Cost-effectiveness of a school-based emotional health screening program.
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%.


CONCLUSIONS
Information concerning costs and effectiveness of school-based emotional health screening programs can guide school districts in making decisions concerning resource allocation.
GHC Center for Health Studies, Seattle, WA 98101, USA. kuo.e@ghc.org
Elena
E
Kuo
Ann
A
Vander Stoep
Elizabeth
E
McCauley
Mary A
MA
Kernic
D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000458:organization & administration; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration; D015995:Prevalence; D012572:School Health Services / Q000191:economics* / Q000458:organization & administration; D012959:Socioeconomic Factors