Cost of Implementing Substance Use Disorder Treatment Strategies for Youth in the Legal System
Cost analysis alongside the multi-state JJ-TRIALS study provides data to inform implementation of new treatment strategies for youth.
In a new article in the Journal of Substance Use and Addiction Treatment, lead author and CHERISH Methodology Core Director Kathryn McCollister and colleagues conducted a cost analysis of implementing evidence-based interventions to improve substance use disorder (SUD) treatment among youth in the legal system (YLS). By analyzing implementation costs, this study offers insights about interagency planning, resource barriers, and expanding YLS access to treatment.
YLS are disproportionately affected by both substance use and mental health disorders. Yet only a small fraction of those identified as needing care are referred to treatment, and fewer utilized services. Coordination between juvenile justice and behavioral health agencies is critical for improving YLS access to SUD treatment, but sustaining these efforts requires addressing cost and staffing barriers through implementation support and stable funding.
The Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) is a NIDA-funded research study aimed to improve the coordination of SUD and behavioral health services for YLS. JJ-TRIALS was organized as a research cooperative that included NIDA, a coordinating center, six academic research centers, and 36 county juvenile justice agencies across seven states.
In their cost-analysis conducted alongside JJ-TRIALS, McCollister and colleagues compared the costs of Core and Enhanced sites. Core interventions involved needs assessment, staff training, and data-driven decision making to improve practices while Enhanced interventions added implementation facilitators to help sites apply data-driven decision-making principles. Expenditures were categorized into three study phases: Baseline (6 months of Core support and training), Experiment (a 12-month period comprising Early and Late phases after randomization to Core or Enhanced interventions), and Sustainment (6 months following the intervention period). The team used a micro-costing approach and captured the costs of staff time, travel time, space, and supplies, using cost tracking worksheets and interviewer-led staff surveys.
The cost analysis of JJ-TRIALS provides insight into how tracking costs in a study setting can help juvenile justice and behavioral health agencies forecast the resources needed to implement and sustain interventions for substance use disorder.
Key Findings
- Although Enhanced intervention sites had higher costs, both Enhanced and Core sites illustrated a similar trend of decreasing costs in the Experiment phase, reflecting fewer meetings and participants over time.
- Baseline represented the largest cost, averaging $11,083 per site, with Enhanced sites incurring higher costs at $13,176 compared to $9,222 for Core sites. Major costs were driven by research center-led activities, such as needs assessment group interviews and goal selection trainings, reflecting the leading role of research centers in delivering Core support activities to juvenile justice and behavioral health partners.
- Across all sites, Enhanced implementation costs were higher, as expected, given that Enhanced sites featured an Implementation Facilitator who supported implementation goals and encouraged monthly workgroup meetings. At the Early Experiment phase, the average monthly costs were $901 per Enhanced site and $348 per Core site, declining to $711 and $233 respectively in the Late Experiment phase.
- Core and Enhanced sites both spent $2,500 on average for the entire Maintenance phase.
From an economic perspective, JJ-TRIALS provides an understanding of how such partnerships can be attained at relatively modest costs, but these costs can still be burdensome enough to make sustaining partnerships across juvenile justice and behavioral health sectors challenging.
Kathryn McCollister PhD, Professor of Health Economics in the Department of Public Health Sciences at the University of Miami Miller School of Medicine
This is the first study to analyze the costs of implementing interventions within juvenile justice and behavioral health partnerships. When adopting new practices, many agencies lack financial and staff resources to allocate toward additional meetings and training. Documenting activities and implementation costs offers policy makers valuable evidence that they can use when developing new strategies to improve service delivery. The authors suggest further research to focus on variations in resource needs and costs across rural and urban settings and different juvenile justice populations.
The study, “Addressing unmet need for substance use disorder treatment among youth in the legal system (YLS): Costs of structured implementation interventions with juvenile justice agencies in seven states,” was published online in the Journal of Substance Use and Addiction Treatment on May 28, 2025.
Rachel Wang is a communications intern at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV. She provides communications support and assists with disseminating research related to substance use disorder. She is currently a senior at Hunter College, majoring in Human Biology. With a background in patient care, she aspires to be a physician assistant dedicated to improving care for underserved populations and advancing research related to health equity.