Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost–benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder—not otherwise specified (PDD—NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD—NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost–benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI effects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3–22 years, and from $656,000 to $1,082,000 per child for ages 3–55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost–benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI. © 1998 John Wiley & Sons, Ltd.     

Hospitalizations for Suicide‐Related Drug Poisonings and Co‐occurring Alcohol Overdoses in Adolescents (Ages 12–17) and Young Adults (Ages 18–24) in the United States, 1999–2008: Results from the Nationwide Inpatient Sample

Drug poisoning is the leading method of suicide‐related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide‐related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates of inpatient hospital stays for SRDP and co‐occurring alcohol overdoses in adolescents (ages 12–17) and young adults (ages 18–24) between 1999 and 2008. Among adolescents, there were 14,615 hospitalizations for drug poisonings in 2008, of which 72% (10,462) were suicide‐related at a cost of $43 million. Rates of SRDP in this age group decreased between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 5% in 1999 to 7% in 2008. Among young adults, there were 32,471 hospitalizations for drug poisonings in 2008, of which 64% (20,746) were suicide‐related at a cost of $110 million. Rates of SRDP did not change significantly between 1999 and 2008. The prevalence of co‐occurring alcohol overdoses increased from 14% in 1999 to 20% in 2008. Thus, while rates of SRDP decreased for adolescents and remained unchanged for young adults, the prevalence of co‐occurring alcohol overdoses increased for both age groups. Such hospitalizations provide important opportunities to employ intervention techniques to prevent further suicide attempts.     

The Fakability of Bar-On's Emotional Quotient Inventory Short Form: Catch Me if You Can

We developed a method for estimating the dollar utility of changes in job performance associated with illnesses and their treatments. Then we applied this method to predict, for each job in the economy, the difference in productivity costs associated with the illness of Seasonal Allergic Rhinitis (SAR) and that due to the difference between 2 commonly used treatments of SAR. The findings suggest that workers are 5% less productive when affected by SAR, and that when workers treat their SAR with desloratadine (a nonsedating antihistamine) instead of diphenhydramine (an over-the-counter 1st-generation antihistamine), they are 7% more productive, translating to a daily productivity cost differential between the 2 treatments of $11 per day, or $2.6 billion annually. The jobs most affected require high amounts of selective attention and perceptual speed (e.g., Aircraft Pilots and Flight Engineers, and those in the fields of manufacturing, security, and emergency response).     

Governmental research funding and economic distortion

Science and technology are “good” things. Still, there are many good things that should not be done by government and there are many other things that the private sector does far better. Government-funded research and development (R&D) falls into both these categories. Research funding is big business. In 1998, the Department of Health and Human Services received $13.1 billion, the National Aeronautics & Space Administration $9.3 billion, the Department of Energy $5.6 billion, and the National Science Foundation $2.3 billion. Newt Gingrich, still adhering to the Progressive dictum that “government does it better,” is now calling for a doubling of current federal research expenditures. This article will assess the theoretical arguments for government-funded research and examine specific research programs of the Department of Energy and the Environmental Protection Agency. Throughout, I will argue that private property rights, the rule of law, and free markets are the greatest incentives to conduct scientific research; under-investment in R&D is due not to market failure but to the failure to have markets. a public interest group active in economic and environmental public policy issues. Located in Washington, D.C., CEI has a web site at http://www.cei.org. Mr. Smith has debated free-market approaches to public problems as a guest on MacNeil/Lehrer, Crossfire, and 20/20. This article began as testimony before the Subcommittee on Energy and Environment, House Committee on Science, 25 March 1998. National Science Foundation website.     

Selling and Sales Management in Action: Sales Training: Status and Needs

Initial training, continuing education and management development activities continue to receive attention in the industrial sector (Honeycutt and Ford 1991). For example, recent reports indicate that organizations spend upwards of $30 billion annually for training programs involving 15 billion work hours (Huber 1985), with the objective being to improve the profitability of the firms.     

Injury control

Injuries are now the cause of more deaths in children than the next six most frequent causes combined. It is estimated that 8.7 million injuries occur each year. Together with noninjury motor vehicle accidents and fires, these accidents cost the nation an estimated $107.3 billion. The major approaches to injury control have involved legislation, health education, and behavioral strategies. In this article, the research evidence on the effectiveness of these strategies is reviewed, and suggestions for additional research are proposed.     

