Economic value of community-based services for problematic sexual behaviors in youth: A mixed-method cost-effectiveness analysis. (July 2020)

• Record Type: Journal Article
• Authors: Dopp, Alex R.; Mundey, Peter; Silovsky, Jane F.; Hunter, Michael; Slemaker, Alexandra
• Is Part Of: Child abuse & neglect. Volume 105(2020)
• Publication Date: 2020-07
• Subjects: Implementation -- Cost-effectiveness analysis -- Evidence-based treatment -- Problematic sexual behavior -- Mixed methods; Child abuse -- Periodicals; 362.76
• DOI: 10.1016/j.chiabu.2019.104043
• Languages: English
• ISSNs: 0145-2134

Abstract

Abstract: Background: Problematic sexual behavior in youth represents a significant public health problem in need of evidence-based treatments. Unfortunately, such treatments are not available in most communities. Objective: This study used a mixed quantitative-qualitative approach to investigate the economics of the implementation of Problematic Sexual Behavior – Cognitive-Behavioral Therapy (PSB-CBT), an evidence-based treatment for problem sexual behaviors in youth. Participants and setting: Youth ( N = 413) participated in PSB-CBT at six program sites in youth service agencies across the United States. Method: We used cost-effectiveness ratios (CERs) to compare the direct and indirect costs of PSB-CBT to self- and caregiver-reported youth clinical outcomes (i.e., problem sexual behavior as well as secondary behavioral health problems). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The design and interpretation of those quantitative analyses were informed by qualitative themes about program costs and benefits that were derived from interviews with 59 therapists, administrators, and stakeholders. Results: CERs (i.e., $ per SD) were $1, 772 per youth for problem sexual behavior and ranged from $2, 867 to $4, 899 per youth for secondary outcomes. These quantitative results, considered alongside the qualitative perspectives of interviewees, suggested that the implementation of PSB-CBT was cost-effective. The results were robust to uncertainty in key parameters under most, but not all, conditions. Conclusions: The results have important implications for decisions made by administrators, policymakers, and therapists regarding use of community-based approaches to address problematic sexual behavior of youth.