OFFICE OF ADOLESCENT HEALTH The Cost of Implementing SEPTEMBER 2017 Select Evidence-Based Programs COST STUDY OF that Prevent Teen Pregnancy: EVIDENCE-BASED TEEN PREGNANCY An Overview of Study Findings PREVENTION PROGRAMS BRIEF There is limited information on the cost of interventions awarded the first Tier 1 replication grants to 75 state designed to reduce teen pregnancies. Estimates for a or local organizations in fall 2010, and programming few teen pregnancy prevention programs are available started in fall 2011 (Kappeler and Farb 2014). from previous research and program developers (Aos 2014; Jemmott et al. 2010; Philiber 2002; Thomas 2011), The initial grant announcement identified 28 evidence- but the data sources and methods for producing these based programs that grantees could select to replicate. estimates vary. Federal agencies and other funders These programs differed in approach, target population, are increasingly interested in knowing how much setting, and length. They included abstinence education, it costs, and what resources organizations require, sex education, and youth development. Some programs to deliver these programs. To expand on currently targeted vulnerable populations, such as expectant available information, the Office of Adolescent Health and parenting teens and youth in the juvenile justice (OAH) in the U.S. Department of Health and Human system. They ranged from relatively low-intensity Services contracted with Mathematica Policy Research interventions with fewer than 10 sessions to multiyear to conduct the multisite Cost Study of Evidence- interventions with 20 or more sessions. Programs Based Teen Pregnancy Prevention (TPP) Programs. could be implemented in a variety of settings, including Mathematica systematically collected cost data from schools (either during or after the school day), health grantees that were implementing select evidence-based clinics, community-based organizations, or specialized programs designed to prevent teen pregnancy. This brief locations such as juvenile justice facilities. summarizes the main study findings. STUDY FINDINGS THE TPP PROGRAM This study assessed the cost of implementing 10 OAH launched the Teen Pregnancy Prevention (TPP) evidence-based programs, at least three of the 2010 Program as a tiered evidence-based program in 2010. grantees implemented each program (see box). Together, Most funding supports replication of programs with 26 grantees provided cost data on the programs included existing evidence of effectiveness (Tier 1), with a in the study. Most grantees provided cost data for smaller proportion reserved to encourage innovation in one program, but two grantees provided data for two the field, specifically for implementing and rigorously programs, resulting in a total of 28 cost estimates. evaluating promising new approaches (Tier 2). OAH 1 Office of Adolescent Health | Website: http://www.hhs.gov/ash/oah/ Email: oah.gov@hhs.gov Phone: (240) 453-2846 The Cost of Implementing Select Evidence-Based Programs that Prevent Teen Pregnancy: An Overview of Study Findings SEPTEMBER 2017 The cost estimates produced by this study are likely Evidence-Based Programs Included in Study useful to a range of stakeholders, but they may be • AdultIdentityMentoring(ProjectAIM) most relevant to program funders and implementing • BeProud!BeResponsible! organizations. These cost estimates are particularly • BecomingaResponsibleTeen valuable for planning and budgeting because they • CarreraAdolescentPregnancyPrevention encompass all resources required to implement a Program program. The information may also be useful for (1) • Cuidate! federal agencies and other funders who are seeking • It’sYourGame…KeepItReal information on how much it costs to deliver these • MakingaDifference! programs and (2) developers and distributors working to • MakingProudChoices! set prices for program materials and provider training. • SaferSexIntervention • TeenOutreachProgram The first step in a cost analysis typically involves Note:Cuidate!andBeProud!BeResponsible!arecombinedbecause Cuidate!isaculturallyadaptedversionofBeProud!BeResponsible! estimating total program cost. For this analysis, the study team defined the total program cost as an estimate of what it cost to operate the program during one year was broad, including all youth who attended at least one of “steady state” operations. The total annual program session of the program. The cost per participant varied, cost estimate included the market value of all resources ranging from $68 to $11,541 (Figure 1). Despite some used to deliver the program, including personnel (staff variability, the per-participant cost for grantees offering salaries, fringe benefits, and the value of donated labor), the same program were similar. supplies and materials, equipment, contracted services, office space and other facility costs, other direct Differences in the design of the programs likely costs (such as professional development and training accounted for most of the variation in costs between expenses and participation incentives), and indirect grantees implementing different programs. This reflects (overhead) costs. The estimates are for the fourth that the resources a program requires, and therefore year of the five-year grant, at which point grantees had its costs, depend on the program’s content, intended operated their programs for about two years after the length, overall approach, and so on. Carrera was the first-year planning period. most intensive program in the study, offering youth a multi-faceted daily afterschool and summer program To account for program size and make it easier to for several years. As expected, per participant costs for compare grantees’ costs for the program, the study team grantees implementing this program were higher than calculated the average cost of serving one participant that of grantees implementing any of the other programs. (the per-participant cost). The study team defined per- Grantees implementing SSI also had a higher per participant cost as the average value of resources that participant cost than most other programs. Even though a grantee used to provide services to one participant. SSI had the smallest number of sessions—one core We estimated this by dividing the total annual cost by session and up to three booster sessions—it was the only the number of participants the grantee served during program with services provided individually in a clinic, the fourth grant year. The definition of “participant” which may account for its higher per participant costs. 