The cost of implementing a 2-1-1 call center-based cancer control navigator program

ObjectivesDetermine the cost of implementing a call center-based cancer screening navigator program.MethodsSocial service call centers in Houston and Weslaco, TX, assessed cancer risks and implemented cancer screening promotion and navigation. Micro costing was used to estimate the program costs. Staff logs and call records tracked personnel time and material costs, including a standard 30% overhead rate. Sensitivity analysis examined the effect of varying uncertain cost parameters. Scale effects were simulated for larger population coverage.ResultsThe total cost to recruit and navigate 732 persons, out of 2933 individuals who called the center was $215,847. The participant time cost was $19,503, and the personnel cost was $116,523. The cost per navigated participant was $295 (95% CI, $290.56–$298.07). The average cost per participant for recruitment and referral only, was $36 (95% CI, $34.9–$36.9). Average cost declines to $34 for recruitment and referral, and to $225 for recruitment, referral, and navigation when the number of participants increases to 15,000 individuals.ConclusionsExpanding 2-1-1 referral services with opportunistic cancer screening promotion takes advantage of existing infrastructure but requires substantial additional staff time, participant time, and budget. Cost estimation is the first step in a full economic evaluation and informs program planners and decision-makers on the resource and budgetary requirements of this innovative strategy for increasing cancer screening in low income communities.     

The social costs of child abuse in Japan

The present study calculates the social costs of child abuse in Japan. The items calculated included the direct costs of dealing with abuse and the indirect costs related to long-term damage from abuse during the fiscal year 2012 (April 1, 2012, to March 31, 2013). Based on previous studies on the social costs of child abuse and peripheral matters conducted in other countries, the present study created items for the estimable direct costs and indirect costs of child abuse, and calculated the cost of each item. Among indirect costs, future losses owing to child abuse were calculated using extra costs with a discount rate of 3%. The social cost of child abuse in Japan in the fiscal year 2012 was at least ¥1.6 trillion ($16 billion). The direct costs totaled ¥99 billion ($1 billion), and the indirect costs totaled ¥1.5 trillion ($15 billion). This sum of ¥1.6 trillion for only the year 2012 is almost equal to the total amount of damages of ¥1.9 trillion caused by the 2011 Tohoku Earthquake and Tsunami in Fukushima Prefecture. Moreover, abuse is a serious problem that occurs every year and has recurring costs, unlike a natural calamity. However, Japan has no system for calculating the long-term effects of abuse. Therefore, owing to the scarcity of data, the calculations in the present study may underestimate the true costs.     

From pipeline to practice: Utilizing tracking mechanisms for longitudinal evaluation of physician recruitment across the health workforce continuum

PurposeArea Health Education Centers work with community partners to prepare a diverse, primary care workforce particularly among rural and underserved communities. We set out to assess our impact on the physician workforce across a multitude of short-term, intermediate, and long-term benchmarksMethodWe used a comprehensive evaluation scaffolding to assess benchmarks of success across the workforce pipeline including short-term (i.e. pre-medical intent to pursue a health career or medical students’ intent to practice in primary care), intermediate (college matriculation and primary care residency match rates) and longterm measures (licensure and medical practice location of program participants).ResultsWe identified significant findings in each part of the AHEC program continuum. Among our alumni, we found a significant increase in the pre-medical learner’s intent to pursue a health care career. Among medical students, we found a significant increase in intent to practice in primary care, rural areas, and medically underserved communities and a high rate of primary care residency match (compared to peers). Approximately one-third of licensed physicians are now practicing medicine serve in an underserved communityConclusionsOur findings confirm the value of longitudinal evaluation on confirming that participation in an AHEC supported program strengthen the physician workforce development.     

Estimating development cost of an interactive website based cancer screening promotion program

ObjectivesThe aim of this study was to estimate the initial development costs for an innovative talk show format tailored intervention delivered via the interactive web, for increasing cancer screening in women 50–75 who were non-adherent to screening guidelines for colorectal cancer and/or breast cancer.MethodsThe cost of the intervention development was estimated from a societal perspective. Micro costing methods plus vendor contract costs were used to estimate cost. Staff logs were used to track personnel time. Non-personnel costs include all additional resources used to produce the intervention.ResultsDevelopment cost of the interactive web based intervention was $.39 million, of which 77% was direct cost. About 98% of the cost was incurred in personnel time cost, contract cost and overhead cost.ConclusionsThe new web-based disease prevention medium required substantial investment in health promotion and media specialist time. The development cost was primarily driven by the high level of human capital required. The cost of intervention development is important information for assessing and planning future public and private investments in web-based health promotion interventions.     

