The primary focus of our Program Evaluation Research Lab (PERL) is cost-inclusive evaluation of mental health and drug abuse services. Our more comprehensive definition of costs includes not only the money it takes to provide program services, but also the types, amounts, and monetary values of the resources that all participants bring to the program. Time of those receiving services is a key resource to evaluate, but monetizing it risks perpetuating economic inequities between recipients and providers.
Inequities in income are highlighted when we ask recipients as well as providers what types and amounts of resources the program requires of them. Time is the major resource for both. Traditional valuation of provider time, however, multiplies time spent in program activities by provider rate of pay. The surprise comes when recipient time is valued the same way. For too many recipients of mental health and drug abuse services, salary and benefits are minimal, seldom approaching providers’.
This time value inequity can result in discrimination, for example, in how and where program services are delivered. Using the traditional valuation method, recipient time and transportation are valued at lower rates than provider time (often as $0, as worthless!). Evaluations using this method can favor delivery of services in centralized clinics. There, providers see all recipients, to and from which recipients must transport themselves after arranging for child- or elder-care—not just for session time but even more time getting to and from those clinics.
See how valuing recipient and provider time in this traditional way prejudices funders toward centralized program delivery: French, Yates, & Fowles (2018). Hint: effectiveness was similar when services were delivered in clinics or in recipient homes, but costs were not.
To put the value of recipient and provider time on more equal footing, try multiple perspectives when valuing time. Use
a) the often lower salaries and benefits reported by recipients versus providers, and
b) the same values for time of recipients and time of providers (e.g., median local salary plus benefits for recipients and for providers).
The second perspective makes the value of recipient and provider time equal. This can “flip” findings from favoring delivery of treatment in one challenging-to-access clinic, to favoring either a “traveling provider” model of service delivery that visits recipients in a circuit through neighborhoods, or tele-health solutions using secure connections to deliver services without the need for recipients or providers to travel to one location.
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