Immigrant Skill Utilization: Trends and Policy Issues

Since 1996, the problem of underutilization of immigrant skills in Canada has grown significantly. University-educated immigrants are more numerous, and census analysis shows their access to skilled occupations in the professions and management decline between 1996 and 2006. The decline in access since 2001 coincided with increased program efforts, including foreign credential assessment, bridge training, and others. Policy differences among provinces, or in occupational groups targeted, also have had little impact on aggregate trends. The value (in today’s dollars) of work lost to the Canadian economy grew from about $4.80 billion annually in 1996 to about $11.37 billion in 2006.     

Delay-discounting probabilistic rewards: Rates decrease as amounts increase

The independence of delay-discounting rate and monetary reward size was tested by offering subjects (N = 621) a series of choices between immediate rewards and larger, delayed rewards. In contrast to previous studies, in which hypothetical rewards have typically been employed, subjects in the present study were entered into a lottery in which they had a chance of actually receiving one of their choices. The delayed rewards were grouped into small ($30–$35), medium ($55–$65), and large amounts ($70–$85). Using a novel parameter estimation procedure, we estimated discounting rates for all three reward sizes for each subject on the basis of his/her pattern of choices. The data indicated that the discounting rate is a decreasing function of the size of the delayed reward (p < .0001), whether hyperbolic or exponential discounting functions are assumed. In addition, a reliable gender difference was found (p = .005), with males discounting at higher rates than females, on average.     

The de facto national system of psychiatric inpatient care. Piecing together the national puzzle

National data regarding psychiatric inpatient episodes can be viewed in 2 ways. The normative method surveys the "specialty mental health sector." A more inclusive method includes smaller sites (e.g., the military), all of general hospital treatment (rather than only the psychiatric unit), residential treatment centers, and other residential care. The difference between the 2 methods represents approximately 725,000 episodes, at a direct cost of more than $6 billion. The more inclusive analysis of the years 1980 and 1985 reveals a strong shift to the private sector and an increase in inpatient care of children and youth that might be obscured by limiting national treatment statistics to the specialty mental health sector.     

A behavioral account of compensation awarding decisions

Suppose an individual loses an irreplaceable object and someone else is at fault. How much should he be compensated? Normatively, compensation should equal the value (utility) to the victim. Our experiments demonstrate that compensation decisions often ignore value and are instead based on cost (how much the victim originally paid for the item) except when cost is zero. For example, we found that people awarded $200 for a destroyed item worth $500 to the victim if the cost was $200; however, they awarded $500 if the original cost was zero. We explain these phenomena in terms of lay scientism (the tendency to base decisions on objective factors) and discuss how the prevalent cost‐based compensation rule hurts consumer welfare. Copyright © 2008 John Wiley & Sons, Ltd.     

Materialism and Fashion Consciousness: The Moderating Role of Status Consumption Tendencies and Religiosity

Understanding whether materialistic values translate directly into fashion consciousness or whether it is the status consumption and religiosity that intensifies this relationship within the specifics of explicitly religious consumers is important as fashion consumption appears to occupy a focal position both socially and economically in the lives of many. The Islamic fashion clothing market has begun to attract recent attention and is becoming an area of interest in consumer research. The Turkish Islamic fashion clothing consumptionscape that reached a yearly sales volume of $39 billion in 2013 within a $266 billion global market shows that the explicitly Muslim Turkish consumer gains excitement and pleasure from keeping up‐to‐date with fashion. Utilizing a unique data set from a survey in Istanbul this article examines the relationships between materialism, status consumption tendencies, intrinsic religiosity, and fashion‐novelty consciousness. Strong evidence is found for the positive relationship of materialism to fashion‐novelty consciousness. In addition, intrinsic religiosity has been identified to have a negative moderating effect on the materialism‐fashion‐novelty consciousness association.     

