6 - (IOP 13) At What Cost? A Time-driven Activity-based Costing Analysis of Implementing a School-based Transdiagnostic Intervention

Background: Schools provide a strategic setting for youth mental health interventions by reducing barriers and stigma, yet successful implementation remains a challenge due to insufficiently specified implementation strategies and resource constraints. To ensure scalability, schools need a clear understanding of the feasibility, workforce demands, and resource requirements of evidence-based interventions. This study evaluates the implementation costs of the Unified Protocol for Preventing Emotional and Academic Challenges in Education (U-PEACE), an adaptation of the Unified Protocol for Adolescents into a school-based prevention program. Using Time-Driven Activity-Based Costing (TDABC), we systematically track resource use, personnel workload, and economic costs to inform sustainable implementation strategies. By providing a detailed implementation process map with comprehensive resource use and cost analysis, this study addresses a critical research gap and offers a replicable framework for evaluating implementation costs of school-based mental health interventions.

Methods: U-PEACE implementation was evaluated in three high-schools over 1.5 years, with training and consultation as core implementation strategies to support school coaches and supervision of program clinicians. Using TDABC, we mapped resource utilization and calculated implementation costs. We developed a process map of implementation workflow, tracking time-based and non-time-based resources at each step to determine costs from a payer perspective.

Results: The total implementation cost was $32,982, entirely attributed to personnel expenses. The largest share went to implementation facilitator (31%) and project coordinator (28%) time, followed by program director time (19%) and clinician time (15%). A significant portion of personnel costs was allocated to problem-solving meetings and administrative work (32%), supervision of clinicians (27%), and coordination and monitoring (23%), along with clinician and coach training and education (8%), consultation of coaches (6%), and stakeholder engagement (4%).

Conclusion: This study highlights that implementation strategies can be prospectively identified, tracked and costed in efficacy research. Early specification enables informed decisions on which to refine, sustain, or phase out, enhancing adoption and impact. Personnel expenses constituted all the implementation costs, consistent with previous research , with monitoring, coordination and administrative activities comprising over half of total cost. Schools implementing similar interventions should anticipate these administrative demands alongside direct delivery costs, as shown in similar studies. Strategic role allocation, such as leveraging existing staff (e.g., mental health coordinators, program managers) for coordination functions could improve feasibility and cost efficiency. Future efforts should streamline administrative processes while maintaining program integrity, reducing costs and enhancing scalability. Understanding context-specific implementation costs is crucial as poor resource planning can lead to discontinued interventions, wasted resources, and limited reach.