20 40 FIGURE 8 Improvement in the number of weeks worked23 (Pre-treatment to post-treatment) By treatment modality 600 nendees Outpatient Residential Methadone Increase in number of weeks worked While treatment non-completers also had modest increases in their average number of weeks worked, treatment completers had far greater increases. This occurred across every module. For example, residential treatment non-completers worked an average of 23 more weeks during the three year period subsequent to their incomplete treatment than they had worked in the two year period prior to treatment. However, residential treatment completers worked an average of 50 more weeks during the three year period subsequent to their treatment than they had worked in the two year period prior to treatment. This represents a 117% better performance by treatment completers than by non-completers. 23 Effect of treatment completion vs. non-completion on improvement in weeks worked subsequent to treatment: F-13.3, p=.0001. Comparison Gro FOOD STAMP ASSISTANCE Records of the history of food stamp assistance provided to clients through AFS were available on micro-fiche. A search was made for the clients in the sample for the period two years prior and three years subsequent to treatment. FIGURE 9 Food stamp assistance in the three years subsequent to treatment24 The average increase in food stamp assistance was reduced significantly for outpatient clients who completed treatment compared to those who were noncompleters. The treatment group had an increase per hundred clients that was onethird of the increase in food stamp assistance experienced by the comparison group. Methadone clients who completed treatment had a significant decline in food stamp assistance while clients in the non-completing comparison group had significant increases. Residential treatment completers showed reverse trend although it was not statistically significant. The above data reflect the total increase in food stamp assistance per hundred clients in the period subsequent to treatment. As such, it includes persons who were not receiving food stamps in the pre-treatment period. One aspect of residential treatment, which involves more "case management,” is an effort to ensure that clients receive 24 Effect of treatment completion vs. non-completion on decreases in food stamp assistance: F=3.2 p=.07. food stamps if they are eligible. Residential providers actually receive food stamps as income for their programs during the period that clients are in residency, motivating residential providers to apply for food stamps for any eligible client who is not currently receiving them. Residential clients may also be encouraged to change employment as a treatment option, thereby potentially increasing food stamp usage temporarily. These factors tend to produce temporary increases in food stamp use by residential treatment completers (and by methadone completers as well). A separate analysis was undertaken to look at only those clients who had a record of food stamp assistance in the pre-treatment period in order to isolate the specific effects of treatment on food stamp assistance. Records of these clients were examined for both pre-treatment and three year post-treatment periods. All three treatment completion groups showed dramatic decreases in their use of food stamps in the three year period subsequent to the completion of treatment. All the decreases are significant beyond the .01 level. Clearly, treatment completion is associated with a dramatic drop in food stamp use for those clients who used food stamps in the pre-treatment period. Oddly, the residential non-completers who were on food stamps in the pre-treatment period also showed a decline in food stamp 25 Effect of treatment completion vs. non-completion on decreases in food stamp assistance: F=3.2, p=.07. assistance (although less than the matched treatment completing clients). One possible explanation is that since this group is arrested and convicted at much higher rates than any of the other groups (see previous graphs in the criminal justice section of this report), they perhaps spend enough time in jail or on the run in the subsequent period to significantly reduce their ability to use food stamps. CHILDREN'S SERVICES DIVISION26 INVOLVEMENT Data from Adult and Family Services' files were used to determine whether clients in these samples were connected to cases in which the Children's Services Division had become involved. Although CSD involvement implies that some kind of child mistreatment may be occurring, assessing the actual responsibility of the sample clients is complex. It is not always possible to know absolutely that a particular client is at fault in a case. Nonetheless, CSD cases are costly to the taxpayer even to investigate, and because the purpose of this study is to examine where costs were avoided, these data are included. Results show the following: the percentage of treatment completers with CSD (Children's Services Division) involvement decreased from 7.8% before treatment to 3.9% after treatment, a 50% reduction; the percentage of non-completers with CSD involvement decreased from 7.6% before treatment to 5.9% after treatment, a 22% reduction. Whether, in individual cases, the decrease is due to the effects of treatment completion per se is conjectural, but the avoided costs to taxpayers for the group of treatment completers can be assessed. 26Very recently CSD has changed its name to SCF (State Office for Services to Children and Families). MEDICAL COSTS Medical claims for public assistance were available through the Office of Medical Assistance Programs (Medicaid) in the Oregon Department of Human Resources. Data were searched for claims from the 1989 to 1995 period. All categories of clients showed increases in paid claim amounts from the pretreatment period to the post-treatment period. However, in all cases the increases for clients who completed treatment are lower, often substantially lower than for those who were non-completers. The results particularly illustrate the staggering expense to the medical system of opiate-using clients who are candidates for methadone treatment but who fail to remain in treatment. A situation that brings complexity to the interpretation of these data is the tendency of some clients who complete treatment to use medical facilities more initially following treatment than they had before, as their new clean and sober status allows them to tend to unmet medical needs. Another complexity affecting these data is that the 1991-92 period was one in which a number of slots for pregnant women were p=.02. 27 Effect of treatment completion vs. non-completion on increases in medical costs: F=5.5, |