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The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

Using Conservation of Resources Theory (COR), the current study examined the relationship between exposure to trauma, resources, and behavioral health in a prospective longitudinal cohort of youth in a public behavioral health system. The sample includes 303 youth, aged 5-19, who had received 6 months of treatment-asusual in an urban, diverse public behavioral health system, and who had experienced at least one type of trauma. Youth entered treatment with an average of four types of trauma and five accessible resources. Consistent with COR, multivariate regression model results showed that both lifetime exposure to trauma and youth resources were significantly associated with behavioral health needs, upon entry to treatment and after 6 months of treatment. Losing resources over 6 months of treatment was associated with greater behavioral health needs, while maintaining or gaining resources over 6 months of treatment was associated with fewer behavioral health needs. This study highlights the need to explore resource gain and resource loss among clients with trauma exposure receiving services in a public system, further test COR-related hypotheses in treatment settings, and develop applicable, multi-level interventions.

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