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This instrument can also be used as a planning and management tool to optimize resources and forecast the impact of future changes in staffing, client flow, program design, and other resources. The Treatment Cost Analysis Tool TCAT automatically provides feedback and generates summaries and charts using comparative data from a national sample read more non-methadone outpatient providers.
TCAT is being used by program staff to capture and allocate both economic and accounting costs, and outpatient service costs are reported for a sample of 70 programs. Future directions include use of a web-based interview version, much like some of the commercially available tax preparation software tools, and extensions for use in other modalities of treatment.
The past decade has seen considerable methodological advancement in cost analysis and the economic study of addiction in the United States.
Several sound and proven methods have been developed and used to help structure and standardize estimates of substance abuse treatment services and their costs. These have included a micro-costing method for treatment services Anderson et al.
Each has been used successfully in research studies to provide reliable estimates of treatment costs.
Early on, we discovered that some of the research design components had unintended but positive effects on program learning, which in some cases impacted managerial practices. Another future direction is the use of an Internet version designed to approximate an interview format, similar to commercially-available tax preparation software. The purpose of the TCAT is to collect, analyze, and report outpatient substance abuse treatment client volume and cost data including the allocation of overhead indirect costs associated with an administrative or parent agency. Methods for the economic evaluation of health care programmes.
However, cost data can serve a dual role, answering broad research and policy questions on the one hand and program management questions on the other Cartwright, At present, research applications are better developed than management applications.
Indeed, with the exception of the Yates Yates,CPPOA methodology, existing approaches to cost data collection were all designed to be used by trained project staff to capture data for research studies. The CPPOA is distinct in that it was designed for use by individuals with varying levels of education and backgrounds.
As a consequence, many of these other developments in the economic arena have not been readily available to practitioners for their direct use. Cartwright reviews several costing methods, discussing their strengths, weaknesses, and applications. His review notes that the ADSS approach relies on a short instrument making the burden on respondents smallerbut still employs economic concepts such as the costs of volunteer time.
These features make the approach appealing for use in large-scale data collection efforts. They also give it the potential to serve a program management function as well as collecting research data. In ADSS, the greatest emphasis was placed on collecting labor costs. Staff time and wages, including the value of volunteer time, were captured for a range of personnel categories.
Labor expenses constitute the bulk of costs for many programs, justifying detailed measurement in this area Drummond et al. Nonetheless, some other cost contributors are worth considering.
For example, when programs are operated by a broader parent organization, the administrative overhead or indirect expenses passed on to link program can be substantial Zarkin et al.
Ignoring these costs could lead to undervaluing the resources programs are using. Likewise, non-personnel costs, including buildings and equipment, can vary among programs.
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These are structured such that they provide a framework and some assistance to users who may be less familiar with the relevant costing concepts.
The purpose of this paper is to report costs from a large sample of outpatient drug-free ODF programs operating in four distinct regions in the U. These cost estimates were developed by program personnel using the tool as part of a study funded by the National Institute on Drug Abuse.
The goal of the parent project in which the TCAT was first used is to develop an information system that can be used by treatment programs to monitor their organizational health. The purpose of the TCAT is to collect, analyze, and report outpatient substance abuse treatment client volume and cost data including the allocation of overhead indirect costs associated with an administrative Athens Georgia Dating Free Article Submission Tools And Equipment parent agency.
Administrative or parent agency overhead is obtained using provider estimates of the proportion of parent resources used by the program targeted in the cost analysis, combined with the dollar value of parent agency administrative costs i. The cost analysis tool is designed to be self-administered by program financial staff or sometimes program directors to capture these data for research studies and build a data set for economic analyses. As experience and data from the TCAT and other cost analyses accumulate, new comparison data can be easily entered into the TCAT data table that is used to automatically generate these graphical comparison charts.
The TCAT allows treatment program personnel rather than just research staff to estimate accounting and economic treatment costs. Accounting costs include explicit monetary values associated with inputs used to provide treatment such as staff wages, fringe benefits, facility costs, other non-personnel costs, and so forth Domino et al.
Economic costs for treatment programs may differ from accounting costs because they also subsume some implicit costs such as the market value for donated goods and services used by a program French et al. Although scientific research studies are still a primary motivator for measuring these costs, they can be used for administrative and management purposes as well. It was included in an information system for investigating program structures, operations, climate, resources, and costs as they are related to treatment service delivery.
Within this multifaceted context, the cost assessment needed to produce reliable estimates at a reasonable expense and level of effort see Luce et al.
However, the TCAT extends the level of detail for measuring costs for some essential treatment resources. The TCAT also is distinct in that it incorporates analysis directly into the instrument, making it an analytic tool rather than simply a data collection device. It relies on the built-in facilities of the spreadsheet software for mathematical computation and graphical presentation for automating the cost analysis process.
Table 1 provides an overview of click to see more data entry and reporting elements.
As users complete the TCAT, internal calculations provide results and diagnostic information. Specifically, the tool uses seven spreadsheets for data input.
These capture information on expenditures concerning staff and payroll or volunteer timenon-personnel items including capital costs and donationsand any overhead allocations from a managing parent organization. Data on client volume and counseling activities also are measured.
An additional, optional page or worksheet is included to assist in determining annualized costs for capital purchases such as buildings or computer equipment. These input pages are linked to a series of seven output pages.
