{"title":"预防有回报吗?针对有心理健康问题儿童的学校干预措施的成本和潜在成本节约。","authors":"Lisa Wellander, Michael B Wells, Inna Feldman","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial.</p><p><strong>Aims of the study: </strong>The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice.</p><p><strong>Methods: </strong>This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required.</p><p><strong>Results: </strong>The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation.</p><p><strong>Discussion: </strong>Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices.</p><p><strong>Implications for health policies: </strong>The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs.</p><p><strong>Implications for future research: </strong>When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"19 2","pages":"91-101"},"PeriodicalIF":1.0000,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.\",\"authors\":\"Lisa Wellander, Michael B Wells, Inna Feldman\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial.</p><p><strong>Aims of the study: </strong>The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice.</p><p><strong>Methods: </strong>This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required.</p><p><strong>Results: </strong>The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation.</p><p><strong>Discussion: </strong>Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices.</p><p><strong>Implications for health policies: </strong>The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs.</p><p><strong>Implications for future research: </strong>When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.</p>\",\"PeriodicalId\":46381,\"journal\":{\"name\":\"Journal of Mental Health Policy and Economics\",\"volume\":\"19 2\",\"pages\":\"91-101\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2016-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Mental Health Policy and Economics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Mental Health Policy and Economics","FirstCategoryId":"3","ListUrlMain":"","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景:在瑞典,地方政府负责资助本地区的学校。一项资助倡议是,学校通过额外的教师、私人助理和特殊教育课程,为有心理健康问题的学生提供额外的支持。学校采取了以证据为基础的预防干预措施,这些措施已被证明可以降低学生的心理健康问题水平。然而,对于当地政府目前在学生心理健康支持上花了多少钱,以及基于证据的干预措施是否会在经济上有益,人们知之甚少。研究目的:本研究的目的是评估为学生心理健康问题提供额外支持的成本,以及潜在的成本抵消(定义为减少基于学校的额外支持),如果在常规实践中实施两项针对儿童心理健康问题的循证学校干预措施。方法:本研究使用学校对有心理健康问题学生的额外支持数据。数据是从一个学区收集的,对象是6至16岁的学生。我们模拟了两种瑞典学校干预措施,Comet for Teachers和Social and Emotional Training (SET),两者都有减少心理健康问题的证据。我们使用了成本抵消分析框架,假设这两种干预措施在整个学区都得到了充分实施。根据已发表的研究,计算了干预措施的预期效果和成本。我们将成本抵消定义为对有持续心理健康问题的学生的预期避免的额外支持的数量,这些学生可能不再需要接受服务,如与额外的老师、私人助理一对一的时间,或被安排在特殊教育教室。从付款人的角度(负责学校筹资的地方政府)进行了成本抵消分析,比较了两种干预措施的成本与由于减少心理健康问题的流行而可能节省的成本,并避免了所需的额外支助。结果:该学区共有6256名学生,其中310名学生接受了心理健康问题的额外支持。其中,143人因患有多动症(n = 111)、社会心理问题(n = 26)或焦虑/抑郁(n = 6)而在原学校获得支持。支付者每学年额外支持的总费用为2,637,850欧元(每位学生18,447欧元)。该学区一年运行这两项干预措施的成本为953,643欧元,而这些干预措施的潜在节省估计为627,150欧元。估计的效果表明,需要额外支持的学生将减少(ADHD 25人,心理社会问题8人,焦虑/抑郁1人),支付者将在实施后不到两年(1.5年)的时间内收到投资资源的回报。讨论:预防性学校干预既可以改善一些儿童的心理健康问题,也可以为付款人带来经济上的好处。然而,它们在将所有学生的心理健康状况降至低于临床临界值的范围内仍然有限;因此,预防性学校干预应作为一种补充,而不是替代,以目前的做法。对卫生政策的影响:研究结果具有政治和社会意义,因为支付者可以将资金重新分配给针对学生心理健康问题的预防措施,同时降低成本。对未来研究的启示:在评估公共卫生行动时,有必要考虑其经济影响。资源是稀缺的,决策者需要知道如何有效地分配资源。成本抵消分析被视为决策者理解研究结果的一种方式;然而,这种分析往往不包括干预措施的全部好处,在日常实施中需要充分评价实际影响。
Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.
Background: In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial.
Aims of the study: The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice.
Methods: This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost-savings due to a reduction in the prevalence of mental health problems and averted additional support required.
Results: The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation.
Discussion: Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices.
Implications for health policies: The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs.
Implications for future research: When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine implementation.
期刊介绍:
The Journal of Mental Health Policy and Economics publishes high quality empirical, analytical and methodologic papers focusing on the application of health and economic research and policy analysis in mental health. It offers an international forum to enable the different participants in mental health policy and economics - psychiatrists involved in research and care and other mental health workers, health services researchers, health economists, policy makers, public and private health providers, advocacy groups, and the pharmaceutical industry - to share common information in a common language.