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Cost Effectiveness of Treatment for People on Probation Farrokh Alemi, Ph.D. Faye Taxman, Ph.D. Jee Vang Meridith Thanner Victoria Doyon Treatment Could Help Probation Over 4 million people on probation with little effect on recidivism Treatment and employment reduces recidivism Does the benefits justify the cost? The Office of National Drug Control Policy (ONDCP) High Intensity Drug Trafficking Areas (HIDTA) Demonstration of a seamless probation program in the Baltimore-Washington, DC corridor Perspective Government agencies costs Others Clinician Clients Payers and insurers Victims Society Population Examined Traditional Probation Seamless Probation Variable Moderate-Risk (N = 75) High-Risk (N = 66) Moderate-Risk (N = 62) High-Risk (N = 69) Black, % 86 91 87 86 Male, % 77 ***92 84 87 Married, % 8 7 10 12 31.1 (9.8) *28.2 (9.4) 31.3 (10.3) 30.0 (7.8) Ever HIV Tested, % Negative, % 70 5 78 2 74 4 81 2 Alcohol use in the past 30 days, % 62 61 55 53 Drug use in the past 30 days, % 43 40 42 35 Report committing criminal act in past year, % 89 *78 89 *77 Currently under parole, % 2 3 0 *5 Incarcerated during past year, % 52 ***78 63 *77 Employed during the past 30 days, % 74 *60 61 72 792 (886) 661 (909) 1005 (1532) 830 (1939) Age, years (sd) Average legal income earned past 30 days, $ Table 1: No statistical significant difference between traditional and seamless groups at baseline ***p .01 ** p .05 * p .10 (significance tests run between seamless and traditional group) Source of Data Self-report We interviewed offenders at baseline and at 12 months Treatment & probation utilization Drug testing Re-arrest from FBI records Unit costs Budget of the agencies Literature review Day not in probation Day not in Treatment Analytical Model Treatment Day Day in probation Cost of consequences Treatment Day Day in probation Day not in Treatment A Cost of Program Treatment Cost/day Seamless probation Day not in probation Treatment Day Day not in Treatment Treatment Day Day in probation A Treatment Cost/day Day not in Treatment A Treatment Day A Day not in Treatment A Treatment Cost/day Arrest Day not in probation Traditional cost/day Treatment Cost/day Traditional cost/day Traditional cost/day Cost of arrest & court processing Treatment Day Day not in Treatment Seamless cost/day Traditional cost/day Traditional probation Day not in probation Seamless cost/day Seamless cost/day A A Traditional probation Seamless cost/day A Day not in Treatment A Arrest Co Technical violation Co Day of incarceration Co Day of homelessness Co Day of employment Tax Day of hospitalization (mental) Co Day of hospitalization (physical) Co Day of use affecting use by others Exp Probability of Participating in Treatment Traditional Probation Seamless probation While under supervision Anytime during follow-up While under supervision Anytime during follow-up Number of cases 141 141 131 131 Number of follow- up days per client 862.7 1230.1 862.7 1250.2 Number of treatment days per client 89.5 92.4 154.2 182.8 Daily probability of treatment per client* 10.4%* 7.5%* 17.9%* 14.6%* Table 2 Treatment Utilization *p<.01 for difference between corresponding seamless and traditional probation values Probability of Reduced Drug use Traditional Probation For all offenders in group Seamless probation While under supervision For all offenders in group While under supervision Number of cases 141 138 131 131 Number of follow-up days per client 1230.1 862.7 1259.9 862.7 Number of positive drug tests per client+ 3.2 3.2 3.4 3.4 Daily probability of positive drug test per client+ 0.3%* 0.4% 0.3%* 0.4% Table 3 Relapse to Drug Use for difference between corresponding seamless and traditional probation values + A positive drug test is assumed to represent 7 days prior and 7 days post the test date unless another test is available contradicting this assumption *p<.01 Daily Probability of Supervision Traditional Probation For all clients in the group While in, or one month after, treatment Seamless probation For all clients in the group While in, or one month after, treatment Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 107 1259.9 206.7 Number of supervision days per client 862.7 103.8 862.7 177.2 Daily probability of supervision per client 70.1* 97.0* 68.5* 85.7* *p<.01 Table 4: Daily Probability of Being Under Supervision for difference between corresponding seamless and traditional probation values Probability of Recidivism Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of arrests per client 0.9 0.8 0.8 0.8 Probability of arrest per client 7%* 20%* 6%* 10%* Table 6: Daily Probability of Arrest * p<.05 for difference between corresponding seamless and traditional probation values Probability of Conviction & Length of Prison Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of days in prison per client 89.2 27.6 110.2 37.0 Daily probability of incarceration