Biomedical subjects

E Michael Foster

Publications and source records attributed to E Michael Foster.

13 recordsLinked to original sources

PubMed2006

Can a costly intervention be cost-effective?: An analysis of violence prevention.

OBJECTIVES: To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. DESIGN: Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. RESULTS: Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. CONCLUSIONS: Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations.

Adolescent↗

PubMed2006

Oppositional defiant disorder toward adults and oppositional defiant disorder toward peers: initial evidence for two separate constructs.

Confirmatory factor analysis of 25 items on the Child and Adolescent Disruptive Behavior Inventory (CADBI, Version 2.3; G. L. Burns, T. K. Taylor, & J. C. Rusby, 2001) was conducted on teacher ratings of 824 kindergarten children and replicated on 534 children. Model fit was improved when correcting for 2 method effects: (a) adjacent items and (b) identical behaviors (e.g., argues with adults, argues with peers). The results show that the 25 items loaded on 3 distinct but correlated factors: Hyperactivity, Oppositional to Adults, and Oppositional to Peers. These more refined constructs from the CADBI may be useful for practitioners in identifying children who are at risk and for helping define appropriate contexts in which to intervene. The CADBI and analytic procedures also may contribute to future psychoeducational research on the development of problem behavior.

Attention Deficit and Disruptive Behavior Disorder↗

PubMed2005

The high costs of aggression: public expenditures resulting from conduct disorder.

OBJECTIVES: We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice. METHODS: We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment. RESULTS: Additional public costs per child related to CD exceeded $70000 over a 7-year period. CONCLUSIONS: Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder.

Adolescent↗

PubMed2005

Developmental psychology and public policy: progress and prospects.

This article outlines a framework for developmentally oriented policy research. Drawing from U. Bronfenbrenner's (1995) dynamic developmental systems theory, the authors suggest ways in which the key tenets of process, persons, context, and time can inform policy research in developmental psychology and can be used to support a causal interpretation of the results of those analyses. Conceptualizing public policies from a dynamic developmental systems perspective has a variety of implications for future research, and this article considers some of these implications.

Adolescent↗

PubMed2005

An episode-based framework for analyzing health care expenditures: an application of reward renewal models.

OBJECTIVE: To illustrate an episode-based framework for analyzing health care expenditures based on reward renewal models, a stochastic process used in engineering for describing processes that cycle on and off with "rewards" (or costs) occurring at the end of each cycle. DATA SOURCES/STUDY SETTING: Data used in the illustration were collected as part of an evaluation of a national initiative to improve mental health services for children and youth. Participants were enrolled in a longitudinal study at a demonstration site and in a comparison community between 1997 and 1999. The illustration involves analyses of mental health expenditures at the two sites and of the dynamics of service use behind those expenditures. DATA COLLECTION/EXTRACTION METHODS: Services data were derived from management information systems as well as patient records at inpatient facilities in the two communities. These data cover services received between 1997 and 2003. The analysis focuses on the year following study entry. PRINCIPAL FINDINGS: Between-site differences in expenditures reflect complex between-site differences in the timing of service use. In particular, children at the demonstration stayed in treatment longer but were less likely to return for treatment later. In contrast, children at the comparison site experienced substantially less continuity of care. Costs per day of treatment within an episode were comparable at the two sites. CONCLUSIONS: Reward renewal models offer a promising means for integrating research on service episodes and the dynamics of service use with that on health care expenditures.

Adolescent↗

PubMed2005

Public costs of better mental health services for children and adolescents.

OBJECTIVE: This study evaluated how improved community mental health services for youths affect public expenditures in other sectors, including inpatient hospitalization, the juvenile justice system, the child welfare system, and the special education system. METHODS: Participants were youths aged six to 17 years who received services through a mental health agency in one of a matched pair of communities. One community delivered mental health services according to the principles of systems of care (N=220). The comparison community delivered mental health services but did not provide for the interagency integration of services (N=211). The analyses are based on administrative and interview data. RESULTS: Preliminary analyses revealed that mental health services delivered as part of a system-of-care approach are more expensive. However, incorporating expenditures in other sectors reduced the between-site gap in expenditures from 81 to 18 percent. This estimate is robust to changes in analytical methods as well as adjustments for differences between the two sites in the baseline characteristics of participants. CONCLUSIONS: These findings suggest that reduced expenditures in other sectors that serve youths substantially, but only partially, offset the costs of improved mental health services. The full fiscal impact of improved mental health services can be assessed only in the context of their impact on other sectors.

Adolescent↗

PubMed2004

Alternative methods for handling attrition: an illustration using data from the Fast Track evaluation.

Using data from the evaluation of the Fast Track intervention, this article illustrates three methods for handling attrition. Multiple imputation and ignorable maximum likelihood estimation produce estimates that are similar to those based on listwise-deleted data. A panel selection model that allows for selective dropout reveals that highly aggressive boys accumulate in the treatment group over time and produces a larger estimate of treatment effect. In contrast, this model produces a smaller treatment effect for girls. The article's conclusion discusses the strengths and weaknesses of the alternative approaches and outlines ways in which researchers might improve their handling of attrition.

Data Collection↗

PubMed2004

The effects of the fast track program on serious problem outcomes at the end of elementary school.

