The cost of implementing and sustaining an evidence-based, behavioral-health electronic screening system in probation departments.

BACKGROUND

Roughly 50%-75% of youths who have had contact with the juvenile justice system have a mental-health disorder. In 2019, a northeastern state required probation departments to implement an evidence-based behavioral health (BH) screen. e-Connect is a digital clinical decisional support system designed to identify suicide thoughts and behaviors and related BH risk and triage youths based on BH need, then facilitate linkage to care.

OBJECTIVE

To identify the resources and estimate the costs required to implement and sustain e-Connect from probation-department and policymaker perspectives.

METHODS

Prospective micro-costing analysis conducted concurrently with a rigorous evaluation of e-Connect. Data were collected for 622 youths ages 10-18 via administrative records, study instruments, and semi-structured interviews. Resources/costs were categorized as "fixed", "time-dependent", or "variable". Mean annual costs (per-county and per-screen, by county) were calculated for two intervention phases, "implementation" and "sustainment". All costs are in 2019 USD.

RESULTS

The policymaker-relevant, annualized, mean, per-county start-up and sustainment costs were $18,704 (SD = $14,320) and $13,374 (SD = $13,317), respectively. The per-screen sustainment cost was $115 (SD = $113) across counties, with variation attributed to a combination of a county's behavioral-health needs, and differences in the types of resources utilized as part of their post-screening clinical response.

CONCLUSION

The results of this analysis will inform the decisions of probation departments and their stakeholders, who are interested in implementing an evidence-based behavioral-health screen for youths on probation. Site-level figures will provide important details regarding the resources/costs associated with various implementation and management strategies. Cross-site, per-person averages will provide crucial inputs into budget impact models and cost-effectiveness analyses.