A Cost–Benefit Analysis of a Family Systems Intervention for Managing Pediatric Chronic Illness

Despite recent increases of psychosocial programs for pediatric chronic illness, few studies have explored their economic benefits. This study investigated the costs–benefits of a family systems‐based, psychosocial intervention for pediatric chronic illness (MEND: Mastering Each New Direction). A quasi‐prospective study compared the 12‐month pre–post direct and indirect costs of 20 families. The total cost for program was estimated to $5,320. Families incurred $15,249 less in direct and $15,627 less in indirect costs after MEND. On average, medical expenses reduced by 86% in direct and indirect costs, for a cost–benefit ratio of 0.17. Therefore, for every dollar spent on the program, families and their third payers saved approximately $5.74. Implications for healthcare policy and reimbursements are discussed.     

Effects of Substance Abuse Central Intake on Treatment and Justice Costs

ABSTRACT

The cost-benefits of a central intake intervention for substance abuse treatment referrals were demonstrated using a transaction cost analysis on two cohorts of participants during the three-year initiative. Costs for clients receiving central intake services were compared with those just prior to the intervention's implementation. In order to study the relationship between substance abuse treatment costs and avoided criminal justice costs, data from three administrative data sets were used. Results indicate that clients receiving the central intake intervention had approximately a 58 percent decrease in costs compared to clients not receiving the intervention. The initiative produced opportunity cost savings to treatment, court, and correctional systems, with completion being crucial to opportunity cost savings.     

An Observational Study in Developing an Intergenerational Shared Site Program

Abstract

This article provides strategic insights into developing and evaluating an intergenerational shared site program at The Community Programs Center (CPC) in Port Jefferson, NY. Conducted under a grant from the Administration on Aging, attention is given to the meth odological challenges in conducting intergenerational evaluation research. The Project Evaluator found that the use of videotaping created a host of difficulties for both the staff and participants. Emphasis is given to chronicling the critical importance of developing a multi-pronged approach to gathering data, and the consequences of utilizing graduate students as evaluators. The evaluation component involved comparing two groups of child/elder participants within a day-care setting during an eight-month period of time. Each session was videotaped and later analyzed for changes in certain participant attributes. Based on the observations gathered, it was found that curriculum development, staff commitment, and programmatic flexibility were critical components in creating an intergenerational-shared site program. Also, the teaching orientation of the intergenerational facilitator was found to play a role in fostering communication among the participants. Important recommendations are provided for both intergenerational practitioners and research evaluators who want to replicate the CPC model. Although positive change was observed in select participants, future evaluation efforts must track change and activity outcomes over a greater period of time.     

Developing Financial Management Training in Low-Income Communities

Abstract

As welfare policy contractions and declines in real wages have placed severe financial pressures on low-income families, programs to improve financial management practices and to help the poor accumulate assets have grown. This article examines the need for such programs and the implications associated with implementing two prominent training strategies-one that focuses solely on financial management training and another that combines such training with savings incentives.

Based on data from a large financial management training program, we find that knowledge deficits about basic financial issues are substantial, and that the type of financial training program offered has important implications with respect to the subgroups of low-income people likely to be served within a community. We discuss program issues critical to the implementation of such programs in low-income communities, with a focus upon more carefully attending to their participant empowerment and community development potential.     

The cost of implementing a jail diversion program for people with mental illness in San Antonio,Texas

Jail diversion programs for people with mental illness are designed to redirect offenders with mental illness into community treatment. Although much has been published about program models and their successes, little detail is available to policy makers and community stakeholders on the resources required to start and implement a jail diversion program and which agencies bear how much of the burden. The current study used data on a model jail diversion program in San Antonio, Texas, to address this research gap. Data on staff costs, client contacts, planning, and implementation were collected for three types of diversion: pre-booking police, post-booking bond, and post-booking docket. An activity-based costing algorithm was developed to which parameter values were applied. The start-up cost for the program was $556,638.69. Pre-booking diversion cost $370 per person; 90% of costs were incurred by community mental health agencies for short-term monitoring and screening (>80% of activities). Post-booking bond and docket diversion cost $238 and $205 per person, respectively; the majority of costs were incurred by the courts for court decisions. Developing a multiple-intercept jail diversion program requires significant up-front investment. The share of costs varies greatly depending on the type of diversion.     

