Latimer Eric A, Bush Philip W, Becker Deborah R, Drake Robert E, Bond Gary R
Douglas Hospital Research Centre, Quebec, Canada.
Psychiatr Serv. 2004 Apr;55(4):401-6. doi: 10.1176/appi.ps.55.4.401.
This study determined the costs of evidence-based supported employment programs in real-world settings.
A convenience sample of 12 supported employment programs known to follow closely the principles of evidence-based supported employment was asked to provide detailed information on program costs, use, and staffing. Program fidelity was assessed by using the Supported Employment Fidelity Scale. Cost and utilization data were analyzed in a comparable manner to yield direct and total costs per client served, per full-year-equivalent client, and per employment specialist.
Usable data were obtained from seven programs in rural and urban locations in seven states: Indiana, Kansas, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont. All programs received high fidelity ratings, ranging from 70 to the maximum value of 75. Annual direct costs per client served varied from dollars 860 in New Hampshire to dollars 2723 in Oregon, and direct costs per full-year-equivalent client varied from dollars 1423 in Massachusetts to dollars 6793 in Indiana. Direct costs per employment specialist did not show as much variation, ranging from dollars 37339 in Rhode Island to dollars 49603 in Massachusetts, with a mean of dollars 44082. Differences in cost per client arose in part from differences in rules for determining who is or is not considered to be on a program's caseload. By assuming a typical caseload of about 18 clients, it was estimated that the cost per full-year-equivalent client averaged dollars 2449 per year, ranging from dollars 2074 to dollars 2756.
The results point to the need for greater uniformity in caseload measurement and help specify the costs of high-fidelity supported employment programs in real-world settings.
本研究确定了现实环境中循证支持性就业项目的成本。
选取了12个已知严格遵循循证支持性就业原则的支持性就业项目作为便利样本，要求其提供有关项目成本、使用情况和人员配备的详细信息。使用支持性就业保真度量表评估项目保真度。对成本和使用数据进行了可比分析，得出每位服务对象、每位全年等效服务对象和每位就业专家的直接成本和总成本。
从七个州农村和城市地区的七个项目中获得了可用数据，这些州包括印第安纳州、堪萨斯州、马萨诸塞州、新罕布什尔州、俄勒冈州、罗德岛州和佛蒙特州。所有项目的保真度评级都很高，从70到最大值75不等。每位服务对象的年度直接成本从新罕布什尔州的860美元到俄勒冈州的2723美元不等，每位全年等效服务对象的直接成本从马萨诸塞州的1423美元到印第安纳州的6793美元不等。每位就业专家的直接成本差异不大，从罗德岛州的37339美元到马萨诸塞州的49603美元不等，平均为44082美元。每位服务对象成本的差异部分源于确定谁属于或不属于项目服务对象范围的规则不同。假设典型的服务对象数量约为18人，估计每位全年等效服务对象的成本平均每年为2449美元，范围从2074美元到2756美元。
结果表明在服务对象数量衡量方面需要更大的一致性，并有助于明确现实环境中高保真支持性就业项目的成本。
