James J. Callahan

The costs of crime and the benefits of substance abuse treatment for pregnant women

Although many pregnant, drug-dependent women report extensive criminal justice involvement, few studies have examined reductions in crime as an outcome of substance abuse treatment programs for pregnant women. This is unfortunate, because maternal criminal involvement can have serious health and cost implications for the unborn child, the mother and society. Using the Addiction Severity Index, differences in pre- and posttreatment criminal involvement were measured for a sample of 439 pregnant women who entered publicly funded treatment programs in Massachusetts between 1992 and 1997. Accepted cost of illness methods were supplemented with information from the Bureau of Justice Statistics to estimate the costs and benefits of five treatment modalities: detoxification only (used as a minimal treatment comparison group), methadone only, residential only, outpatient only, and residential/outpatient combined. Projected to a year, the net benefits (avoided costs of crime net of treatment costs) ranged from US

The impact of substance abuse treatment modality on birth weight and health care expenditures.

32,772 for residential only to US

A shortage of long-term care workers: Effects on clients with dementia

3,072 for detoxification. Although all five modalities paid for themselves by reducing criminal activities, multivariate regressions controlling for baseline differences between the groups showed that reductions in crime and related costs were significantly greater for women in the two residential programs. The study provides economic justification for the continuation and possible expansion of residential substance abuse treatment programs for criminally involved pregnant women.

Mental health/substance abuse treatment in managed care: the Massachusetts Medicaid experience

Abstract During the 1990s, substance abuse treatment programs were developed for pregnant women to help improve infant birth outcomes, reduce maternal drug dependency and promote positive lifestyle changes. This study compared the relative impact of five treatment modalities—residential, outpatient, residential/outpatient, methadone and detoxification-only—on infant birth weight and perinatal health care expenditures for a sample of 445 Medicaid-eligible pregnant women who received treatment in Massachusells between 1992 and 1997. Costs and outcomes were measured using the Addiction Severity Index and data from birth certificates, substance abuse treatment records and Medicaid claims. Multiple regression was used to control for intake differences between the groups. Results showed a near linear relationship between birth weight and amount of treatment received. Women who received the most treatment (the residential/outpatient group) delivered infants who were 190 grams heavier than those who received the least treatment (the detoxification-only group) for an additional cost of

Play It Again Sam — There Is No Impact

17,211. Outpatient programs were the most cost-effective option. increasing birth weight by 139 grams over detoxification-only for an investment of only

Elder Abuse: Some Questions for Policymakers

1,788 in additional health care and treatment costs. A second regression using five intermediate treatment outcomes—prenatal care, weight gain, relapse, tobacco use and infection—suggested that increases in birth weight were due primarily to improved nutrition and reduced drug use, behaviors which are perhaps more easily influenced in residential settings.

Case Management for the Elderly

Although advocates promote caregiving services to families in need, the formal care system is directly dependent upon the availability of workers willing to provide this type of care. If there is a worker shortage, are clients with cognitive impairment more adversely affected than other clients? This article reports the findings from a study conducted in one state during a worker shortage. A worker bias was found against servicing Alzheimer clients in their homes that was not evident in day care facilities or nursing homes with Alzheimer units. Policy is sues are raised and recommendations made concerning workers wages and benefits, work life, job design, and the structure of the long term care industry.