{"edition":"usa","organization":"The Headstrong Project","organizationId":"ein:45-5261907","boundaryVersion":"USA-50-states-DC-v1","updated":"2026-09-13","model":{"version":"usa-alpha-headstrong-2026-09-13","costScope":"Ordinary unrestricted recipient donation, with all accounting overhead included in session cost; no cherry-picked trauma modality. G=$10,000 is arithmetic normalization only. Donor cost is gross, with no fee-for-service leverage or avoided medical-cost deduction assumed. Paid clinicians already enter the cost. Patient time, extended-care copays and incremental downstream care are excluded from donor cost and tested separately where possible.","geographicAttribution":"Reported domestic in-person network and all-50-state telehealth support predominantly 50-states/DC resident benefits. Central g=.99, favorable1 and pessimistic.95 are residence-share judgments allowing overseas/territorial service-member spillover; client military status is not residence. A verified residence extract is missing.","formula":"Episode-equivalents = G/(c×n). q = q1 × sum[t=1..T](p^(t−1)/(1.03^t)). Q_all = G/(c×n) × q × f × b × s. Q_USA = Q_all×g. Price per10 =10G/Q_USA. q1 is a net intention-to-treat first-year increment, already including trial attrition/treatment burden; no additional completer multiplier is applied.","counterfactual":"q1 compares an effective trauma-treatment offer with insufficient/less-effective care, not with perfect health. s discounts for an equivalent health trajectory through VA, military, insurer or other charity treatment; delayed treatment can yield partial additionality. b separately discounts for reserves, replacement funding and capacity not expanded by a gift. Annual persistence p includes relapse and untreated/comparator catch-up. No suicide mortality reduction is inferred from symptoms.","attribution":"f discounts transfer from researched modalities/populations to the actual mixture of adult trauma, family care and routine delivery. It is not the accounting program-expense share and does not remove overhead twice. Full-portfolio dollars remain in c. Clinical improvements and funding access are separate links.","uncertainty":"The central is a deliberately cautious judgment informed by observed costs and external causal evidence, not a fitted organizational effect. First-year utility, long-term persistence, treatment episode length and counterfactual access dominate. Scenarios span plausible favorable and poor execution rather than statistical percentiles; zero health additionality remains possible.","nativeOutcomes":"2025 reported 52,000 sessions and 2,947 clients; 70% of sessions via telehealth per Form990. These are annual services, not incident treatment courses. At central c=$275 and n=30, the normalization buys 36.36 nominal sessions or1.212 episode-equivalents before the funding and counterfactual discounts.","inputs":[{"name":"G","value":10000,"unit":"USD normalization","basis":"judgment","rationale":"Calculation unit, not a quoted funding opportunity.","sourceIds":[]},{"name":"2025 expenses","value":13963947,"unit":"USD","basis":"observed","rationale":"Form990 total expense; annual report gives14029100, not silently substituted.","sourceIds":["hs-99025","hs-ar25"]},{"name":"2025 sessions","value":52000,"unit":"sessions","basis":"observed","rationale":"Rounded organizational report; more than52000 in990, use conservative52000 denominator.","sourceIds":["hs-ar25","hs-99025"]},{"name":"2025 clients","value":2947,"unit":"clients/year","basis":"observed","rationale":"Annual report page6; not completed course count.","sourceIds":["hs-ar25"]},{"name":"c","value":275,"unit":"USD/session including overhead","basis":"judgment","rationale":"Rounded above13963947/52000=$268.54; sensitivity200–350 reflects capacity and delivery cost.","sourceIds":["hs-99025","hs-ar25"]},{"name":"n","value":30,"unit":"sessions/entry-equivalent","basis":"judgment","rationale":"Current first30 free and historical mean32/median20 inform full-episode prior; annual sessions/client cannot identify episode length. Sensitivity15–45.","sourceIds":["hs-care","hs-program-paper"]},{"name":"q1","value":0.05,"unit":"net first-year QALY/therapy offer","basis":"judgment","rationale":"Close to external randomized0.056 PE-vs-sertraline estimate, not copied as Headstrong efficacy; trial mostly civilian women, benefits versus no adequate care may differ. Net intention-to-treat including dropout.","sourceIds":["ptsd-utility-trial","ptsd-veteran-rct","ptsd-waitlist-rct"]},{"name":"p","value":0.8,"unit":"annual