Residential Women’s Treatment: Cost-Benefit and Outcome Findings from a CSAT Cross-Site Evaluation

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)

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

28. Average Treatment Episode Costs by Group

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)

35. RWC/PPW Benefit Summary

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