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APHA Scientific Session and Event Listing

A. James Lee, PhD, Dept. of Community Health & Sustainability, University of Massachusetts Lowell, 528 Andover Street, Lowell, MA 01852, 978-703-0146, AJames_Lee@uml.edu and Matthew R. Cornish, MA, LADC I, Bureau of Substance Abuse Services, Massachusetts Department of Public Health, 250 Washington Street, 3rd Floor, Boston, MA 02108.

At the time of this study, the Massachusetts Bureau of Substance Abuse Services funded nine family shelter providers, ranging in size from five to 12 families. The programs provided shelter and coordinated substance abuse treatment on behalf of predominantly female-headed "homeless" families. The family shelter programs were much more costly than other residential treatment models. State officials were concerned that the “scale” or size of these programs averaging (averaging just eight families) was too small to be economical. Indeed, the data suggested that increasing the average program size by just three families would reduce the average per-diem costs by 24 percent.

This paper investigates the advantages and disadvantages of larger-sized family treatment programs. It uses a two-pronged approach: 1) We identify 50 family treatment programs included in SAMHSA’s 2000 National Survey of Substance Abuse Treatment Services and then use the Lowess curve-fitting technique to analyze scale effects from this sample. Our analysis indicates strong economies of scale up until an average family census of 13 or 14, and no additional scale effects beyond that point. 2) We also developed information on the program models, costs, reimbursement arrangements and experiences with larger-sized family treatment programs in other states. While study respondents consistently told us that larger programs are manageable, their programs were unlike the Massachusetts family shelter programs in three important respects: (1) The family treatment programs in other states rarely take adolescent children. (2) Most family treatment programs take a mix of women with and without children. (3) Only a few of the programs represented had a predominantly homeless clientele. For these reasons, we were reluctant to extrapolate the respondents’ experiences with larger programs to Massachusetts’ family shelter programs; the Massachusetts family shelter providers were clearly confronting much greater management challenges than those seen in other states. In any event, the study data clearly establishes that family treatment programs are much more costly than other residential programs.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Recognize the importance of scale effects in program development.
• Learn methods for analyzing scale effects.

Keywords: Substance Abuse Treatment, Cost Issues

Presenting author's disclosure statement:

Not Answered