Summary
What do they do? RAMS Adult/Older Adult Outpatient provides counseling, case management, psychiatric services and other support, emphasizing underserved linguistic and cultural communities. Its training materials describe psychodynamic approaches. This report isolates a hypothetical depression-counseling course within that service, not all outpatient clients. More
Why this approach interests us
- Culturally and linguistically responsive counseling can help people with depression who would otherwise lack effective care.
Our main reservations
- Local modality, patient mix, existing treatment and marginal funding differ from the reference trial.
What do you get for your dollar?
Our central analyst estimate is $4.21M per better life (10 QALYs). We model a hypothetical fifteen-contact depression course—not a verified RAMS CBT program. RAMS describes predominantly psychodynamic training, so the external CBT result is a heavily qualified calibration. Inspect the model →
- central estimate
- $4.21M — per 10 incremental QALYs; conditional local transfer
- positive scenarios
- $359K–$160M — Not a RAMS confidence interval; null/harm possible
- course allowance
- $3,000 — Assumed fifteen contacts plus intake/support
- funding room
- Unverified — Reimbursement and existing care may replace donations
1. What do they do?
RAMS Adult/Older Adult Outpatient provides counseling, case management, psychiatric services and other support, emphasizing underserved linguistic and cultural communities. Its training materials describe psychodynamic approaches. This report isolates a hypothetical depression-counseling course within that service, not all outpatient clients.
Identify the treatment subgroup
A depression-focused course needs an actual diagnosis, severity and current-care definition. Do not extrapolate the reference to psychosis, bipolar disorder or every clinic client.
Price an offered course
Fifteen contacts is our planning dose, not a verified standardized RAMS protocol. Include intake, supervision, coordination and noncompletion effort.
Measure added health
Compare with realistic existing counseling and medication access; treatment received anyway is not caused by the gift.
Scope of this review. The mixed adult public contract also includes Broderick residential and API collaborative services. Dividing it by outpatient clients would not estimate marginal course cost.
2. Monitoring and information sharing
Mixed-age and mixed-diagnosis outpatient care
Local service and training descriptions. Counseling delivery and psychodynamic training verified; depression-specific dose and cost are not.
Our assessment. This is not a claim that RAMS delivers the CoBalT manualized CBT intervention.
469 UK adults with antidepressant-resistant depression
External randomized adjunct-CBT trial. Imputed incremental .057 one-year QALYs, 95% CI .015–.099; complete joint cost/QALY data for 78%.
Our assessment. Different modality and care context; exclusions and UK utility tariffs limit transfer. Imputation assumptions matter.
Treatment-resistant depression; much longer therapy
External psychoanalytic economic trial. Approximately sixty sessions and CORE-6D valuation over a much longer follow-up.
Our assessment. Supports investigating psychodynamic care, but cannot supply a per-session coefficient for this course; uncertainty includes null.
3. Qualitative assessment
Culturally and linguistically responsive counseling can help people with depression who would otherwise lack effective care.
Key reservations
- The local modality and course are not the reference intervention.
- Public reimbursement and existing psychotherapy may leave little marginal room.
- Cost and transfer fractions are subjective.
- Missing trial data and local subgroup selection can change the result.
Benefits not included in our estimate
- Residential Broderick and API collaborative services
- Additional years or routine completion multipliers applied to the integrated QALY estimate
- Employment, family or healthcare savings
- Psychodynamic trial gains divided linearly by sessions
4. What do you get for your dollar?
Central scenario: $4.21M per 10 QALYs.
The external trial contributes .057 cumulative one-year QALYs per offered course. We retain 25% as a local calibration and assume 50% funding additionality. Both fractions and the $3,000 cost are judgment calls, not measured RAMS inputs.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
DOLLARS PER BETTER LIFE: 10 × $3,000 ÷ (0.057 × 25% × 50%)
$4,210,526 per 10 QALYs
Model inputs and assumptions
- Marginal course allowance
- 3000 (range: 2000 / 3000 / 6000). Assumed fifteen contacts at $150 loaded delivery each, plus $750 intake, supervision and coordination = $3,000. Neither dose nor rate is a RAMS quote. Includes offered-course effort and noncompletion. Analyst assumption.