This study examines the effects of the Fast Track program, which is a multicomponent, intensive intervention for children with early-onset conduct problems and continues from 1st grade through high school. Prior research has shown that Fast Track produces small positive effect sizes on children's social and behavioral outcomes at the end of 1st and 3rd grades in comparison to control children. This study addresses the important question of whether this intervention reduces cases of serious problems that can occur during the 4th- and 5th-grade years. Fast Track did have a significant but modest influence on children's rates of social competence and social cognition problems, problems with involvement with deviant peers, and conduct problems in the home and community, compared to children in the control condition. There was no evidence of intervention impact on children's serious problems in the school setting at Grades 4 and 5. This evaluation indicates that Fast Track has continued to influence certain key areas of children's adjustment throughout the elementary school years, reducing children's likelihood of emerging as cases with problems in their social, peer, or home functioning. The stage is set to examine potential prevention effects on these youths' serious antisocial behaviors during adolescence.

Achievement↗

PubMed2004

Can better mental health services reduce the risk of juvenile justice system involvement?

OBJECTIVES: We evaluated how improved mental health services affect justice involvement among juveniles treated in the public mental health system. METHODS: Our analyses were based on administrative and interview data collected in 2 communities participating in the evaluation of a national initiative designed to improve mental health services for children and youths. RESULTS: Results derived from Cox proportional hazard models suggested that better mental health services reduced the risks of initial and subsequent juvenile justice involvement by 31% and 28%, respectively. Effects were somewhat more pronounced for serious offenses. CONCLUSIONS: Our findings suggest that improved mental health services reduce the risk of juvenile justice involvement.

Adolescent↗

PubMed2003

The effect of Medicaid managed care on mental health care for children: a review of the literature.

Despite its widespread adoption, little is known about the effect of Medicaid managed care (MMC) on children using mental health services. To assess the state of current research, we reviewed the literature on MMC and synthesized findings regarding access to care, expenditures, utilization, cost-shifting, and quality of care. A literature search was conducted and updated in November 2001. Studies were included if they involved evaluations of MMC, included children with mental health or substance abuse disorders, and had a non-MMC comparison group. Eight studies were included in the review. Most involved carve-outs and capitation. All of the studies that measured cost and service use showed decreases in total costs, inpatient care costs, and inpatient service use. These changes were frequently accompanied by increases in outpatient care. Some evidence suggests that MMC increased access to care for those with less serious conditions. There was no convincing evidence of cost-shifting from mental to physical health or other public agencies. Finally, no study directly measured health outcomes or quality of care. By reducing service use in inpatient settings, MMC has the potential to reduce children's mental health expenditures. The available research provides virtually no evidence on quality of care.

Child↗

PubMed2003

Propensity score matching: an illustrative analysis of dose response.

BACKGROUND: Health services researchers are often interested in the effect of a treatment or a service in situations in which randomization is difficult or impossible. One useful alternative involves propensity score methods, a means for matching members of different groups based on a range of characteristics. Under certain assumptions, comparisons of the matched groups reveal the impact of the treatment of interest. OBJECTIVES: This article reviews propensity score methods and illustrates their use in an analysis of dose response, the relationship between the volume of services received, and treatment outcomes. In mental health policy, this question is central to key issues such as parity. RESEARCH DESIGN: Data for the illustrative analysis are taken from a well-known study of children's mental health services. This analysis estimates the impact of outpatient therapy based on comparisons of individuals receiving different treatment doses. Those comparisons are adjusted for preexisting observed differences among the groups using propensity score methods. SUBJECTS: The study includes 301 participants aged 5 to 18 years treated at the study sites. MEASURES: The analyses are based on family characteristics and the mental health status of children and adolescents reported in interviews with parents as well as administrative data on service use. RESULTS: Analyses using propensity score matching suggest that added services improve treatment outcomes, especially child functioning. However, at least for the services and outcomes considered, the marginal benefits to high levels of treatment are limited. CONCLUSIONS: These analyses illustrate the potential value of propensity score methods to health services researchers.

Adolescent↗

PubMed2002

Early identification of children at risk for costly mental health service use.

Children and adolescents with serious and persistent conduct problems often require large public expenditures. Successfully diverting one high risk child from unfortunate outcomes may result in a net savings to society of nearly $2 million, not to mention improving the life of that child and his or her family. This figure highlights the potential of prevention, which often rests on the ability to identify these children at a young age. This study examined the ability of a short conduct-problems screening procedure to predict future need for mental health assistance, special education services, and the juvenile justice system during elementary school ages. The screen was based on teacher and parent report of child behavioral habits in kindergarten, and was used to identify children as either at risk or not at risk for behavioral problems. Service outcomes were derived from a service-use assessment administered to parents at the end of the sixth grade, while special education information was gathered through a survey of school records. Study participants (463 kindergarten children; 54% male, 44% African American) were from economically disadvantaged neighborhoods in four diverse communities across the United States. Results indicated that, while controlling for demographic background variables, the risk indicator strongly predicted which children would require services related to conduct disorder or behavioral/emotional problems. Additional analyses revealed that the dichotomous high risk indicator was nearly as strong as the continuous screening variable in predicting the service-use outcomes, and that the screening of both parents and teachers may not be necessary for determining risk status.

Adolescent↗

PubMedDate not supplied

How economists think about family resources and child development.

Research in child development reveals that the sources, level, stability, and uses of family resources have a profound effect on children's well-being and long-term outcomes. Although that research has incorporated economic constructs and measures, developmentalists generally ignore the formal economic framework for thinking about family resources and child outcomes. Building on the premise that children are an investment, that framework explains how families allocate resources and links that decision to other family choices and to key child outcomes, such as schooling, morbidity, and mortality among others. This article explains economists' general approach to family behavior (the so-called theory of household production) and then describes how that framework is useful for thinking about families and children. The article then outlines how economists model parental investment in children and examines the implications of that approach for developmental science. This discussion is illustrated using an example of interest to developmentalists--the involvement of children and adolescents in after-school activities. A concluding section discusses the benefits of and potential barriers to collaboration between economists and developmentalists.

Child↗