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.
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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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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.
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
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
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
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
Attribute Pre-Tx (%) Post-Tx (%) pMain Source of Support:
Public Assistance46.2 45.4 .5890
Employed in the Past 30Days
6.7 37.1 < .0001
Client in Vocational/Educational Training
2.2 18.5 < .0001
Client Lived with AOD-Involved Spouse/Partner
45.2 11.8 < .0001
Client Had At Least OneChild in Foster Care
28.4 19.7 < .0001
Client Physical and Mental Health Problems, Pre-Post Change
70%
53%46%
40%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Any Physical HealthProblem
Any Mental HealthProblem
Per
cent
age
of C
lien
ts
Pre-TxPost-Tx
Pregnancy OutcomesOutcome per 100 Live Births
OutcomeMeasure
ComparisonSamples(n varies)
All U.S. Women(n = 3.8 million)
RWC/PPWClient In-Tx
Deliveries(n = 739)
PrematureDelivery
27.0* 11.4 7.3
Low BirthWeight
34.0** 7.5 5.8
Infant Death 1.2*** 0.7 0.4
* 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
Percentage of Clients Abstinent Post Discharge, by LOS and Study
71%
21%
43%
25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
< 1Month
1 - 3Months
4 - 6Months
> 6Months
Length of Stay in Treatment
Per
cent
age
of C
lien
ts
RWC/PPW
DATOS 6-Month
NTIES
Key Client Outcomes, Broken Out By Length of Stay
Client Length ofStay
Characteristic* 0-90 Days 91+ Days pClient Arrested 20.1% 10.5% < .0001Employment is Main Source
of Income18.8% 36.1% < .0001
Living with AOD-InvolvedSpouse/Partner
17.0% 8.7% .0005
Client has Custody of 1+Children
51.4% 70.1% < .0001
Child(ren) Removed fromCustody Post-Tx
15.2% 6.9% < .0001
Sustainability Status of RWC/PPW Projects at End of CSAT Grant (n = 36)
58%
8%
33%
0%
10%
20%
30%
40%
50%
60%
70%
Active (Same) Active (Modified) Inactive
Sustainability Status
Per
cent
age
of P
roje
cts
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
Treatment Cost
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)
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
Average Treatment Episode Costs by Group
Statistics
Group
Total 1-30 31-90 91-180 181+ Pregnt Not pre
N (clients) 1768 368 362 381 657 457 1311
Mean LOS (days) 151.8 15.6 58.2 140.2 286.5 143.2 154.8