MODIFIED TC FOR HOMELESS MICAS--BENEFIT/COST ANALYSIS

描述：(申请人摘要) 该项目的中心目标是提供一个效益-成本分析 改良式治疗社区(TC)适用于精神分裂症患者 社区住宅中的疾病和化学品滥用(MICA)诊断(CR) 设置。增加了对L五年(1991年-1996年)的效益成本分析 NIDA资助的研究(#5 P50 DA 07700)，包括斜体修订， 对以前提交的IRG摘要(打印日期为1995年4月27日)作出回应 建议(10/1/94)。它评估了改进的TCS的有效性 在吸毒、犯罪、心理变化和 其他关键结果变量。它遵循成功实现的 程序、设计、样品积累程序和仪器 学习。它利用了该研究的相关数据以及新收集的数据 数据，以便进行拟议的经济分析。 有四个具体目标：1)成本分析：提供全面的 改良TC与其他两种治疗方法的成本分析 备选方案；2)结果分析：提供一个全面的结果(或 改良TC与其他两种治疗方法的比较分析 方案；3)成本效益分析：确定相对成本和 修改后的TC方案与其他两个方案的有效性比较 治疗方案；4)效益成本分析：确定效益成本 将修改后的TC方案与其他两种治疗方案进行比较。 这项研究借鉴和提炼了#年的经济分析技术。 实现这些具体目标。 基础研究设计遵循无偏序贯分配 程序和安置从收容所转介的无家可归的MICA个人和 精神病院可选择以下三种治疗方式之一：1)改良 治疗社区(TC)；2)加强精神康复(EPR)； (3)照常治疗(TAU)。基础研究跟踪客户在一项 五个时间段的纵向、前瞻性、重复测量设计： 基线(三个选项之一的摄入量)；六个月的治疗； 治疗中12个月；治疗后6个月；和12个月 后处理。 建议的研究提供了三种情况的比较 全面衡量成本、结果和详细的成本效益 和效益-成本分析。它以收益-成本的形式计算 证明了前两种治疗条件的改善。这个 预期的结果是：a)显著更好的效益-成本结果 改良TC与EPR和TAU组在许多变量上的比较 (例如，吸毒、犯罪、心理功能)；b)显著 与其他两种方案相比，改进后的TC具有更好的效益成本结果 治疗组在某些特定变量(例如，自尊； 从属关系；就业；社交技能)；和(C)明显更好 经修改的TC和EPR模型的效益-成本结果与 TAU小组对大多数变量的看法。 拟议的研究对研究、政策有相当大的潜在影响 和计划。它将经济项目评估扩展到一个成功的 实施创新治疗计划(经修改的TC)和另外两个 关键社会问题的相关处理方法(EPR和TAU) 无家可归的米卡人。它通过以下方式推进了成本分析的方法论 访问基于政府的数据源(例如，Medicaid)以获得更准确的信息 评估项目成本。它提出了评价方法(即经济评价方法 用货币表示结果的估计技术)通过应用 将它们转换为程序变量的综合数组。它增加了及时性和 相关效益-成本信息，并将其与其他评估相结合 措施。它为政策制定者提供关键的决策，并 规划者关于不同治疗相关的收益和成本 帮助无家可归的云母的方法。

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.