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. 2025 Apr 21;13(1):24.
doi: 10.1186/s40352-024-00312-6.

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

Techna Cadet  1 , Katherine S Elkington  2 , Margaret Ryan  2 , Ali Jalali  3 , Gail A Wasserman  2 , Faye S Taxman  4 , Michael L Dennis  5 , Sean M Murphy  3
Affiliations

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

Techna Cadet et al. Health Justice. .

Erratum in

Abstract

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.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: No competing interests to declare.

Figures

Fig. 1
Fig. 1
Total policymaker-relevant annualized implementation and sustainment costs, by county
Fig. 2
Fig. 2
Average policymaker-relevant sustainment costs, per e-connect screen
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References

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    1. Centers for Disease Control and Prevention (2015). Rates of Mental and BehavioralHealth Service Providers by County.

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