{"edition":"los-angeles","organization":"John Tracy Center","organizationId":"org:john-tracy-center","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-jtc-judgment-communication-health-v2","costScope":"Whole recipient gross accrual Form 990 resources, including event costs; no program-only or net-of-reimbursement denominator.","geographicAttribution":"Each pathway needs LA and Orange County residence attribution. International visits and online users are not assumed local.","formula":"Q_LA=N*b*g*t*k*.59*A; A=sum(w_y/1.03^y). Central N=100,b=.25,g=.8,t=.5,k=.02,w=[1,.5,.25],C=6479214. Price10=10*C/Q_LA. This is the parent-coaching partial-health branch at full recipient cost; Qportfolio=Q_LA+Qother-H, other health unidentified.","counterfactual":"Publicly funded education, Early Start, insurance, existing endowment support and other providers continue. The controlled trial effect must be transferred to this service and its actual alternative, not compared to permanent absence of language access.","attribution":"Count each unique child once. Do not credit implantation, hearing-aid provision, preschool and parent coaching with the same developmental gain. b reflects incremental resource response, while t reflects clinical transport; neither is an observed local estimate.","uncertainty":"The central and broad range are subjective judgments anchored to actual service format, historical scale and an external randomized communication effect. Eligible volume and preference utility are not measured. Their uncertainty does not automatically erase a finite central. Zero, harm and unpriced other pathways are retained.","nativeOutcomes":"Additional eligible LA parent-coaching offers -> communication-score improvement relative to current alternatives -> finite preference-weighted health trajectory. Diagnostic appointments and uncontrolled progress percentages do not supply the missing steps.","inputs":[{"name":"C","value":6479214,"unit":"USD annual gross recipient expense","basis":"observed","rationale":"FY2025 Part IX plus direct event expenses.","sourceIds":["99025"]},{"name":"d_comm","value":0.59,"unit":"SD child communication effect immediately after randomized intervention","basis":"observed","rationale":"External six-month parent-mediated intervention trial; not a local effect or health utility.","sourceIds":["rct25"]},{"name":"N","value":100,"unit":"eligible annual parent-coaching offers","basis":"judgment","rationale":"Judgment of 100 potentially trial-compatible annual offers, about9% of historical1110 audiology children over9months. Not measured enrollment or inferred directly from all diagnostic visits; current weekly coaching at three campuses makes this order of magnitude plausible. Test25–250.","sourceIds":["parent","preschool","99025"]},{"name":"b","value":0.25,"unit":"incremental funding responsiveness","basis":"judgment","rationale":"Judgment .25 marginal resource responsiveness after public funding, assets and other donors; test .05–.6 and zero.","sourceIds":["parent","preschool","99025"]},{"name":"g","value":0.8,"unit":"LA resident share","basis":"judgment","rationale":"Judgment .8 LA/Orange residence among in-person coaching offers, not whole worldwide recipient; test .5–.95.","sourceIds":["parent","preschool","99025"]},{"name":"t","value":0.5,"unit":"clinical effect transfer","basis":"judgment","rationale":"Judgment half the external communication effect after modality, population and usual-care differences; test .2–.8 and zero.","sourceIds":["parent","preschool","99025"]},{"name":"k","value":0.02,"unit":"utility per communication-score SD","basis":"judgment","rationale":"Explicit normative health bridge: one communication-score SD corresponds to .02 utility for a year through reduced distress and improved family-chosen functioning. This is not an estimated psychometric conversion or lower value assigned to Deaf identity; test .005–.05 and zero.","sourceIds":["rct25","lochi25"]},{"name":"T","value":3,"unit":"finite persistence years","basis":"judgment","rationale":"Finite3years with rapid fading; neither RCT nor cohort establishes persistence. Test1–5years.","sourceIds":["rct25","lochi25"]},{"name":"w_y","value":[1,0.5,0.25],"unit":"year-specific retained effect fraction","basis":"judgment","rationale":"Retained effect1,.5,.25 across years1–3, then zero; subjective fading rather than lifetime extrapolation.","sourceIds":["parent","preschool","99025"]},{"name":"Q_other_LA","value":null,"unit":"non-overlapping other LA QALYs","basis":"unknown","rationale":"Not identified by reviewed sources; requires explicit measurement or justified judgment before pricing.","sourceIds":["parent","preschool","99025"]},{"name":"H","value":null,"unit":"additional LA harm QALYs","basis":"unknown","rationale":"Not identified by reviewed sources; requires explicit measurement or justified judgment before pricing.","sourceIds":["parent","preschool","99025"]}],"scenarios":[{"id":"central","label":"Judgment best estimate: parent-coaching communication health","costUSD":6479214,"allPopulationQalys":0.24646618048240776,"editionQalys":0.19717294438592622,"assumptions":"N=100; b=0.25; g=0.8; t=0.5; k=0.02; d_comm=.59; w=[1,0.5,0.25]; A=1.6709571558129341; 3% annual discount; no effects after year 3. Joint judgment scenario, not empirical confidence bounds."