Date: Thursday, February 20, 2025
This is an updated, improved version of an AEA365 post from June 20, 2021
Hello! I’m Brian Yates PhD, consultant, author. Since 1976 I have supervised cost-inclusive program evaluation theses and dissertations of graduate students enrolled in the Clinical Psychology Ph.D. program at American University in Washington, DC.
The primary focus of our Program Evaluation Research Lab (PERL) has been 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 those resources that all participants bring to the program. Time devoted by participants to program activities, aka to “receiving services,” is an essential resource to evaluate. Monetizing (yes, a real word!) that time helps it figure into funding and program operations, but also it risks perpetuating economic inequities between recipients and providers.
How? Keep reading…
Inequities in income are highlighted when cost-inclusive evaluation (CIE) asks program participants as well as program 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. (That’s monetization for you!)
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’. The following visual attempts to drive that home. Despite the difference in size (of payrate, represented by the small red pawn versus the large white rook), I propose that the two should be better balanced, that is, should be valued the same (as shown by the equal heights of the two sides of this balance.
Time value inequity can result in discrimination, for example, in how and where program services are delivered. Using the traditional economic valuation method, recipient time and transportation typically are valued at lower rates than provider time because most recipients earn less than most providers. Often, unemployed program recipient time is valued as $0–worthless!—even if the recipient is an essential caregiver to children or to elders or both.
Evaluations using this method can become biased in favor of delivery of services in centralized clinics rather than in satellite clinics in the community, streets, or homes.
See how valuing recipient and provider time in this traditional way can prejudice funders toward centralized program delivery: read French, Yates, & Fowles (2018). Hint: We found effectiveness to be similar for programs delivered in clinics or in recipients’ homes, but costs were not!
To place the value of recipient and provider time on more equal footing, try multiple perspectives when valuing time … and all resources, including transportation. Compare cost-inclusive evaluation findings when you use…
a) … the often lower salaries plus benefits reported by recipients versus providers, versus
b) … the identical values (median payrates—salary plus employment benefits—for people in the region, for example) for the time of recipients and time of providers.
The second approach above for costing-out recipient and provider time makes the monetary value of recipient and provider time equal.
My colleagues and I have found that this second approach can “flip” findings from favoring delivery of treatment in one challenging-to-access central clinic, to favoring either a “traveling provider” model of service delivery that visits recipients in a circuit through neighborhoods, satellite clinics, or telehealth solutions using secure connections to deliver services without the need for recipients or providers to travel to one location.
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