Bowser Diana, Henry Brandy F, McCollister Kathryn E
Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
Health Serv Insights. 2019 Jun 18;12:1178632919855037. doi: 10.1177/1178632919855037. eCollection 2019.
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.
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.
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.
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.
近65%涉及司法事务的青少年存在物质使用和/或心理健康障碍。尽管针对同时患有心理健康和物质使用障碍的青少年已确立了循证实践方法，但由于环境和组织方面的复杂性，这些方法在少年司法机构中并未得到广泛应用。
我们的研究建立在“少年司法——法律系统中青少年干预措施的转化研究”（JJ - TRIALS）基础之上，这是一项由少年司法机构与合作的行为健康机构开展的多地点合作研究项目。我们还整合了州和县一级的数据，以支持对实施成功的关键驱动因素进行更广泛的评估。
我们提出了一个经济/系统概念模型，描述了环境背景、系统组织和实施的经济成本如何影响实施结果。对干预条件（核心组与强化组）和实施前成本（高成本组与低成本组）的比较发现，保险报销和类型以及机构人员配置特征存在差异。
在系统层面实施新程序或政策时，必须在广泛的背景下考虑实施结果。诸如人口统计学特征、初级保健和行为健康治疗能力、失业率以及用于治疗和其他服务的公共资金等因素，对于确定干预的成功与否和可持续性至关重要。