persistence factor","basis":"judgment","rationale":"20% annual attenuation from relapse and comparator catch-up; external economic model uses expert relapse assumptions, not measured Headstrong persistence.","sourceIds":["ptsd-model"]},{"name":"T","value":3,"unit":"years","basis":"judgment","rationale":"Finite horizon; favorable5, pessimistic1. No lifetime symptom relief.","sourceIds":[]},{"name":"f","value":0.8,"unit":"clinical/population transfer factor","basis":"judgment","rationale":"Further adjustment for military population, treatment mix/fidelity and family services; not an observed allocation.","sourceIds":["hs-care","hs-ar25","ptsd-utility-trial"]},{"name":"b","value":0.75,"unit":"funding/capacity additionality","basis":"judgment","rationale":"Expansion and demand support positive contribution, but reserves/replacement donors limit certainty.","sourceIds":["hs-ar25","hs-audit24","hs-99025"]},{"name":"s","value":0.6,"unit":"counterfactual-care health additionality","basis":"judgment","rationale":"Substantial need despite VA/insurance access, without treating all alternative care as absent.","sourceIds":["hs-nyhealth","hs-care"]},{"name":"g","value":0.99,"unit":"USA resident share","basis":"judgment","rationale":"Domestic network implies mostly in-boundary; residence data not published.","sourceIds":["hs-ar25"]},{"name":"discount","value":0.03,"unit":"annual","basis":"judgment","rationale":"Analyst convention; all first-year gains discounted to year end.","sourceIds":[]},{"name":"2023 audited expense comparator","value":11640268,"unit":"USD","basis":"observed","rationale":"Audit differs from Form99011795084; retained as reconciliation rather than mixed in990 series.","sourceIds":["hs-audit24","hs-99024"]},{"name":"Patient resource increment","value":1000,"unit":"USD/episode-equivalent","basis":"judgment","rationale":"Illustrative travel/time/copay cost addition; actual net downstream costs unknown.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Cautious treatment-access judgment","costUSD":10000,"allPopulationQalys":0.05041398928801731,"editionQalys":0.04990984939513714,"assumptions":"c=275; n=30; q1=0.05; p=0.8; T=3; f=0.8; b=0.75; s=0.6; g=0.99; q=0.11553205878503965. Judgment scenario, not measured donor productivity."},{"id":"favorable","label":"Efficient treatment reaching otherwise untreated clients","costUSD":10000,"allPopulationQalys":1.2262179333194803,"editionQalys":1.2262179333194803,"assumptions":"c=200; n=15; q1=0.12; p=0.9; T=5; f=0.95; b=0.95; s=0.9; g=1; q=0.45289674360830307. Judgment scenario, not measured donor productivity."},{"id":"pessimistic","label":"Long courses with limited additional access","costUSD":10000,"allPopulationQalys":0.00022191400832177532,"editionQalys":0.00021081830790568656,"assumptions":"c=350; n=45; q1=0.01; p=0.5; T=1; f=0.6; b=0.3; s=0.2; g=0.95; q=0.00970873786407767. Judgment scenario, not measured donor productivity."},{"id":"zero-additionality","label":"Equivalent treatment financed elsewhere","costUSD":10000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"b=0 or s=0; no finite favorable price."},{"id":"patient-resource-cost","label":"Central with illustrative patient-resource cost","costUSD":11212.121212121212,"allPopulationQalys":0.05041398928801731,"editionQalys":0.04990984939513714,"assumptions":"Adds $1,000 per nominal entry-equivalent for time/travel/copays; not a measured societal ICER and no avoided costs credited."}],"sensitivity":["At central inputs, halving episode length from30 to15 sessions halves the price only if net clinical efficacy is preserved; more sessions are not automatically more QALYs.","With30 sessions at$275 and f×b×s×g=.3564, meeting$100,000 per10 requires q≥2.3148 per entry; meeting$1 million requires q≥.23148. Central q=.11553 meets neither.","Holding central efficacy and other factors fixed, the$1 million threshold requires n≤14.97 sessions; the$100,000 threshold requires n≤1.50, which is inconsistent with a full clinical course.","Dropping durability to one year raises central price to roughly$4.77 million per10. Benefit persistence beyond3years could improve the estimate but is not assumed without follow-up.","No suicide deaths or family spillover are added. If validated, these could increase benefit; symptom reduction alone is insufficient evidence.","Using2025 annual-report instead of tax expense changes the gross session benchmark by less than1%, much less than uncertainty in episode length or counterfactual care."],"missingInputs":["A current completed entry-cohort dataset linking