AMCHP Return on Investment Analytic Action Learning Collaborative Massachusetts Team

Project Overview Project LAUNCH Model to promote early childhood social and emotional well-being “Power team” to enhance capacity of family-centered medical home to provide care coordination and preventive intervention Family Partner with lived experience Early Childhood Mental Health Clinician 5 year implementation in 2 community health centers and 1 hospital-based pediatric primary care clinic in Boston Collaboration between MDPH and BPHC

Process External evaluation results show Project LAUNCH is effective Decrease in parental depression (PHQ-9 scores) from baseline Decrease in parental stress (PSI scores) from baseline Improvement in child social- emotional health (ASQ-SE/CBCL scores)

Process Cost Analysis Cost Effectiveness Analysis MDPH and BPHC invoices SFY 2010-15, adjusted for inflation Meetings to determine staff training costs and costs of in-kind resources Meetings to sort costs from grant to determine costs for programmatic implementation and replication Determined 4 cost sensitivity analyses Cost Effectiveness Analysis Project LAUNCH standardized evaluation results over 5 years of implementation and cost analysis used to determine: Cost per positive parental depressive screen identified Cost per positive child social/emotional risk screen prevented TA calls with Scott Grosse & Mac McCullough throughout ROI process to discuss methodology and reach consensus Development of communications product

Challenges Evaluation Cost Analysis IRB process delays led to delays to consenting families and reduced ability to collect data Technical requirements for sites to collect data perceived as a burden and reduced buy-in Cost Analysis Compilation of cost information from different places due to grant implementation (MDPH and BPHC) Disaggregation of shared resources and costs (MYCHILD and LAUNCH) Consensus on true cost of implementation Determination of cost of comparison site

Challenges Cost Effectiveness Analysis Communication Product How to allocate costs when parent and child outcomes examined separately? Proportional cost allotment for parents (34%) and children (66%) based on enrollment How to handle qualitatively different results for child LAUNCH and comparison sites (LAUNCH children improved; comparison children got worse)? Absolute difference in outcomes extrapolated to larger population How to incorporate loss to follow-up? Assumption those above cut-off screen at baseline did not change Communication Product Audience selection: State Medicaid or providers?

Results Program enrollment over 5 years: 1,353 participants 890 children; 463 parents Annual costs range based on sensitivity analyses: $459,572.58-$855,994.12 Annual cost for core components (w/ 3 sites): $459,572.58 ~$350,000 for 3 sites ~$117,000 per site: 1 ECMH Clinician and 1 Family Partner ~$91,000 for 1 Program Director and supervisory support ~$19,000 for development, trainings and operations Average annual cost (2015 $) Average annual cost for parents (2015 $) Average annual cost for children (2015 $) Base-Core components $ 459,572.58 $ 157,266.89 $ 302,305.69 Sensitivity 1-Core components + evaluation $ 593,662.08 $ 203,152.65 $ 390,509.42 Sensitivity 2-Core components + extra support $ 752,601.79 $ 257,542.22 $ 495,059.57 Sensitivity 3-As implemented $ 855,994.12 $ 292,923.34 $ 563,070.78

Results  

Results Annual Cost per Parent Depressive Positive Screen Identified (2015 $) Annual Cost per Child S/E risk Positive screen prevented (2015 $) Base-Core components $ 1,160.00 $ 685.59 Sensitivity 1-Core + evaluation $ 1,498.46 $ 918.12 Sensitivity 2-Core + extra support $ 1,899.63 $ 1,193.76 Sensitivity 3-As implemented $ 2,160.61 $ 1,373.06 Other cost information for mental health services for children and adults: The cost of treating depression in Massachusetts to Medicaid is $1,327.87 per person (inflated to 2015 $). (CDC Chronic Disease Calculator) The average mental health care expenditure per child 0-17 years is $2,273.29 (inflated to 2015 $). (National Institute of Mental Health, AHRQ’s MEPS)

Communications Product

Communications product