx offsets22.412.7(14) Foster care48,432 days3.11.82 Crime22,243 crimes15.58.810 Public support121,071 days3.82.12 Post-tx benefits135.176.4(86) LBW, lifetime55 LBWs24.714.016 Foster care, 1 st plmt1,217 placemts78.244.250 Crime, 1 st yr39,317 crimes28.316.018 Pub. assist 1 st yr349 families3.92.22

36 All clients (n=1768) Long-stay clients (n=657) Pregnant clients (n=457)

37 Conclusions Q: Do program benefits exceed costs? A: Yes Total B exceeds Total C by $65,000/client ($89.1K-$$21.2K), for B/C=3.7:1 For LT, B-C=$76,000; B/C=2.8:1 For preg, B-C=$103,000; B/C=5.5:1 Post-tx B ($76.4K)/net C ($11.5K)=6.6:1

38 Caveats Outcome data from client self-report No control group Benefit estimates conservative and incomplete in type, duration Analysis excluded role of leveraged services

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