Download Cost Effectiveness of Treatment for People on Probation

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?