MODIFIED TC FOR HOMELESS MICAS--BENEFIT/COST ANALYSIS

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DESCRIPTION: (Applicant's Abstract) The central aim of this project is to provide a benefit-cost analysis of modified therapeutic community (TC) for individuals with co-occurring mental illness and chemical abuse (MICA) diagnoses in community residence (CR) settings. It adds a benefit cost analysis to l five year (1991-1996) NIDA-funded study (# 5 P50 DA 07700) and includes revisions, in italics, responsive to the IRG summary (print date 4/27/95) of a previously submitted proposal (10/1/94). It evaluates the effectiveness of modified TCs for homeless MICAs in terms of drug use, criminality, psychological change and other key outcome variables. It follows the successfully implemented programs, design, sample accumulation procedures and instrumentation of that study. It draws on relevant data from that study as well as newly collected data in order to conduct the proposed economic analyses. There are four specific aims: 1) Cost Analysis: To provide a comprehensive cost analysis of the modified TC in comparison with two other treatment options; 2) Outcome Analysis: To provide a comprehensive outcome (or impact) analysis of the modified TC in comparison with two other treatment options; 3) Cost-Effectiveness Analysis: To determine the relative cost and effectiveness of the modified TC program in comparison to two other treatment options; 4) Benefit Cost-Analysis: To determine the benefit-cost of the modified TC program in comparison to two other treatment options. The study draws on and refines the techniques of economic analysis in accomplishing these specific aims. The basic research design follows an unbiased sequential assignment procedure and places homeless MICA individuals referred from shelters and psychiatric facilities to one of three treatment options: 1) modified therapeutic community (TC); 2) enhanced psychiatric rehabilitation (EPR); and (3) treatment-as-usual (TAU). The basic study follows clients in a longitudinal, prospective, repeated measures design at five time periods: baseline (intake in one of the three options); six months in-treatment; twelve months in-treatment; six months post-treatment; and twelve months post-treatment. The proposed study provides comparisons of the three conditions on comprehensive measures of costs, outcomes and detailed cost-effectiveness and benefit-cost analysis. It calculates in benefit-cost terms the demonstrated improvements for the first two treatment conditions. The anticipated findings are: a) significantly better benefit-cost results for the modified TC as compared to the EPR and TAU groups on many variables (e.g., drug use, criminality, psychological functioning); b) significantly better benefit cost results for the modified TC as compared to the two other treatment groups on certain specific variables (e.g., self-esteem; affiliation; employment; social skills); and (c) significantly better benefit-cost results for the modified TC and the EPR models as compared to the TAU group on most variables. The proposed study has considerable potential to impact on research, policy nd planning. It extends economic program evaluation to a successfully implemented innovative treatment program (modified TC) and two other relevant treatment methods (EPR nd TAU) for a critical social problem -- homeless MICA individuals. It advances the methodology of cost analyses by accessing a government-based data source (i.e., Medicaid) for more accurate assessment of program costs. lt advances evaluation methods (i.e., economic estimation techniques for expressing outcomes in monetary terms) by applying them to a comprehensive array of program variables. It adds timely and relevant benefit-cost information and integrates it with other evaluation measures. It provides critical determinations for policy makers and planners on the benefits and costs associated with different treatment approaches to homeless MICAs.