Residential Women

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Residential Womens 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 Womens 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.

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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
  Administrations 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

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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

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RWC/PPW Projects Provided (cont)

• Educational vocational services for clients
  children
• Other support services for clients children
• Individualized case management, w/ active
  involvement of clients
• Family member involvement in childrens Tx
• Full continuum of care in residential setting

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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

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Project Characteristics (n32)
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Client Characteristics (n 1,768)
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Client Characteristics (continued)
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Child Characteristics (n4,048)
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Client, Pregnancy, and Project Outcomes
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Outcome Dimensions Covered

• Abstinence vs. Relapse
• Arrests for Illegal Activities
• Economic/Social Outcomes
• Physical and Mental Health
• Pregnancy Outcomes
• Project Sustainability

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Client Substance Use, Pre-Post Change
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Client Arrests for Illegal Activities
p lt .0001 in all 3 comparisons
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Economic/Social Outcomes
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Client Physical and Mental Health Problems,
Pre-Post Change
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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
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Percentage of Clients Abstinent Post Discharge,
by LOS and Study
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Key Client Outcomes, Broken Out By Length of Stay
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Sustainability Status of RWC/PPW Projects at End
of CSAT Grant (n 36)
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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

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Treatment Cost
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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)

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Site Variation in RWC/PPW Unit Costs
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Average Treatment Episode Costs by Group
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Monetizing Benefits
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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

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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)

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RWC/PPW Benefit Summary
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All clients (n1768)
Long-stay clients (n657)
Pregnant clients (n457)
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Conclusions

• Q Do program benefits exceed costs? A Yes
• Total B exceeds Total C by 65,000/client
  (89.1K-21.2K), for B/C3.71
• For LT, B-C76,000 B/C2.81
• For preg, B-C103,000 B/C5.51
• Post-tx B (76.4K)/net C (11.5K)6.61

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Caveats

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