Cost Effectiveness of Treatment for People on Probation

Farrokh Alemi, Ph.D.Faye Taxman, Ph.D.

Jee VangMeridith 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 costsOthers

Clinician Clients Payers and insurers Victims Society

Population Examined

Traditional Probation Seamless Probation

VariableModerate-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

Age, years (sd) 31.1 (9.8) *28.2 (9.4) 31.3 (10.3) 30.0 (7.8)

Ever HIV Tested, % Negative, %

705

782

744

812

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

Average legal income earned past 30 days, $ 792 (886) 661 (909) 1005 (1532) 830 (1939)

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 testingRe-arrest from FBI records Unit costs

Budget of the agencies Literature review

Analytical Model

Seamlessprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Seamlesscost/day

TreatmentCost/day

Seamlesscost/day

Seamlesscost/day

Seamlesscost/day

Traditionalprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Traditionalcost/day

TreatmentCost/day

Traditionalcost/day

Traditionalcost/day

Traditionalcost/day

Cost of consequences

Cost of Program

A

Arrest

Technical violation

Day of incarceration

Day of homelessness

Day of employment

Day of hospitalization (mental)

Day of use affecting use by others

Day of hospitalization (physical)

Cost of arrest & court processing

Cost of arrest without processing

Cost of day of incarceration

Cost of day of shelter

Tax income per day (negative cost)

Cost of day of hospitalization (mental)

Expected cost of drug use for others

Cost of day of hospitalization (physical)

Seamlessprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Seamlesscost/day

TreatmentCost/day

Seamlesscost/day

Seamlesscost/day

Seamlesscost/day

Traditionalprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Traditionalcost/day

TreatmentCost/day

Traditionalcost/day

Traditionalcost/day

Traditionalcost/day

Cost of consequences

Cost of Program

A

Arrest

Technical violation

Day of incarceration

Day of homelessness

Day of employment

Day of hospitalization (mental)

Day of use affecting use by others

Day of hospitalization (physical)

Cost of arrest & court processing

Cost of arrest without processing

Cost of day of incarceration

Cost of day of shelter

Tax income per day (negative cost)

Cost of day of hospitalization (mental)

Expected cost of drug use for others

Cost of day of hospitalization (physical)

Seamlessprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Seamlesscost/day

TreatmentCost/day

Seamlesscost/day

Seamlesscost/day

Seamlesscost/day

Traditionalprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Traditionalcost/day

TreatmentCost/day

Traditionalcost/day

Traditionalcost/day

Traditionalcost/day

Cost of consequences

Cost of Program

A

Arrest

Technical violation

Day of incarceration

Day of homelessness

Day of employment

Day of hospitalization (mental)

Day of use affecting use by others

Day of hospitalization (physical)

Cost of arrest & court processing

Cost of arrest without processing

Cost of day of incarceration

Cost of day of shelter

Tax income per day (negative cost)

Cost of day of hospitalization (mental)

Expected cost of drug use for others

Cost of day of hospitalization (physical)

Seamlessprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Seamlesscost/day

TreatmentCost/day

Seamlesscost/day

Seamlesscost/day

Seamlesscost/day

Traditionalprobation

Day in probation

TreatmentDay

Day not in Treatment

A

A

TreatmentCost/day

Day not in probation

TreatmentDay

Day not in Treatment

A

A

Traditionalcost/day

TreatmentCost/day

Traditionalcost/day

Traditionalcost/day

Traditionalcost/day

Cost of consequences

Cost of Program

A

Arrest

Technical violation

Day of incarceration

Day of homelessness

Day of employment

Day of hospitalization (mental)

Day of use affecting use by others

Day of hospitalization (physical)

Cost of arrest & court processing

Cost of arrest without processing

Cost of day of incarceration

Cost of day of shelter

Tax income per day (negative cost)

Cost of day of hospitalization (mental)

Expected cost of drug use for others

Cost of day of hospitalization (physical)

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 Seamless probation

For all offenders in group

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

*p<.01 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

Daily Probability of Supervision

Traditional Probation Seamless probation

For all clients in the group

While in, or one month after, treatment

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*

Table 4: Daily Probability of Being Under Supervision*p<.01 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%*

Table 9: Probability of Mental Health Hospitalization*p<0.01 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 ProbationAgency costs

Investigative reporting++

Seamless supervision++

Traditional supervision++

Personnel services $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

Economic cost of volunteers 5,013 $687 $334 $3,993

Total $1,694,643 $232,117 $112,828 $1,349,697

Cost per work day $6,009 $823 $400 $4,786

Number of client-days   15,792 9,588 206,424

Cost per day per client   $15 $12 $7

Cost of Day of Treatment

Category TotalCROP

programOutpatient 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

Total costs 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

Cost per enrollment day

$8.70 $15.80 $14.25

Table 12: Cost of a Day of TreatmentThis 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 millionsExpenditure 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 ProcessingIncludes 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 –Virginia-

West Virginia metropolitan area: $30.43 per day for an efficiency apartment

Cost of Day of Employment

Alexandria Montgomery County

Seamless Traditional Seamless Traditional

Average Income Per Day1, (sd) $61.64 ($86.19)

$66.32 ($96.18)

$49.53 ($68.42)

$46.63 ($65.96)

Estimated per day tax on income based on single exemption

$1.8 $2.18 $1.01 $0.82

Any Full-Time Work, % 62 64 60 67

Any Part-Time Work, % 15 21 19 30

Table 13: Income Per Day at First Follow-up (12 month retrospective)1 Months worked past year times average monthly income divided by 240 working days

So what?

Expected costs Does treatment pay for itself?

What if we have better treatment?What if supervision is longer?