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Bowser D, McCollister K, Berchtold G, Ruscitti B, Yang Y, Hines H, Fardone E, Knight D. Start-Up and Implementation Costs for the Trust Based Relational Intervention. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00803-0. [PMID: 39153158 DOI: 10.1007/s10935-024-00803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
Capturing costs associated with prevention activities related to substance use disorders (SUD) and mental health (MH) is critical. In this study, Trust Based Relational Intervention (TBRI®), an attachment-based, trauma-informed intervention, is conceptualized as a preventive intervention to reduce substance and opioid use among youth involved with the legal system. When implemented alongside community reentry, TBRI leverages family systems as youth transition from secure residential care into communities through emotional guidance and role modeling. Activity-based cost (ABC) analysis was used to guide cost data collection and analysis for both start-up and implementation of the TBRI intervention. Start-up costs were estimated using data across eight sites during their start-up phase. All components, activities, personnel involved, and time associated with implementation of TBRI sessions according to protocol were defined. National wages were extracted from O*NET and utilized to calculate total costs for each TBRI component. Total and average TBRI intervention costs were calculated with a breakdown by TBRI sessions and number of staff and participants. A sensitivity analysis was conducted to estimate TBRI implementation costs with travel. The total cost for the TBRI intervention, representing 42 sessions, ranges from $6,927, without travel expenses or $12,298, with travel expenses. The average per family cost ranges from $1,385 (without travel) to $2,460 (with travel). Costs are primarily generated by time investments from primary interventionists. The sensitivity analysis shows costs for responsive coaching would double with travel costs included. Results aim to show that using ABC for prevention activities, like TBRI, to understand cost drivers can facilitate future intervention sustainability.Clinical Trail.gov ID: NCT04678960.
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Affiliation(s)
- Diana Bowser
- Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 0467, USA.
| | - Kathryn McCollister
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
| | - Grace Berchtold
- Heller School for Social Policy and Management, Brandeis University, 415 South St., Waltham, MA, 02453, USA
| | - Brielle Ruscitti
- Connell School of Nursing, Boston College, 140 Commonwealth Ave., Chestnut Hill, MA, 0467, USA
| | - Yang Yang
- Institute of Behavioral Research, Texas Christian University, 3034 Sandage Ave, Fort Worth, TX, 76109, USA
| | - Heather Hines
- Institute of Behavioral Research, Texas Christian University, 3034 Sandage Ave, Fort Worth, TX, 76109, USA
| | - Erminia Fardone
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
| | - Danica Knight
- Miller School of Medicine, University of Miami, 1400 NW 12th Ave, Miami, FL, 33125, USA
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Stanley JN, DeLucca SC, Perron L, Belenko S. The impact of co-occurring mental health problems on referral to and initiation of treatment among youth under probation supervision: Findings from a cluster randomized trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209279. [PMID: 38135122 DOI: 10.1016/j.josat.2023.209279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Many youth under community supervision have substance use and co-occurring mental health issues. Yet, access to treatment is limited, and many programs cannot address co-occurring disorders. This study examines how co-occurring symptoms among youth on probation affect referral to and initiation of treatment. We hypothesize that both referral and initiation rates will be lower for youth with any co-occurring indicators. METHODS This study collected administrative data from 14 sites in three states between March 2014 and November 2017 using JJ-TRIALS, a cluster randomized trial. Among 8552 youth in need of treatment (screened as having a substance use problem, drug possession arrest, positive drug test, etc.), 2069 received a referral to treatment and 1630 initiated treatment among those referred. A co-occurring indicator (n = 2828) was based on symptoms of an internalizing and/or externalizing issue. Descriptive analyses compared referral and initiation by behavioral health status. Two-level mixed effects logistic regression models estimated effects of site-level variables. RESULTS Among youth in need with co-occurring internal, external, or both indicators, only 16 %, 18 %, and 20 % were referred to treatment and of those referred, 63 %, 69 %, and 57 % initiated treatment, respectively. Comparatively, 27 % and 83 % of youth with a substance use only indicator were referred and initiated treatment respectively. Multi-level multivariate models found that, contrary to our hypothesis, co-occurring-both (p = 0.00, OR 1.44) and co-occurring-internal indicators (p = 0.06, OR 1.25) predicted higher referral but there were no differences in initiation rates. However, there was substantial site-level variation. CONCLUSIONS Youth on probation in need of substance use treatment with co-occurring issues have low referral rates. Behavioral health status may influence youth referral to treatment depending on where a youth is located. Depending on the site, there may be a lack of community programs that can adequately treat youth with co-occurring issues and reduce unmet service needs.