The psychiatric inpatient treatment of children and youth in general hospitals

National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) in short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for mental disorders in general hospitals at an estimated cost of over $1.5 billion. Compared to adults, children were more likely to be treated in scatter beds (vs. specialty units); have a diagnosis of mental disorder (vs. alcohol/drug disorder); stay much longer; and pay with commercial insurance. Previous work focusing on psychiatric units of general hospitals identified less than 40% of the total episodes, a figure very similar to that for adults. The majority of psychiatric inpatient episodes for children and youth in the United States takes place in short-term general hospitals. Community psychologists need to be aware of national trends in inpatient care and be involved in the development and promulgation of alternative models of care.     

Cost Comparison of Early Intensive Behavioral Intervention and Special Education for Children with Autism

The financial implications of the increased prevalence of autism, though rarely discussed, will be extremely important to society. We compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention (EIBI) in an effort to minimize the need for special education. Our results indicate that the state of Texas would save $208,500 per child across eighteen years of education with EIBI. When applied to the conservative estimate of 10,000 children with autism in Texas, the State would save a total of $2.09 billion with EIBI. Implications for taxpayers, policymakers, and treatment are discussed.     

Genetic Counseling Graduate Student Debt: Impact on Program,Career and Life Choices

The cost of education is rising, increasing student financial aid and debt for students pursuing higher education. A few studies have assessed the impact of student debt in medicine, physical therapy and social work, but little is known about the impact of student debt on genetic counseling students and graduates. To address this gap in knowledge, a web-based study of 408 recent alumni of genetic counseling programs in North America was conducted to assess the impact of student debt on program, career and life choices. Over half (63 %; n?=?256/408) of the participants reported that loans were extremely important in their ability to attend their training program, with most using subsidized loans no longer available to current graduate students. While participants were generally satisfied with their genetic counseling education, 83 % (n?=?282/342) of participants with student debt reported feeling burdened by their debt, which had a median of $40,000–$50,000. This debt is relatively close to the median starting salary reported by survey participants ($45,000–$50,000), breaching the “20-10 rule” that states student debt should not exceed 20 % of annual net income. In response to this critical issue, we propose recommendations for the genetic counseling field that may help alleviate student debt impact and burden.     

The Influence of Culture on Consumer Impulsive Buying Behavior

Impulse buying generates over $4 billion in annual sales volume in the United States. With the growth of e‐commerce and television shopping channels, consumers have easy access to impulse purchasing opportunities, but little is known about this sudden, compelling, hedonically complex purchasing behavior in non‐Western cultures. Yet cultural factors moderate many aspects of consumer's impulsive buying behavior, including self‐identity, normative influences, the suppression of emotion, and the postponement of instant gratification. From a multi‐country survey of consumers in Australia, United States, Hong Kong, Singapore, and Malaysia, our analyses show that both regional level factors (individualism–collectivism) and individual cultural difference factors (independent –interdependent self‐concept) systematically influence impulsive purchasing behavior.     

Developing an Online Early Detection System for School Attendance Problems: Results From a Research-Community Partnership

School refusal and other school attendance problems are vexing problems for school-aged youth, families, school personnel, and clinicians. However, few resources exist to detect problematic attendance. The current report describes three steps of a research-community partnership to develop an early identification program to detect youth at risk for problematic attendance. First, a survey was conducted to estimate the scope and cost of school refusal across grades K–12. School administrators estimated relatively few youth exhibiting significant school refusal (missing 5 or more days per year) but estimated the costs associated with services for these youth to be very high (mean cost of in-district programs: $94,052; mean cost of out-of-district placements: $496,657). Second, elementary school counselors were tasked with tracking absenteeism among at-risk youth using an online attendance tracking prototype. Counselors identified a high number of youth who showed elevated absences, lates, or early departures (17.2% of enrolled students), and counselor ratings were significantly related to whether the student (a) had received an individualized education plan or 504 plan, (b) had a sibling with similar attendance problems, (c) was older, or (d) had divorced or separated parents. In a final step, counselor feedback was sought and revisions were incorporated in the attendance tracker. Findings reinforce the prevalence and cost of school attendance problems, provide guidance for using technology to monitor attendance and related indices (tardies, early departures), and direct attention to youth factors that may be useful in identifying youth at risk for poor attendance.     

