High rates of mental health, behavioral health, and substance use disorders are documented among youth in the criminal-legal system. Rates of suicidal behavior are elevated among this population due to a confluence of risk factors, including traumatic exposure, impulsivity, and substance use. However, many youths are left untreated, whether due to low rates of referral, treatment linkage, or service uptake.
The e-Connect system is an evidence-based mental health screening tool designed to educate probation officers on identifying suicidal behavior and associated behavioral health risk, facilitate cooperation between juvenile criminal-legal and behavioral health agencies, and create referral plans for behavioral health services.
Studies show that probation officers who used e-Connect were five times more likely to identify youths with suicidal thoughts and behaviors. However, when e-Connect or similar systems are broadly adopted and implemented, public agencies incur costs for the system as well as downstream costs associated with actions prompted by the behavioral health screen.
In a research article in Health & Justice, Dr. Sean Murphy, professor of population health sciences, and colleagues conducted a site-specific micro-costing analysis alongside a study evaluating the effectiveness of e-Connect.
The analysis utilized data from study instruments, semi-structured interviews, and administrative records for 622 youths aged 10 to 18 who entered the probation system. Researchers evaluated “real-world” resource and cost requirements for e-Connect from the perspectives of probation departments and policymakers and organized these according to implementation and sustainment phases.
Findings indicate that the average probation department would incur $7,216 over the course of the first year to implement e-Connect. Upon reaching the sustainment phase and paying off fixed start-up costs, the cost would fall to $2,086, denoting $17 per behavioral health screen. From a policymaker perspective, which incorporated the additional clinical and legal resources required to ensure a seamless clinical response, the average per-county implementation cost would be $18,704. Upon reaching the sustainment phase, this falls to $13,374, denoting $146 per behavioral health screen.
The results of this analysis can inform the resource allocation decisions of probation departments and policymakers interested in implementing e-Connect, or a similar behavioral health screening system. The absence of such information is often cited as a barrier to uptake. Moreover, the site-level estimates provide important details regarding the resources and costs associated with alternative implementation and management strategies.
- Highlights