Addressing unmet need for substance use disorder treatment among youth in the legal system (YLS): Costs of structured implementation interventions with juvenile justice agencies in seven states

Introduction

Implementation of integrated strategies for improving access to behavioral health services for youth in the legal system requires evidence of the costs of changing existing practices, and stakeholders need to be aware of what types of investments (e.g., personnel, data systems) lead to more efficient implementation and better outcomes.

Methods

A cost analysis was conducted alongside the Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), a research cooperative comprising 34 community supervision agencies in seven states that were randomly assigned to Core or Core+Enhanced implementation interventions. Both were focused on improving screening, referral, and linkage to behavioral health services for youth with substance use disorders (SUD). Cost data were collected prospectively across all implementation phases.

Results

During Baseline, the average cost was $11,083 per site (range: $1104 to $19,399). Enhanced sites had relatively higher baseline costs ($13,176 vs. $9222 in the Core sites). During the Experiment phase, Enhanced sites continued to incur higher implementation costs relative to the Core sites, but these costs steadily declined and ultimately converged with Core sites as they entered the sustainment phase.

Conclusions

Enhanced sites had higher implementation costs; but both Enhanced and Core sites showed similar trends in decreasing costs across the Experiment period. These decreasing costs reflected both fewer meetings and lower participation over time. In a funding climate where available resources are already scarce, access to cost data can help agencies prepare to implement and sustain new practices.