},{"id":"low","label":"Weak eligible volume, transfer and persistence","costUSD":6479214,"allPopulationQalys":0.0007160194174757282,"editionQalys":0.0003580097087378641,"assumptions":"N=25; b=0.05; g=0.5; t=0.2; k=0.005; d_comm=.59; w=[1]; A=0.970873786407767; 3% annual discount; no effects after year 1. Joint judgment scenario, not empirical confidence bounds."},{"id":"high","label":"Favorable eligible volume, transfer and persistence","costUSD":6479214,"allPopulationQalys":11.53941467679038,"editionQalys":10.962443942950859,"assumptions":"N=250; b=0.6; g=0.95; t=0.8; k=0.05; d_comm=.59; w=[1,1,0.75,0.5,0.25]; A=3.2597216601102765; 3% annual discount; no effects after year 5. Joint judgment scenario, not empirical confidence bounds."},{"id":"zero","label":"Complete replacement or no incremental health","costUSD":6479214,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0, Q_other_LA=0, H=0; this is a possible case, not the best estimate."},{"id":"adverse","label":"Illustrative adverse net effect","costUSD":6479214,"allPopulationQalys":-1,"editionQalys":-1,"assumptions":"One net LA QALY lost is an explicit stress test, not an empirical harm estimate."},{"id":"portfolio-unknown","label":"Other recipient health unpriced","costUSD":6479214,"allPopulationQalys":null,"editionQalys":null,"assumptions":"No independent diagnostic, device, preschool, family or training health is added without a non-overlap model."}],"sensitivity":["Required net LA health is 64.79214 QALYs at $1m/10 or 647.9214 at $100k/10.","At assumed 0.1 discounted QALY per genuinely additional LA child, required additional children are 647.9214 or 6479.214. This is break-even arithmetic only.","Any finite positive course model must report its time horizon, utility mapping, public-service substitution and geography; indefinite lifetime multiplication is not supported.","Other family, diagnostic and professional-training value may be important. Leaving it unpriced does not set it to zero."],"missingInputs":["Current unique eligible parent-coaching offers and LA residence, separate from all audiology visits.","Marginal unrestricted service capacity after public payment, reserves and replacement donors.","Preference-weighted utility change attributable to communication improvement and finite persistence.","Independent non-overlapping diagnostic, preschool, family and training pathways."]},"sources":[{"id":"99025","title":"FY2025 original Form 990, filed July 14, 2026","url":"https://projects.propublica.org/nonprofits/full_text/202631959349302018/IRS990","publisher":"John Tracy Clinic / IRS","published":"2026-07-14","retrieved":"2026-09-14"},{"id":"99024","title":"FY2024 original Form 990, filed July 14, 2025","url":"https://projects.propublica.org/nonprofits/full_text/202511959349300981/IRS990","publisher":"John Tracy Clinic / IRS","published":"2025-07-14","retrieved":"2026-09-14"},{"id":"99023","title":"FY2023 original Form 990, filed July 15, 2024","url":"https://projects.propublica.org/nonprofits/full_text/202411979349302401/IRS990","publisher":"John Tracy Clinic / IRS","published":"2024-07-15","retrieved":"2026-09-14"},{"id":"scheduled","title":"FY2025 expense and endowment reconciliation","url":"https://projects.propublica.org/nonprofits/full_text/202631959349302018/IRS990ScheduleD","publisher":"John Tracy Clinic / IRS","published":"2026-07-14","retrieved":"2026-09-14"},{"id":"scheduler","title":"FY2025 related entity disclosure","url":"https://projects.propublica.org/nonprofits/full_text/202631959349302018/IRS990ScheduleR","publisher":"John Tracy Clinic / IRS","published":"2026-07-14","retrieved":"2026-09-14"},{"id":"services","title":"Current service portfolio","url":"https://jtc.org/","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"},{"id":"parent","title":"Parent-infant services","url":"https://jtc.org/services/parent-infant-program/","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"},{"id":"preschool","title":"Preschool and public contracting","url":"https://jtc.org/services/preschool/","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"},{"id":"worldwide","title":"Worldwide parent education","url":"https://jtc.org/wwparentedu/","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"},{"id":"newsletter23","title":"Summer 2023 newsletter: partial-year audiology activity","url":"https://www.jtc.org/publish/publications/pdf_source/2023-August-Summer-Newsletter-Summer-Session.pdf","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"},{"id":"rct25","title":"Early Communication Intervention for Deaf/Hard of Hearing Toddlers: A Randomized Clinical Trial","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12278989/","publisher":"Jones and colleagues / Pediatrics","published":"2025-06-01","retrieved":"2026-09-14"},{"id":"lochi25","title":"Nine-year language and quality-of-life cohort","url":"https://pubmed.ncbi.nlm.nih.gov/40059097/","publisher":"Ching and colleagues / Ear and Hearing","published":"2025-03-10","retrieved":"2026-09-14"},{"id":"earlystart","title":"What is Early Start?","url":"https://www.dds.ca.gov/services/early-start/what-is-early-start/","publisher":"California Department of Developmental Services","published":null,"retrieved":"2026-09-14"},{"id":"annual-access","title":"Annual report announcement; linked report unavailable during review","url":"https://mailchi.mp/jtc.org/our-2023-24-annual-report-is-here","publisher":"John Tracy Center","published":null,"retrieved":"2026-09-14"}]}