The cost of implementing new strategies (COINS): A method for mapping implementation resources using the stages of implementation completion

Objective: Illustrate the value of a strategy used for measuring the costs and resources used in the implementation process over and above the costs of the intervention itself in the context of a two-arm randomized controlled trial. Methods: Counties in California and Ohio (sites) were invited to implement Multidimensional Treatment Foster Care (MTFC), an alternative to congregate care for youth. Participating sites (n = 53) were randomized to one of two implementation strategies, (1) Community Development Teams (CDT) where sites share information and move through the implementation process as a cohort facilitated by an MTFC purveyor or (2) Individual Implementation (IND: "as usual") where sites work individually with the MTFC purveyor. The implementations were monitored using the Stages of Implementation Completion (SIC) measure of a number of observable activities, developed as part of the trial to segment the implementation process into 8 stages of implementation. Resource data gathered from the implementation purveyors and site participants were used to map costs onto each of the 8 stages to generate total cost measures stratified by type of resource and stage of implementation for each of the study arms. Results: The SIC provided a feasible costing template to map costs onto observable activities and to enable the examination of important differences in implementation strategies for an evidence-based practice. The average total implementation cost prior to program start-up of CDT was $133,106; IND costs $118,699. While CDT costs more in a number of stages, it resulted in fewer county staff hours being used and shorter mean times to implementation than IND. In cases where rapidity of implementation of reducing staff time required for implementation is valued, then CDT would be the preferable implementation approach. Conclusions: The SIC is a useful tool for determining implementation resources needed for new evidence-based practice programs for youth and particularly for comparing different implementation strategies that might be tried in pilot programs. (C) 2013 Elsevier Ltd. All rights reserved.