Cost Effectiveness of Strategies for Recruiting Low-Income Families for Behavioral Parent Training

The goal of this study was to assess cost, effectiveness, and cost-effectiveness of recruitment strategies used to engage low-income families of young children with disruptive behavior disorder to participate in a Behavioral Parent Training (BPT) program. For this analysis, we used data on labor and non-labor resources associated with 13 recruitment strategies implemented in February 2014 through February 2016. We assessed the effectiveness of each strategy as the number of families that enrolled into the study. Cost-effectiveness of each recruitment strategy was expressed as cost per family enrolled; analysis was conducted in 2016. We calculated the cost of total recruitment effort for 13 strategies during the 2-year period to be $11,496 with an average cost of $885 per recruitment strategy or $255 per enrolled family. Across strategies, total costs ranged from $25 to $2540. “University mass e-mail” and “school flyers” resulted in the most phone screens (34 each); however, only 10% of these families enrolled in the study (three and four families, respectively). “Craigslist” was the most effective strategy with 30 families screened and 11 of them enrolling. Three strategies did not yield any participants. The four strategies with the lowest cost per family enrolled were “Facebook page,” “Craigslist,” “university mass e-mail,” and “organization/agency” (<$90). In conclusion, we found that some recruitment strategies were more successful at engaging low-income families to participate in a BPT program than others. Our results indicate that using a combination of recruitment strategies may be the optimal approach for recruiting low-income families.     

Costs of Treating Conduct Disordered Medicaid Youth with and without Family Therapy

This longitudinal, retrospective study investigated the healthcare costs of youth treated for conduct disorder in the Kansas Medicaid system. Along with a comprehensive range of services, youth received in-office individual therapy, in-office family therapy, or in-home family therapy. Data was available for 3753 youth. Overall, 3086 youth received care that included individual therapy (and no family therapy), 503 received in-home family therapy and 164 others received in-office family therapy. Healthcare costs for a period of two and one half years after therapy were available for analysis. The average cost of healthcare for youth receiving no family therapy was $16, 260. For those receiving in-office family therapy, the average cost was $11,116. Youth who received in-office family therapy received $5,144 (32%) less care on average than those receiving only individual therapy. Those who received in-home family therapy averaged $1,622 over the follow-up the period. Those who received in-home family therapy were least expensive of all, averaging at least 85% less than any form of in-office therapy. There does not appear to be an increase in the healthcare cost when family therapy is included in treatment.     

Purchases of food in youth. Influence of price and income

One way to increase choice of healthy over unhealthy behaviors is to increase the cost of less healthy alternatives or reduce the cost of healthier alternatives. The influence of price on purchases of healthy and unhealthy foods was evaluated in two laboratory experiments. In Experiment 1, thirty-two 10- to 12-year-old youth were given $5.00 and allowed to purchase multiple portions of a healthy food (fruit or vegetable) and a less healthy food (higher-fat snack). The price of one type of food varied from $0.50 to $2.50, while the price of the other type was held at $1.00. Increasing the price of a type of food reduced purchases of that type of food, but did not lead to substitution with the alternative type of food. In Experiment 2, twenty 10- to 14-year-old youth were given $1.00, $3.00, and $5.00 to purchase healthy and unhealthy foods. The price of each food was raised and lowered by 25% and 50%. Raising the price of healthy or unhealthy foods resulted in decreased purchases of those foods, and income available interacted with price to predict the pattern of substitution of alternative foods. These results show the potential for controlled laboratory studies of price and food purchases, and show that the substitution of healthier for unhealthy food is related to available money.     

The Economic Benefits of Increased Treatment Duration and Intensity in Residential and Outpatient Substance Abuse Treatment Settings

This study presents estimates of the economic benefits to society from community-based substance abuse treatment. The analysis focused on the impact of length of stay and frequency of counseling on clients' crime-related and health care costs, welfare receipts, and income taxes. The results indicate that the benefits from an additional day of treatment were on average $21 for short-term residential treatment (or 29% the cost of a day of care), $13 for outpatient drug-free treatment (or 94% the cost of a day of care), and $5 for long-term residential treatment (or 9% the cost of a day of care). No benefits were found from additional counseling provided by a client's primary therapist. Withthe exception of short-term residential care, estimated increases in client earnings from longer lengths of stayexceeded the benefits to society. Our estimates do not include benefits realized during treatment or beyond the year after treatment.