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Cost-Effectiveness of a School-Based Emotional Health Screening Program

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ABSTRACT Background: 

School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening Program, in which students undergo universal classroom emotional health screening and those who have positive screens are provided with on-site clinical evaluation and referral. Methods: 

Costs are enumerated for screening and clinical evaluation in terms of labor and overhead and summarized as cost per enrolled student, per positive screen, and per referral. Cost-effectiveness is summarized as cost per student successfully linked to services. School demographics are used to generate a predictive formula for estimating the proportion of students likely to screen positive in a particular school, which can be used to estimate program cost. Results: 

Screening costs ranged from $8.88 to $13.64 per enrolled student, depending on the prevalence of positive screens in a school. Of students referred for services, 72% were linked to supportive services within 6 weeks. Cost-effectiveness was estimated to be $416.90 per successful linkage when 5% screened positive and $106.09 when 20% screened positive. A formula to estimate the proportion of students screening positive proved accurate to within 5%. Conclusion: 

Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.
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Keywords: child and adolescent health; emotional health; organization and administration of school health programs

Document Type: Research Article

Affiliations: 1: Associate Professor, ( ), Department of Psychiatry and Behavioral Sciences and Department of Epidemiology, 6200 NE 74 Street, Suite 210, Seattle, WA 98155., Email: [email protected] 2: Professor, ( ), Psychiatry and Behavioral Sciences, University of Washington, Seattle Children‘s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105., Email: [email protected] 3: Research Assistant Professor, ( ), Department of Epidemiology, University of Washington, HIPRC, 325 Ninth Ave, Box 359960, Seattle, WA 98104., Email: [email protected]

Publication date: June 1, 2009

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