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Affiliation(s)
- Jennifer N Stanley
- Temple University, Department of Criminal Justice, 1115 Polett Walk, Philadelphia, PA 19122, United States.
| | - Sarah C DeLucca
- Temple University, Department of Criminal Justice, 1115 Polett Walk, Philadelphia, PA 19122, United States
| | - Lauren Perron
- Temple University, Department of Criminal Justice, 1115 Polett Walk, Philadelphia, PA 19122, United States
| | - Steven Belenko
- Temple University, Department of Criminal Justice, 1115 Polett Walk, Philadelphia, PA 19122, United States
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Viglione J, Childs KK, Peck JH, Chapman JE, Drazdowski TK, McCart MR, Sheidow AJ. Examining the measurement precision of behavior problems among a sample of primarily rural youth on juvenile probation and their parents. CHILDREN AND YOUTH SERVICES REVIEW 2023; 152:107039. [PMID: 38312220 PMCID: PMC10836716 DOI: 10.1016/j.childyouth.2023.107039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Accurate and timely intervention in the justice system is particularly critical in rural communities, given documented barriers to accessible, evidence-based services for youth. As youth in the juvenile justice system have a high prevalence of behavioral health needs, accurate assessment of those needs is a critical first step in linking youth to appropriate care. The goal of the current study is to examine the reliability of a brief assessment (the Brief Problem Checklist [BPC]) among a sample of 222 justice-involved youth and their caregivers who primarily reside in rural communities in the United States. Using a series of reliability analyses and tests of agreement, we examined whether youth and caregiver BPC produces reliable scales, the strength of the convergence among each of the BPC scales, and youth and caregiver agreement on the BPC scales. Findings support the reliability of the BPC, but not inter-rater reliability. Poor agreement between youth and caregiver reports exists for both youth internalizing and externalizing problems. Additionally, the BPC was significantly related to several theoretically relevant constructs, including treatment, substance use disorder severity, and family history of substance use. These findings lend merit to discussions about the need for more research on the reliability and validity of assessment instruments before their widespread use in guiding youth- and agency case planning decisions, along with informing conclusions about program effectiveness.
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Affiliation(s)
- Jill Viglione
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Kristina K. Childs
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Jennifer H. Peck
- Department of Criminal Justice, University of Central Florida, 12805 Pegasus Drive, Orlando, FL 8216, United States
| | - Jason E. Chapman
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Tess K. Drazdowski
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Michael R. McCart
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
| | - Ashli J. Sheidow
- Oregon Social Learning Center (OSLC), 10 Shelton McMurphey Blvd., Eugene, OR 97401, United States
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O'Grady MA, Tross S, Cohall A, Wilson P, Cohall R, Campos S, Lee S, Dolezal C, Elkington KS. Readiness to change among justice-involved young adults in an alternative sentencing program who screened positive for alcohol or drug risk. Addict Behav Rep 2022; 16:100456. [PMID: 36147454 PMCID: PMC9485898 DOI: 10.1016/j.abrep.2022.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 08/05/2022] [Accepted: 08/28/2022] [Indexed: 11/26/2022] Open
Abstract
Justice-involved young adults are in need of tailored substance use interventions. Readiness to change is a key component of substance use behavioral change. Many justice-involved young adults were ready to change their substance use. Personal reasons to quit using drugs are a potential intervention target.