total sessions across years, early exits, modality, diagnoses and health utility at6/12/24months.","Whether marginal unrestricted dollars expand clinician capacity or replace committed fee-for-service, public/private funding or reserves.","Client VA/insurance eligibility, previous treatment, likely alternative provider and waiting time without Headstrong.","Current measured health utility or validated symptom-to-utility mapping, with adverse outcomes and missing follow-up included.","Residence within50states/DC, not merely military affiliation or clinician location.","Reconciliation of annual report, audited and Form990 financial differences; current2026 operating budget and reserve deployment plan.","Actual patient copays/time costs and incremental downstream medical utilization, without assuming all avoided bills are net savings."]},"sources":[{"id":"hs-care","title":"Connect to care: 30 cost-free sessions and extended-care copay","publisher":"The Headstrong Project","url":"https://theheadstrongproject.org/get-help/","published":null,"retrieved":"2026-09-13"},{"id":"hs-about","title":"About Headstrong and qualified clinical outcome claims","publisher":"The Headstrong Project","url":"https://theheadstrongproject.org/about/","published":null,"retrieved":"2026-09-13"},{"id":"hs-ar25","title":"2025 Annual Report, pages 2–9","publisher":"The Headstrong Project","url":"https://theheadstrongproject.org/wp-content/uploads/2026/04/2025AnnualReport_FINAL.pdf","published":null,"retrieved":"2026-09-13"},{"id":"hs-99025","title":"Original Form 990, year ended December 2025","publisher":"Head Strong Project Inc. / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202621319349302162/IRS990","published":null,"retrieved":"2026-09-13"},{"id":"hs-99024","title":"Original Form 990, year ended December 2024","publisher":"Head Strong Project Inc. / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202541499349300609/IRS990","published":null,"retrieved":"2026-09-13"},{"id":"hs-audit24","title":"Audited financial statements, December 2024 with 2023 comparison","publisher":"Headstrong Project Inc. / SAX LLP","url":"https://docs.candid.org/efiles/9218143/d01eb21e-d83c-43de-935c-f44b59e37424.pdf","published":null,"retrieved":"2026-09-13"},{"id":"hs-program-paper","title":"Utilizing EMDR as the primary modality in a community veteran program","publisher":"Trauma Treatment NYC / Weill Cornell Headstrong program authors","url":"https://www.traumacenternyc.org/projects/utilizing-emdr-as-the-primary-modality-to-treat-veteran-ptsd-in-a-community-based-program","published":null,"retrieved":"2026-09-13"},{"id":"hs-nyhealth","title":"Maintaining and maximizing veterans' access to mental health care, June 2026","publisher":"New York Health Foundation","url":"https://nyhealthfoundation.org/grant-outcome/maintaining-and-maximizing-veterans-access-to-mental-health-care/","published":null,"retrieved":"2026-09-13"},{"id":"ptsd-utility-trial","title":"Cost-effectiveness of prolonged exposure versus sertraline, randomized preference trial","publisher":"Le et al. / Journal of Clinical Psychiatry","url":"https://www.psychiatrist.com/wp-content/uploads/2021/02/12214_cost-effectiveness-prolonged-exposure-therapy-versus.pdf","published":null,"retrieved":"2026-09-13"},{"id":"ptsd-veteran-rct","title":"Comparison of prolonged exposure versus cognitive processing therapy in 916 US veterans","publisher":"Schnurr et al. / JAMA Network Open","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8771295/","published":"2022-01-19","retrieved":"2026-09-13"},{"id":"ptsd-waitlist-rct","title":"Cognitive processing therapy for veterans with military-related PTSD","publisher":"Monson et al. / Journal of Consulting and Clinical Psychology","url":"https://pubmed.ncbi.nlm.nih.gov/17032094/","published":null,"retrieved":"2026-09-13"},{"id":"ptsd-model","title":"Cost-effectiveness of psychological treatments for PTSD in adults","publisher":"Mavranezouli et al. / PLOS ONE","url":"https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232245","published":"2020-04-30","retrieved":"2026-09-13"},{"id":"ptsd-va","title":"Overview of psychotherapy for PTSD","publisher":"US Department of Veterans Affairs, National Center for PTSD","url":"https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp","published":null,"retrieved":"2026-09-13"},{"id":"hs-donate","title":"Give the gift of life-changing care","publisher":"The Headstrong Project","url":"https://support.theheadstrongproject.org/campaign/743939/donate","published":null,"retrieved":"2026-09-13"}]}