Four pages present analytic results including unit costs e. Three pages present comparative bar charts. Analytic output is discussed in more detail below. Figure 1 illustrates these input-output links within the TCAT.
The left panel Figure 1a shows a portion of the data entry page concerning client volume and counseling activity. The analyst types appropriate values for client admissions, discharges, length of stay, and so forth in the cells of the spreadsheet based on program records from the financial reporting period of interest.
The right panel Figure 1b shows part of the summary page with several key cost analysis results. Values shown are generated internally by the tool. Pre-programmed calculations produce unit costs in Figure 1b e. The analyst spends his or her time in monitoring and interpreting the analysis, and if necessary modifying the inputs, rather than in performing mathematical operations. Inconsistencies can reflect data entry errors or unusual program operations that might threaten the validity of conclusions.
These checks involve constructing and comparing parallel estimates from separate data elements, and using ranges drawn from prior research to identify unusual cases. For example, estimates of the average number of active clients in a program are constructed from annual admissions and discharges, and then these are compared with the point prevalence count. Specifically, multiplying the number of annual client admissions or discharges by the average length of stay and dividing by produces a close approximation to the point prevalence count.
These admission- and Athens Georgia Dating Free Article Submission Tools And Equipment client counts, as well as the point prevalence count, are used in estimating occupancy rates i.
These consistency checks are viewed as both technical and methodological strengths that allow for reconciliation of discrepant data.
The use of parallel estimates with expected ranges helps to ensure the collection of high quality data that can be checked during data entry by program staff, as well as later by research analysts after completion and submission of the Excel workbooks. Without consistency checks, opportunities to identify questionable data and reconcile discordant entries may be missed.
The set of automatically-generated analytic results within the TCAT allows users to see the product of the cost analysis procedure immediately. These can visit web page helpful even to experienced analysts working in the field. They also offer some benefits of cost analysis to treatment program managers, even if they do not know all the computational details.
Several different pages are included that range in level of detail.
Recent developments in alcoholism: Statistical principles in experimental design. Client volume and cost information are presented in Table 3 for each of the three major types of ODF programs regular, intensive, and mixed.
For comparative purposes, three bar charts present both the program and ADSS Substance Abuse and Mental Health Services Administration, data inflated to the current year for personnel cost breakdown, unit costs, and staff wages.
These give program personnel an additional reference point for interpreting their service costs. The program sample was not selected randomly, nor was it intended to be representative of the ODF population of treatment programs in the U.
Specifically, participating providers had to be primarily non-methadone, outpatient drug abuse treatment programs although they could be embedded in the criminal justice or mental health systemand they had to have at least three more info staff members.
A quota-sampling plan was developed to provide adequate coverage of various program types e. Each ATTC assisted with program recruitment and a target of approximately 25 programs was set for each region. Athens Georgia Dating Free Article Submission Tools And Equipment these, 94 participated in the first of three years of staff and client survey data collection in Among the 21 non-participating programs, there were 6 that closed between the time of initial data collection and the first year surveys, 3 programs were undergoing significant reorganization, 2 were rebuilding following Hurricane Katrina, and 10 others withdrew from the study.
Of the 94 programs participating in survey data collection, 82 completed TCATs and e-mailed them to the project office as part of the field data collection effort. Seventy were useable for the present study. Twelve TCATs were not used; two came from programs that started or significantly changed operations during the fiscal year 1 new startup and 1 acquired in a merger2 were incomplete and the additional information could not be obtained, and 8 had discrepancies in client or financial data that could not be reconciled.
Treatment Cost Analysis Tool (TCAT) for Estimating Costs of Outpatient Treatment Services
Data collected focused on assembling cross-sectional views of program operations, costs, staff, and clients from each of three years of data collection. The first of these went to the field inand the second and third waves occurred subsequently at approximately one-year intervals.
Program structure also was assessed upon enrollment in the project, and was updated in subsequent years, using the Survey of Structure and Operations SSO; Knight et al. Finally, program costs were evaluated using the TCAT. A program official usually a financial officer or program director completed the TCAT based on program records from the most recently-completed fiscal year, and then project staff reviewed the files.
A callback strategy Athens Georgia Dating Free Article Submission Tools And Equipment. Prior to data collection, Program Directors and Financial Officers from the participating outpatient non-methadone programs received a full day of training covering the use and interpretation of project instruments. Half of the day was spent on the TCAT, including simulated use of the cost workbook. On average, program personnel reported that it took 6 hours to complete the workbooks including gathering, compiling, and entering data.
All participation in the project was voluntary, and the research protocol and procedures for informed consent were approved by the TCU Institutional Review Board. Table 2 describes the 70 programs in the sample.
Client volume and cost information are presented in Table 3 for each of the three major types of ODF programs regular, intensive, and mixed.
Costs reported here are inflated to U. On average, regular outpatient programs tended to be moderately learn more here average active client count of Consistent with their more specialized focus, intensive programs tended to be relatively small averaging an active client count of Programs with mixed regular and intensive tracks tended to be the largest with an average active client count of The relative size and duration of these programs also have implications for their costs.
The cost data in Table 3 are summarized in two ways — both using the conventional mean and standard deviation statistics, and using the continue reading mean.