Cost- effectiveness and Cost- benefit Research Across the Generations

Symposium Facilitators:
Katharine Briar-Lawson (Lead presenter)
School of Social Welfare
University at Albany the State University of New York
135 Western Avenue
Albany, NY 12222
518-442-5324
518-442-5380 (fax)
kbrairlawson@uamail.albany.edu

James Blackburn
Helen Bader School of Social Work
University of Wisconsin-Milwaukee
PO Box 786
Milwaukee, WI 53201
414-229-4400
cushman@uwm.edu

Paper 1 Title: The Cost and Quality of Life Outcomes of Social Work Services in Aging: A Review of the Literature
Victoria M. Rizzo
Institute of Gerontology, School of Social Welfare
University at Albany, State University of New York
135 Western Avenue
Albany, NY 12222
518-437-3695
518-442-3823 (fax)
vmrizzo@albany.edu

Jeannine M. Rowe
Helen Bader School of Social Work
University of Wisconsin-Milwaukee
PO Box 786
Milwaukee, WI 53201
(414) 229-5892
rowejm@uwm.edu

Paper 2 Title: The Cost Effectiveness of a Health Education Group for Caregivers in an HMO
Ronald Toseland
Institute of Gerontology, School of Social Welfare
University at Albany, State University of New York
135 Western Avenue
Albany, NY 12222
518-442-5353
518-442-3823 (fax)
toseland@albany.edu

Tamara Smith
Institute of Gerontology, School of Social Welfare
University at Albany, State University of New York
135 Western Avenue
Albany, NY 12222
518-442-5344
518-442-3823 (fax)
tsmith@albany.edu

Paper 3 Title: Examining the Provision of Social Services in Schools through a Cost-Benefit Analysis
Dawn Anderson-Butcher
325D Stillman Hall, 1947 College Road
College of Social Work
The Ohio State University
Columbus, Ohio
614-292-8596
614-292-6940 (fax)
Anderson-butcher.1@osu.edu

Mary Ann Frye
Director of Pupil Services
Reynoldsburg School District
7214 East Main Street
Reynoldsburg, OH 43068
614-501-1027
614-501-1050
Mfrye@reyn.org
 
The movement for evidence-based practice in social work will be enhanced by research that addresses the cost -effectiveness and the cost- benefits of social work interventions and social services. Investment in social work services and programs by public and private funders and policy makers require more studies and analyses that show the differential benefits of social work interventions and social service programs.  Despite the need for such cost benefit and cost effectiveness research, to date there has been only limited attention to rigorous cost analyses in social work research.  This symposium addresses this gap by 1) presenting findings from a literature review of empirical studies of social interventions with the aging population; 2) presenting cost- benefit and cost effectiveness findings from two studies focused on social work interventions and social services across the generations; and 3) discussing ways in which empirical studies of social work interventions can more consistently include rigorous cost analyses.

The first paper sets the stage by presenting findings from a review of 52 studies addressing cost and quality of life outcomes for social work services in aging. The second paper examines health and cost outcomes for caregivers using an educational intervention provided by social workers. The third paper examines the costs and benefits of social services provided in after school programs and the implications of these for school social workers.  The symposium will conclude with an overview of 1) strategies to increase the use of cost- benefit and cost- effectiveness analyses in social work research; (2) econometric approaches one can use to conduct cost analyses; and (3) strategies to enhance and increase the dissemination of social work studies that include analyses of cost outcomes.

The Cost and Quality of Life Outcomes of Social Work Services in Aging: A Review of the Literature

The population of Americans aged 65 and older is growing rapidly creating an increased demand for social workers.  Known for their expertise in mental health services and case management provision, the demand for social workers will continue to increase because they possess the skills necessary to help aging individuals cope with the myriad of mental and physical health issues associated with aging.  However, the present reimbursement structures of Medicare and Medicaid present significant access barriers for aging individuals seeking social work services as well as discouraging social workers from working with the elderly.

To build a case for the modification of the Medicare and Medicaid reimbursement structures for social work services and to further our understanding of the cost outcomes of social work services in aging, we conducted a review of research studies from 1990 to present.  A total of fifty-two articles in four broad categories, including caregiving (n=13), health (n=17), geriatric evaluation management (n=8) and general aging (n=12), were reviewed with the goal of identifying social work interventions that positively impacted both cost and quality of life outcomes.  Forty-three percent of articles yielded interventions that were found to be cost effective.  Ninety-one percent of the articles cited findings that had a significant (p > .05) positive impact on the quality of life for older adults.

The results of our review indicate that social work interventions can positively impact the health care costs, the use of health care services, and the quality of life of older Americans.  However, this body of literature is small.  To build a stronger case for the re-examination of the present Medicare/Medicaid reimbursement structures for social work services, further empirical studies using replicable social work interventions and rigorous cost analyses are needed.

The Cost Effectiveness of a Health Education Group for Caregivers in an HMO

This study examined the health care cost outcomes resulting from a Health Education Program (HEP) for spouse caregivers of frail older adults.  HEP is a multi-component group program offered in 8 weekly, 2-hour sessions, and 10 monthly, 2-hour follow-up sessions in a staff model health maintenance organization (HMO).  It includes emotion-focused and problem-focused coping strategies, education, and support.  One hundred and five spouses were recruited and randomly assigned to HEP or usual care (UC).  Health care cost data were collected from the HMO’s management information system for both the spouse caregivers and care recipients in quarterly increments for a 30-month period.  These data were compared using Random Effects Regression Models (RERMs).  The results indicate that caregivers who participated in HEP had significantly lower outpatient costs and overall health costs.  Care recipients whose spouses participated in HEP had statistically significantly lower outpatient costs, drug costs, and overall health costs. These findings have tremendous practice and policy implications: although caregiver support groups have been shown to moderately improve caregiver psychosocial well-being, this is the first study to show that support to caregiver can actually translate to lower health costs.  HMOs should consider implementing caregiver support groups as a way of increasing caregiver well-being, and lowering the accumulated costs for caregivers and care recipients over time.

Examining the Provision of Social Services in Schools through a Cost-Benefit Analysis

Schools across the country are struggling to address the many non-academic barriers to learning evident among student populations and their families. Numerous program strategies have emerged that are designed to address these various social and emotional needs. These include alternative education settings, day treatment programs, more intensive school-based or -linked services, and other educational placements that incorporate the provision of social services within the school day. Some of these programs may cost up to $1,200 per month for each student served.  Questions remain related to whether these investments really make a difference for students’ success in school and life; or whether less invasive, and less costly, interventions may indeed produce similar results.  In response, this paper compares and contrasts these many new emergent strategies, examining the pros and cons related to each various educational option.

More specifically, a cost-benefit analysis is used to consider whether the additional resources employed in one school district to fund more intensive out-of-school placements are actually “worth” the benefits accrued as a result of the interventions. Findings suggest that early intervention and prevention investments within this school district appear to be more fiscally sound than more intensive pull-out programs. Questions remain related to which strategies, however, are actually most beneficial in creating positive outcomes for students.  Implications are drawn in relation to school funding policies, as well as for the delivery of social work services within schools. The need for more rigorous research related to the delivery of services within schools is identified.