Cost effectiveness of a school readiness intervention for foster children

ObjectiveMany young children in foster care suffer from emotional and behavior problems due to neglect and abuse. These problems can lead to difficulties in school, and functioning in school is linked to long-term health and development. Early intervention to reduce emotional and behavioral issues can help children successfully transition to school, which can improve long-term outcomes. However, communities need information on relative costs and benefits associated with programs to make informed choices. The objective of this study was to assess cost effectiveness, over 12 months, of the Kids in Transition to School (KITS) intervention compared to usual services available to children in a foster care control group (FCC).MethodRandomized controlled trial of 192 children in foster care entering kindergarten who were randomized to KITS (n = 102) or FCC (n = 90). KITS includes school readiness groups and parent training over 4 months. Main outcomes were days free from internalizing symptoms (IFD), days free from externalizing behavior (EFD), intervention costs, public agency costs, and incremental cost effectiveness.ResultsKITS significantly increased IFD and EFD compared to FCC. Average total cost of the intervention was $932 per family. The intervention did not significantly impact usual services. Average incremental cost effectiveness was $64 per IFD and $63 per EFD.ConclusionsThe cost of KITS is comparable to, or less than, similar programs, and the intervention is likely to provide significant emotional and behavioral benefit and improvement in school readiness for young children in foster care.     

Effect of Pediatric Influenza on Caregivers’ Burden—A Literature Review

Influenza, or the flu, is a common and potentially serious infection that disproportionally affects children with more than 20,000 yearly hospitalizations in children under the age of 5. A literature review of the caregiver burden associated with pediatric influenza was conducted. Two main types of burdens were identified: economic and noneconomic. Flu treatment costs $3,990 for pediatric inpatients services and $730 for emergency department (ED) pediatric patients. Caregivers may also face out-of-pocket costs ($178 for inpatients, $125 for ED patients, and $52 for outpatients) or those not covered by health insurance. Caregivers can also face indirect costs while caring for their children with the flu. Indirect costs were common, and 75% of pediatric caregivers reported these costs when caring for a sick child. Missed work is the most common indirect cost and is estimated as high as 73 work hours ($1,456) missed while caring for a sick child. Other costs associated with pediatric influenza included noneconomic burden: sudden changes in daily life, loss of leisure time, social disruption, and psychological impact or stress. Noneconomic burdens were also found to be significant and lowered the quality of life of caregivers even after the child’s illness. Socioeconomic status is an important predictor of influenza rates. Residents in high-poverty areas are three times more likely to have hospitalizations due to pediatric influenza than those in low-poverty areas. From the literature it is evident that pediatric influenza has demonstrated a considerable impact on caregivers’ lives both financially and in other aspects.     

Exploring community stress and empowerment among stakeholders and youth in an urban community

ABSTRACT

Community-level stress, such as pervasive substance abuse and violence, can yield negative health and mental heath outcomes for youth from disadvantaged communities. Community empowerment is a process whereby community members work together to increase control in their community. This qualitative inquiry analyzed in-depth interviews with adult stakeholders (n = 17) as well as focus group interviews with token youth (n = 85) to explore perceptions of community stress and empowerment in one disadvantaged locale. Each of the 102 total participants helped interrogate the research questions: What does it mean to live in a stressed community? How might youth and adults perceive themselves capable of impacting a stressed community’s quality of life? Emergent themes, which include a nod to the utility of coalition building, are explored. Implications for policy, practice, and future research are also discussed.     

A cost-benefit analysis of a smoking cessation program

Smoking cessation programs are usually evaluated in terms of the percentage of participants who have stopped smoking at least 6 months after the program's completion. This paper shows how a relatively low rate of behavior change may actually result in a high ratio of benefits to costs. Cost-benefit analysis is done for a specific program but the procedures and cost estimates are generalizable to other smoking cessation programs. Benefits to the firm included reduced costs of insurance and the savings due to employee absenteeism and disability. Costs included the program costs as well as the opportunity costs of the participants. Data from the literature and from the specific program are combined to form conclusions about the effectiveness of the program.     

Worker time and the cost of stability

This paper investigates the time caseworkers spend supporting long-term foster care and adoption placements. Undertaken in Australia through collaboration between university and non-government agency researchers, the ‘Cost of Support Study’ tracked the hours that caseworkers spent supporting twenty-seven children and their carers over a nine month period.³ The placements were part of a ‘Find-A-Family’ program for ‘hard to place children’, many of whom had previously experienced multiple placement breakdowns. The program has a history of 78% stability on the first placement (over the young person's time in the program) and 93% by the second, with the type of support provided by this accredited agency's program detailed here. The weekly worker diaries reveal an average of 3 hours 32 minutes of worker time per week per placement; however wide variation is apparent in the time given to each placement, and depends on the characteristics of the child involved. Further, the resources required to support each placement are found by multiplying worker hours by the hourly cost per worker, using New South Wales government costings. The paper contributes to the important debate regarding the link between worker time and stability in care, by deepening our understanding of the costs involved in providing high quality support and supervision of casework.     

