Community-based implementation of trauma-focused interventions for youth: Economic impact of the learning collaborative model.

Abstract

This study investigated the economics of the learning collaborative (LC) model in the implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), an evidence-based intervention for traumatic stress in youth. We evaluated the cost-effectiveness of the LC model based on data from 13 LCs completed in the southeastern United States. Specifically, we calculated cost-effectiveness ratios (CERs) for two key service outcomes: (1) clinician TF-CBT competence, based on pre- and post-LC self-ratings (n = 574); and (2) trauma-related mental health symptoms (i.e., traumatic stress and depression), self- and caregiver-reported, for youth who received TF-CBT (n = 1,410). CERs represented the cost of achieving one standard unit of change on a measure (i.e., d = 1.0). The results indicated that (1) costs of $18,679 per clinician were associated with each unit increase in TF-CBT competency and (2) costs from $5,318 to $6,548 per youth were associated with each unit decrease in mental health symptoms. Thus, although the impact of LC participation on clinician competence did not produce a favorable CER, subsequent reductions in youth psychopathology demonstrated high cost-effectiveness. Clinicians and administrators in community provider agencies should consider these findings in their decisions about implementation of evidence-based interventions for youth with traumatic stress disorders.

Proposing a mechanistic model of clinician training and consultation.

“…Studies of Learning Collaboratives focused on client outcomes have found that this method is associated with improved engagement in behavioral health services (Cavaleri et al, 2006(Cavaleri et al, , 2007(Cavaleri et al, , 2010Rutkowski et al, 2010), including initiating (Cavaleri et al, 2006) and sustaining (Cavaleri et al, 2007) gains in initial appointment attendance rates. It also has been associated with improvements in children's behavioral support services in schools (Stephan, Connors, Arora, & Brey, 2013) and trauma-focused service providers (Dopp, Hanson, Saunders, Dismuke, & Moreland, 2017;Lang, Franks, Epstein, Stover, & Oliver, 2015).…”

Evaluation of the Mental Health Services Act in Los Angeles County: Implementation and Outcomes for Key Programs

“…A pre-post analysis of the impact of scaling up MAP in LA County demonstrated significant improvements in client outcomes (Southam-Gerow et al, 2014). While the evidence for MAP as a system is limited, it is built on the deep and well-established literature of EBPs for delivery in community mental health systems (Chorpita, Daleiden, and Collins, 2014 (Cohen, Mannarino, and Deblinger, 2016), TF-CBT has extensive empirical evidence supporting its ability to reduce PTSD, depressive symptoms, and behavioral problems among children ages 3-18 who have experienced different traumas (e.g., Allen and Hoskowitz, 2017;Dopp et al, 2017;Lang and Connell, 2017;Lang et al, 2015;Roundfield and Lang, 2017;Wamser-Nanney and Steinzor, 2017). It has been implemented across the globe in a wide variety of settings.…”

Making Implementation Last: Understanding the Sustainability of an Evidence-based Treatment

“…LC models may be effective in improving clinicians' networks of advice, and serve as a means of informal support throughout implementation (Bunger et al, 2016). Compared to other training methods, the LC is costly at approximately $19,000 per clinician (Dopp, Hanson, Saunders, Dismuke, & Moreland, 2017). A cost-effectiveness analysis revealed that the LC model may be less cost-effective than other training approaches in improving clinician skill; however, the subsequent changes in client outcomes were highly costeffective (Dopp et al, 2017).…”

“…Compared to other training methods, the LC is costly at approximately $19,000 per clinician (Dopp, Hanson, Saunders, Dismuke, & Moreland, 2017). A cost-effectiveness analysis revealed that the LC model may be less cost-effective than other training approaches in improving clinician skill; however, the subsequent changes in client outcomes were highly costeffective (Dopp et al, 2017). Another study found that the LC model was ineffective at increasing provider use of preventive services (Solberg et al, 2000).…”