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Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 22, Issue 3, 2019. Pages:109-120
Published Online: 1 September 2019

Copyright © 2019 ICMPE.


 

Net Benefits of Recovery High Schools: Higher Cost but Increased Sobriety and Educational Attainment

David L. Weimer,1 D. Paul Moberg,2* Falon French,3 Emily E. Tanner-Smith,4 and Andrew J. Finch5

1Ph.D., Assistant Professor of Clinical Health Policy and Management (in Psychiatry) New York State Psychiatric Institute Department of Psychiatry, Columbia 1Ph.D., Edwin E. Witte Professor of Political Economy, Department of Political Science & Robert M. La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
2Ph. D., Research Professor and Senior Scientist, Population Health Institute, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
3M.P.A., Graduate Project Assistant, Lafollette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
4Ph,D., Associate Professor and Associate Dean for Research, College of Education, University of Oregon, Eugene, OR, USA
5Ph.D., Associate Professor of the Practice, Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA

* Correspondence to: D. Paul Moberg, PhD, Population Health Institute, University of Wisconsin-Madison, 610 Walnut St., Madison, WI 53726, USA.
Tel.: +1 608 263 1304
Fax: +1 608 263 5243
E-mail: dpmoberg@wisc.edu

Source of Funding: This work was supported by grant R01-DA029785 from the US National Institute on Drug Abuse. This project has also benefited from the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1-TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Abstract
Recovery high schools (RHS) provide a supportive environment for students subsequent to treatment for substance use disorders. This analysis estimates the incremental impacts of RHSs using data from a multi-site study that followed RHS students and a comparison group of students discharged into other high school settings. Two beneficial impacts of statistical and substantive importance were identified: increased probability of high school graduation and increased sobriety. Incremental benefits of RHSs were estimated by monetizing the increased probability of high school graduation and comparing it to incremental costs. Other impacts were also estimated and monetized. To take account of uncertainties in impacts and shadow prices, the analysis used Monte Carlo simulations to estimate distributions of net benefits. Mean net benefits ranged from $16.1 thousand to $51.9 thousand per participant; benefit-to-cost ratios ranged from 3.0 to 7.2. These findings suggest that RHSs are an efficient use of social resources.


Background
: Recovery high schools (RHS) provide a supportive educational and therapeutic environment for students subsequent to treatment for substance use disorders (SUDs). Most students served by RHSs have concurrent mental health disorders and are at risk for school failure or dropout and substance use relapse.

Aims of the Study: The central question addressed is whether RHSs are economically efficient alternatives to other high school settings for students in recovery. The aim is to estimate the incremental cost-benefit of RHSs.

Methods: A quasi-experimental non-equivalent pretest-posttest comparison group design was used. We compared substance use and educational outcomes for adolescents who had received specialty SUD treatment; 143 who enrolled in an RHS were compared to 117 who enrolled in a non-RHS school. Groups were balanced by use of a propensity score to drop students who were not similar to those in the other group. The propensity score was also used as a covariate in multiple regression to estimate cost and outcome parameters and standard errors. To take account of uncertainties in impacts and shadow prices, we used Monte Carlo simulations to estimate the distribution of incremental benefits of RHS relative to non-RHS schooling.

Results: Two beneficial impacts of statistical and substantive importance were identified: increased probability of high school graduation and increased sobriety. RHS students had significantly (p <.05) less substance use during the study period -- at 12-month follow-up, 55% of RHS and 26% of comparison students reported 3 month abstinence from alcohol and drugs. Urinalysis confirmed abstinence from THC (cannabis) for 68% of RHS versus 37% of comparison students. RHS students' high school graduation rates were 21 to 25 percentage points higher than comparison students. Adopting a societal perspective, incremental benefits of RHSs were estimated by monetizing the increased probability of high school graduation and comparing it to incremental costs. Mean net benefits ranged from $16.1 thousand to $51.9 thousand per participant; benefit-to-cost ratios ranged from 3.0 to 7.2.

Discussion: Monetizing the benefits and the incremental costs of RHS relative to conventional schooling show substantial positive net benefits from RHS participation. Two factors lend credibility to the results. First, the RHS improvement in substance use indicates a mechanism through which the increased probability of high school graduation can plausibly occur. Second, the estimated increases in the probability of high school graduation were large and statistically significant. As the productivity gains from high school graduation are also large, the dominant benefit category is very plausible. \underlineLimitations include the non-randomized design; selection bias into the study conditions not fully controlled by the propensity scores; generalizability only to young people with treated behavioral health disorders; lack of estimates for direct monetization of reduced substance use among adolescents; possible attenuation of the value of education among individuals with behavioral health issues; and uncertainty in calculation of school costs.

Implications for Behavioral Health Policies: This research provides evidence that the recovery high school model provides cost beneficial support for high school students after primary SUD treatment. The students who enroll in RHSs typically have co-occurring mental health and substance use disorders, adding complexity to their continuing care. Funding policies recognizing the multiple systems of care (behavioral health, education, child and family services, juvenile justice) responsible for these young people are called for.


Received 1 May 2019; accepted 3 September 2019

Copyright 2019 ICMPE