An Overlapping Systems Conceptual Framework to Evaluate Implementation of a Behavioral Health Intervention for Justice-Involved Youth.

BACKGROUND

Nearly 65% of justice-involved youth have a substance use and/or mental health disorder. Although evidence-based practices have been established for adolescents with co-occurring mental health and substance use disorders, these practices are not widely used in juvenile justice agencies due to environmental and organizational complexities.

METHODS

Our study builds on Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), a multi-site cooperative research initiative of juvenile justice and partnering behavioral health agencies. We also integrate state and county-level data to support broader assessment of key drivers of implementation success.

RESULTS

We present an economics/systems conceptual model describing how the environmental context, systems organization, and economic costs of implementation can affect implementation outcomes. Comparison of intervention condition (Core vs Enhanced) and pre-implementation costs (High vs Low) found differences in insurance reimbursements and types, as well as agency staffing characteristics.

DISCUSSION

Implementing new procedures or policies at a systems level must consider implementation outcomes in a broad context. Factors such as population demographics, primary care and behavioral health treatment capacity, unemployment rates, and public funding for treatment and other services are important in determining intervention success and sustainability.