2 Office of Adolescent Health | Website: http://www.hhs.gov/ash/oah/ Email: oah.gov@hhs.gov Phone: (240) 453-2846 The Cost of Implementing Select Evidence-Based Programs that Prevent Teen Pregnancy: An Overview of Study Findings FIGURE 1 SEPTEMBER 2017 Range in average cost per participant This figure combines cost findings for grantees that implemented the same evidence-based program. For each program, it shows the range in the number of participants served and average per participant cost among the grantees that implemented the same program. Across all programs, the number of participants served ranged from 55 to 14,492. The average per participant cost ranged from $68 to $11,541. Range in number of Range in average cost to Program participants served serve a participant $0 $12K BRPR/Cuidate! 500-3,142 $323 $982 $0 $12K BART 107-237 $2,189 $3,557 $0 $12K Carrera! 55-121 $7,734 $11,541 $0 $12K 665- IYG 14,492 $68 $618 $0 $12K MAD 404-7,519 $133 $1,792 $0 $12K MPC 750-2,179 $412 $990 $0 $12K Project AIM 163-1,354 $481 $3,358 $0 $12K SSI 90-1,054 $627 $5,084 $0 $12K TOP 1,846-4,312 $842 $2,343 BPBR/Cuidate! (Be Proud! Be Responsible!) IYG (It’s Your Game…Keep It Real) Project AIM (Adult Identity Mentoring) BART (Becoming a Responsible Teen) MAD (Making a Difference!) SSI (Safer Sex Intervention) Carrera (Carrera Adolescent Pregnancy MPC (Making Proud Choices!) TOP (Teen Outreach Program) Prevention Program) Note:Thisfigurereflectstherangeacrossgranteesimplementingthesameprogram.Thegranteewiththelowest averageamountforonemeasuremaynotbethegranteewiththelowestaverageamountforothermeasures. 3 Office of Adolescent Health | Website: http://www.hhs.gov/ash/oah/ Email: oah.gov@hhs.gov Phone: (240) 453-2846 The Cost of Implementing Select Evidence-Based Programs that Prevent Teen Pregnancy: An Overview of Study Findings SEPTEMBER 2017 Program design decisions also influenced costs. addition, most grantees operated their programs in Programs implemented in community-based locations, urban counties or in both urban and rural counties, so juvenile justice facilities, or in schools but outside of it was not possible to determine whether the setting school hours had higher costs than those implemented influenced costs. in schools during school hours. Among grantees implementing MAD and MPC, grantees implementing REFERENCES in school during school had lower costs. Looking across Aos, Steve, Roxanne Lieb, Jim Mayfield, Marna Miller, the different programs, grantees implementing BART and Annie Pennucci. “Benefits and Costs of Prevention had the highest cost per participant served compared and Early Intervention Programs for Youth.” Olympia, to similar programs, including BPBR, Cuidate, IYG, WA: Washington State Institute for Public Policy, MAD, and MPC. Of these programs, BART was the only September 2004. program for which all grantees implemented exclusively Jemmott, John B. III, Loretta S. Jemmott, Geoffrey in community-based settings with no programming T. Fong, and Knashawn H. Morales. “Effectiveness in schools (during or after school). This comparison of an HIV/STD Risk-Reduction Intervention for supports the inference that implementing in school- Adolescents When Implemented by Community-Based based settings during the school day lowered costs. Organizations: A Cluster-Randomized Controlled Trial.” American Journal of Public Health, vol. 100, no. 4, Several other factors may have influenced per- April 2010, pp. 720–726. participant cost, particularly among grantees offering the same program. For example, grantees that served Kappeler, Evelyn M., and Amy Feldman Farb. more participants may have generated cost efficiencies “Historical Context for the Creation of the Office of by distributing their resources widely. Grantees that Adolescent Health and the Teen Pregnancy Prevention offered youth additional services to supplement the Program.” Journal of Adolescent Health, vol. 54, no. 3, services they received through the program, or that 2014, pp. S3–9. provided services to parents or community members in Philliber, Susan, Jacqueline Williams Kaye, Scott addition to program participants, typically had higher Herrling, and Emily West. “Preventing Pregnancy costs than grantees that offered the same program and Improving Health Care Access Among Teenagers: with no additional services. If a grantee used staff An Evaluation of the Children’s Aid Society-Carrera from external organizations, instead of relying on staff Program.” Perspectives on Sexual and Reproductive hired and overseen directly by the grantee, it may have Health, vol. 34, no. 5, September/October 2002. increased costs because of extra administrative work Thomas, Adam. “Estimating the Effects and Costs of to oversee contracted organizations. It is unclear how Three Pregnancy-Prevention Programs.” Washington, much geography affected costs because the study team DC: Brookings Institute, Center on Children and standardized personnel costs to the national level. In Families, 2011. Authors ThisbriefwaswrittenbyHeatherZaveri,TheresaSchulte,andAdamSwinburnfromMathematicaPolicy ResearchfortheHHSOfficeofAdolescentHealthunderContractNo.GS10F0050L/HHSP233201300461G. 4 Office of Adolescent Health | Website: http://www.hhs.gov/ash/oah/ Email: oah.gov@hhs.gov Phone: (240) 453-2846