- External one-year QALY calibration
- 0.057 (range: 0.099 / 0.057 / 0.015). CoBalT imputed baseline-adjusted EQ-5D-3L area-under-curve difference .057, 95% CI .015–.099, CBT plus usual care versus usual care in antidepressant-resistant depression. Already integrates one year and offered-treatment outcomes. Not an endpoint utility or RAMS effect. External randomized endpoint; not local efficacy.
- Modality and population transfer
- 0.25 (range: 0.75 / 0.25 / 0.1). 25% judgment for a substantial mismatch: RAMS describes predominantly psychodynamic training, not CoBalT CBT fidelity. Severity, existing psychotherapy and local delivery also differ. This is not evidence that psychodynamic care has one-quarter CBT efficacy. Analyst assumption.
- Additional funded care
- 0.5 (range: 0.75 / 0.5 / 0.25). 50% judgment for funding replacement/reimbursement and genuinely added capacity. No verified donor-sized gap or restricted depression tranche. Analyst assumption.
Illustrative $100,000: 33.3 gross course-equivalents before additionality; 0.2375 additional QALYs
- Favorable positive: $359.15K per 10 QALYs. 2.78 QALYs per $100,000; actual capacity unverified
- Central analyst estimate: $4.21M per 10 QALYs. 0.238 QALYs per $100,000; actual capacity unverified
- Unfavorable positive: $160M per 10 QALYs. 0.00625 QALYs per $100,000; actual capacity unverified
Uncertainty. Positive scenarios combine a trial interval with subjective local assumptions; they are not a RAMS confidence interval. Zero local benefit or added capacity means no finite positive-benefit price. Signed reference QALYs preserve possible harm. No unmeasured long-term benefit added.
An integrated QALY estimate is not a utility score or a session effect.
CoBalT used one-year EQ-5D area under the curve and imputed missing data. Its offered-treatment estimate already includes nonattendance. Multiplying by another year or routine completion rate would count those adjustments twice.
ADDITIONAL QALYS PER OFFERED COURSE: 0.057 × 25% × 50%
0.007125 QALYs
QALY conversion assumptions
The 25% transfer assumption is not a finding that psychodynamic therapy is one-quarter as effective as CBT. Longer psychoanalytic studies are triangulation, not benefits to divide by session count.
5. Funding and previous grants
No current depression-course quote or verified additional treatment capacity.
Funding additionality addresses genuinely added treatment versus reimbursement/replacement. The separate transfer fraction addresses modality, subgroup and counterfactual differences; neither is a measured percentage of a RAMS gift.
This review does not establish a verified marginal funding offer or a complete history of grants.
Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.
6. Sources
- Adult Outpatient Services. RAMS. Counseling service identity; no standardized depression-course cost. Published: Undated current page; retrieved: 2026-09-07.
- Outpatient Clinical Practicum. RAMS. Predominantly psychodynamic training; not verified CBT fidelity. Published: Undated current page; retrieved: 2026-09-07.
- RAMS FY2023–24 funding summary. San Francisco. Mixed adult contract includes outpatient, residential and collaborative services; not marginal course cost. Published: FY2023–24 summary; April 2024 file revision; retrieved: 2026-09-07.
- CoBalT economic results. Wiles et al. / NIHR. 469-person randomized trial; one-year imputed EQ-5D economic endpoint. Published: 2014-05; retrieved: 2026-09-07.
- CoBalT full report Table 64. Wiles et al. / NIHR. Base-case .057 QALYs, CI .015–.099; not descriptive .053 estimate. Published: 2014-05; retrieved: 2026-09-07.
- Long-term psychoanalytic psychotherapy economic evaluation. Tavistock Adult Depression Study economic researchers. Longer 60-session protocol and CORE-6D; triangulation, not a scaled course coefficient. Published: 2023-05-08 online; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $28,033,069. Organization size is separate from the modeled cost-effectiveness of a donation.
Richmond Area Multi-services Inc
Whole legal entity Form 990 total functional expenses, IRS data extracted by ProPublica; fiscal-end year derived from tax_prd.
Newer filings without extracted data: 202406. Latest-three-year series is incomplete pending extraction. Stale latest extracted year; show date explicitly.