Federal Welfare and Housing Policy at the Crossroads

Abstract

A time-series design was used to investigate an innovative, rent incentive-based employment initiative in a predominantly African American public housing community. The purpose of the research was to assess the impact of the Welfare-to-Work (W-t-W) program on resident employment levels and on Public Housing Authority (PHA) revenues and costs. Data were collected on a purposive sample of heads of household (N = 313) representing 78.3% of those in the community. Over half of the residents were under 17 years of age, followed by 24.7% who were 18-34, and 15.5% who were 35-54 years of age. Mean annual income for most participants was less than $5,000, and 60% were welfare reliant. Fifty-six percent of the participants in the study (N = 179) received monthly rent credits (discounts) ranging from $23 to $333 (m = $87, s.d. = $38.60). Employment levels in the community increased considerably over the study period and the W-t-W initiative was cost-effective to the PHA. Implications are discussed regarding advantages and limitations of intersected federal welfare and housing policies, the need for formative, evidence-based assessments of W-t-W programs, and the achievement of economic self-sufficiency of public housing residents.     

The lifetime economic and social costs of child maltreatment in Australia

A cost of illness (COI) study was undertaken to estimate the magnitude and range of lifetime effects associated with child maltreatment in Australia, using an incidence-based approach. Costs were primarily estimated through calculation of population attributable fractions (PAFs) to determine the marginal effects of child maltreatment on a range of outcomes. PAFs were then applied to estimates of expenditure, inflated to 2014–15 Australian dollars, projected over the life course, according to a baseline age of incident cases for child maltreatment in 2012–13, and discounted at 7% per annum. Sensitivity analysis was conducted using a best and lower bound estimate of incidence of child abuse. The best estimate of the total estimated lifetime financial costs for incident cases of child maltreatment in 2012–13 was $9.3 billion (a cost per child maltreated of $176,437), with a lower bound of $5.8 billion. The best estimate of lifetime costs associated with reduced quality of life and premature mortality (non-financial costs) for all incident cases of child maltreatment in 2012–13 was $17.4 billion, or $328,757 per child maltreated. The considerable lifetime costs associated with child maltreatment warrants an expansion of existing investment in primary and secondary prevention and targeted support services for children and families at risk.     

Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families

Decision makers typically face uncertainty in determining whether the outcomes of promising child welfare interventions justify the investment. Despite repeated calls for cost analysis in child welfare, original studies that evaluate the costs and effects of child welfare programs have been limited. Moreover, no cost analyses have focused on family reunification programs that address the needs of substance-affected families. The purpose of this study was to evaluate the costs and effects of a federally funded implementation of the Strengthening Families Program (SFP), a 14-week family training curriculum, on time to reunification with a substance-involved child welfare population. Based on event history analysis, we find the typical child participating in SFP spends 190 fewer days in out of home care when compared to a propensity score matched comparison group of children in out-of home care receiving treatment as usual. Re-entry rates between the two groups were not significantly different at follow-up. At an average out-of-home care rate of $86 per child per day in this state, SFP saves approximately $16,340 per participating child in out-of-home care costs. From a cost–benefit perspective, every $1 invested in SFP yields an average savings of $9.83 in this Midwestern demonstration.     

Childhood morbidities among income- and categorically-eligible WIC program participants and non-participants

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is the largest supplemental food assistance program in the United States. WIC benefits include food and infant formula, nutrition counseling, health screenings, and health-care referrals to low-income, nutritionally at-risk pregnant and postpartum women, infants, and children up to age five. This research explored the associations between childhood morbidities among income- and categorically-eligible WIC participant and non-participant groups in a diverse, nationally representative sample of children. Results indicate significant differences in the maternal sociodemographic profiles of eligible child WIC participants and non-participants. After propensity score-matching methods were used to create more appropriate comparison groups among child WIC participants and non-participants, complete covariate balance was obtained for all sociodemographic characteristics. Further, no significant differences in child asthma, respiratory illness, severe gastrointestinal illness, or ear infection diagnosis, or with mothers rating their health as poor, were noted between child WIC participants and non-participants, once the matched pairs were compared. Government regulators formulating future policies around WIC would benefit from understanding the characteristics of eligible non-participants in order to offer appropriate food, health, and educational assistance beneficial to child health.     

Readings in Evidence-Based Social Work

Abstract

This article describes the development, validity, and reliability of the Parent Empowerment and Efficacy Measure (PEEM). Development was guided by theory and by challenges faced by Pathways to Prevention family support staff who required a short, practical, and reliable measure of parent empowerment. The measure's psychometric properties were tested using data from 866 parents of children aged 5 to 12, living in high to low socioeconomic status areas. Principal factor analysis revealed a strong general dimension with high internal consistency (α = 0.92) that correlated at 0.60 or more with three validation measures, as well as the existence of two hypothesised subfactors (correlated at 0.78): efficacy to parent and efficacy to connect, each with internal consistencies of 0.85+. Test–retest reliability (n = 200) was 0.84. PEEM exhibits excellent convergent and concurrent validity and is a reliable tool for use in planning services, monitoring participant progress, and evaluating program effectiveness.