per client* 0.7%* 5.4%* 0.8%* 6.3%* * Table 7: Probability of a Day in Prison p<.01 for difference between corresponding seamless and traditional probation values Probability of Unemployment Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of days employed per client 382.4 132.5 355.1 130.4 Daily probability of employment per client 6.7%* 26.0%* 4.4%* 22.1%* Table 8: Probability of Employment *p<0.01 for difference between corresponding seamless and traditional probation values Probability of Mental Illness Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of days in mental health hospital per client 0.20 0.03 1.0 0.7 Daily probability of hospitalization for mental health per client 0.02%* 0.006%* 0.08%* 0.1%* *p<0.01 Table 9: Probability of Mental Health Hospitalization for difference between corresponding seamless and traditional probation values Probability of Physical Hospitalization Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of days in general hospital per client 0.4 0.04 1.4 0.8 Daily probability of hospitalization for physical illness per client 0.03%* 0.008%* 0.1%* 0.1%* Table 9 (continued): Probability of Hospitalization for Physical Illness *p<.01 for difference between corresponding seamless and traditional probation values Probability of Homelessness Traditional Probation Seamless probation For all clients in the group While in, or one month after, probation For all clients in the group While in, or one month after, probation Number of cases 141 141 131 131 Number of follow-up days per client 1230.1 510.4 1259.9 589.0 Number of days in shelter per client 1.0 0.0 5.0 1.2 Daily probability of homelessness per client 0.08%* 0.00%* 0.4%* 0.2%* Table 10: Probability of Homelessness * p<.01 for difference between corresponding seamless and traditional probation values Cost of a Day of Probation Agency costs Investigative reporting++ Seamless supervision++ Traditional supervision++ $1,191,362 $163,182 $79,320 $948,859 Contractual services $11,984 $1,641 $798 $9,544 Supplies & materials $9,436 $1,293 $628 $7,516 Building rental $206,144 $28,236 $13,725 $164,183 Equipment rentals* $122,083 $16,722 $8,128 $97,233 Information services+ $148,621 $20,357 $9,895 $118,369 5,013 $687 $334 $3,993 $1,694,643 $232,117 $112,828 $1,349,697 $6,009 $823 $400 $4,786 Number of clientdays 15,792 9,588 206,424 Cost per day per client $15 $12 $7 Personnel services Economic cost of volunteers Total Cost per work day Cost of Day of Treatment Category Total CROP program Outpatient program Methadone program Personnel 1,266,651 64,425 732,452 469,774 Building lease value 75,435 5,372 48,275 21,788 Equipment lease value 65,420 2,456 26,773 36,191 Operations 47,425 1,259 15,888 30,278 Centralized management 397,259 15,814 240,449 140,996 1,852,189 89,325 1,063,836 699,027 Enrollment days based on counselor’s estimated panel size 9,490 89,790 40,150 Enrollment days based on time between most recent discharge & admission dates 11,043 44,860 57,945 Total costs Cost per enrollment day $8.70 $15.80 $14.25 Table 12: Cost of a Day of Treatment This work is based on Alemi F, Sullivan T. An example of activity based costing of treatment programs using time between discharges (in review) Cost of Arrest & Criminal Justice Number of cases in millions Expenditure in 2001 in millions Cost per case in 2001 Cost per case inflated to 2004 prices Police arrests 13.7 $72,406 $5285.11 $6330.35 Adult judicial cases 92.8 $37,751 $406.80 $487.25 Table 12: Cost of Arrest & Court Processing Includes local, State and Federal costs. Data are based on Bauer L, Owens SD. Justice expenditure and Employment in the United States 2001, Bureau of Justice Statistics Bulletin, May 2004. Cost of Prison The Bureau of Justice Statistics: Cost of a day in prison to be $62.01 in 2001. 6.2% inflation in prison costs in prior years Cost of a day in prison in 2004 to be $74.27 Cost of Day of Hospitalization Secretary of Health’s report to Congress inflated to 2004: $1,163.59 Maryland’s hospital cost reports: $1,868 per day of hospitalization in 2004 Cost of Day of Homelessness Fair Market rent set by U.S. Department of Housing & Urban Development as part of Section 8 Housing Assistance: 2004 for Washington DC- Maryland –VirginiaWest Virginia metropolitan area: $30.43 per day for an efficiency apartment Cost of Day of Employment Alexandria Montgomery County Seamless Traditional Seamless Traditional $61.64 ($86.19) $66.32 ($96.18) $49.53 ($68.42) $46.63 ($65.96) $1.8 $2.18 $1.01 $0.82 Any Full-Time Work, % 62 64 60 67 Any Part-Time Work, % 15 21 19 30 Average Income Per Day1, (sd) Estimated per day tax on income based on single exemption Table 13: Income Per Day at First Follow-up (12 month retrospective) worked past year times average monthly income divided by 240 working days 1 Months So what? Expected costs Does treatment pay for itself? What if we have better treatment? What if supervision is longer?