Introduction Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method Justice-involved young adults (18–24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut, School of Medicine, USA
| | - Susan Tross
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Alwyn Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Patrick Wilson
- Mailman School of Public Health, Columbia University, USA
| | - Renee Cohall
- Mailman School of Public Health, Columbia University, USA.,New York Presbyterian Hospital, USA
| | - Stephanie Campos
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Sin Lee
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA
| | - Curtis Dolezal
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
| | - Katherine S Elkington
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, USA.,HIV Center of Clinical and Behavioral Studies, USA
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Henry BF, Hartmann J, Goddard-Eckrich D, Chang M, Wu E, Hunt T, Gilbert L, Wimberly AS, El-Bassel N. Typologies of Stressful Life Events and Their Association With Sexual Risk Behaviors and Communication Among Justice-Involved Males and Their Female Sex Partners. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:379-394. [PMID: 36181499 PMCID: PMC9576004 DOI: 10.1521/aeap.2022.34.5.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Stressful life events are prevalent among justice-involved populations and are associated with sexual risk behaviors and partner communication regarding safe-sex practices. We describe patterns of stress exposure for heterosexual couples (where males are under community supervision) and how stress patterns are associated with sexual risk behaviors and communication (460 individuals; 230 couples). Latent class analysis identified patterns of stress. Multinominal logistic regression models identified associations between sex, race, ethnicity, and stress classes. Multilevel Poisson regression models described relationships between sexual risk behaviors and frequency of communication about condoms/HIV, and stress classes. We found four classes that differed by sex, race, and ethnicity and were associated with the number of sexual partners, condom use self-efficacy, discussing condoms with partner, and discussing HIV prevention with partner. Partner class was associated with the number of sexual partners. Findings inform future assessment/interventions for sexual health that consider patterns of stress and demographics.
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Affiliation(s)
- Brandy F Henry
- School of Social Work, Columbia University, New York, New York
- College of Education, Pennsylvania State University State College, Pennsylvania
| | | | | | - Mingway Chang
- School of Social Work, Columbia University, New York, New York
| | - Elwin Wu
- School of Social Work, Columbia University, New York, New York
| | - Timothy Hunt
- School of Social Work, Columbia University, New York, New York
| | - Louisa Gilbert
- School of Social Work, Columbia University, New York, New York
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Bowser DM, Henry BF, McCollister KE. Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review. Implement Sci 2021; 16:26. [PMID: 33706780 PMCID: PMC7953634 DOI: 10.1186/s13012-021-01094-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.
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Affiliation(s)
- Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Brandy F Henry
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA. .,School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1019, Miami, FL, 33136, USA
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Watson DP, Snow-Hill N, Saldana L, Walden AL, Staton M, Kong A, Donenberg G. A Longitudinal Mixed Method Approach for Assessing Implementation Context and Process Factors: Comparison of Three Sites from a Housing First Implementation Strategy Pilot. IMPLEMENTATION RESEARCH AND PRACTICE 2020; 1. [PMID: 33392509 DOI: 10.1177/2633489520974974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Implementation science's focus on establishing implementation strategy effectiveness has overshadowed the need to understand differential performance of such strategies under various conditions. Methods allowing for assessment between implementation context and process can help address this gap. This paper provides a detailed description of a mixed method procedure for assessing factors related to the implementation context and process intersection, which was developed as part of the pilot study of the Housing First Technical Assistance and Training (HFTAT) Program, a multifaceted strategy designed to support Housing First model implementation. Methods The HFTAT was pilot tested among a sample of three organizations. Our mixed method approach combines two tools often used in implementation research-the Stages of Implementation Completion and the Consolidated Framework for Implementation Research-in a novel way. Several stages to analysis were completed, starting with a separate analysis of data pertaining to each measure and then two levels of mixed method analysis. Results The approach provided a better understanding of the issues that impacted the implementation guided by the HFTAT, suggesting: (1) individual determinants seemed to have a bigger impact based on the number of SIC phases they affected, (2) implementation context and process were connected through climate-related factors in the inner setting that made the sites more or less responsive to addressing identified barriers, and (3) there is a need to better assess context factors to identify areas where implementation drivers should be better targeted to facilitate change, and this is supported by prior research. Conclusions Understanding the underlying factors impacting a setting's performance related to a specific implementation strategy has potential to improve decision-making and optimize future implementation efforts. The approach likely be as successful combining the SIC with other determinant frameworks and should be utilized at the onset of an implementation project to maximize its usefulness.
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Affiliation(s)
| | - Nyssa Snow-Hill
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | | | | | - Monte Staton
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, & Policy, University of Illinois at Chicago
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
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