A microcosting approach for planning and implementing community-based mental health prevention program: what does it cost?

Sharmily Roy; Henry Shelton Brown 3rd; Lisa Sanger Blinn; Sarah Carter Narendorf; Jane E Hamilton

doi:10.1186/s13561-024-00510-w

A microcosting approach for planning and implementing community-based mental health prevention program: what does it cost?

Health Econ Rev. 2024 May 21;14(1):35. doi: 10.1186/s13561-024-00510-w.

Authors

Sharmily Roy^{1

2}, Henry Shelton Brown 3rd³, Lisa Sanger Blinn⁴, Sarah Carter Narendorf⁵, Jane E Hamilton⁶

Affiliations

¹ School of Public Health, Department of Management Policy and Community Health, University of Texas Health Science Center, Houston, 1200 Pressler St, Houston, TX, 77030, USA. sharmily.roy@gmail.com.
² School of Public Health, University of Texas Health Science Center, Houston, 1200 Pressler St, Houston, TX, 77030, USA. sharmily.roy@gmail.com.
³ School of Public Health, Department of Management Policy and Community Health, University of Texas Health Science Center, Houston, 1200 Pressler St, Houston, TX, 77030, USA.
⁴ The Harris Center for Mental Health and IDD, 9401 Southwest Freeway, Houston, TX, 77074, USA.
⁵ Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204, USA.
⁶ Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, 1941 East Road, Houston, TX, 77054, USA.

Abstract

Background: Estimating program costs when planning community-based mental health programs can be burdensome. Our aim was to retrospectively document the cost for the first year of planning and implementing Healthy Minds Healthy Communities (HMHC), a mental health promotion and prevention multi-level intervention initiative. This Program is among the first to use the Community Initiated Care (CIC) model in the US and is aimed at building community resilience and the capacity for communities to provide mental health support, particularly among those disproportionately impacted by COVID-19. Our objective is to share our methods for costing a program targeting 10 zip codes that are ethnically and linguistically diverse and provide an example for estimating the cost of a mental health prevention and promotion programs consisting of multiple evidence-based interventions.

Methods: We used a semi-structured interview process to collect cost data through the first year of program planning, start-up and initial implementation from key staff. We calculated costs for each activity, grouped them by major project categories, and identified the cost drivers of each category. We further validated cost estimates through extensive literature review. The cost analysis was done from the provider's perspective, which included the implementing agency and its community partners. We delineated costs that were in-kind contributions to the program by other agency, and community partners. Sensitivity analyses were conducted to estimate uncertainty around parameters.

Results: For the first year of the development and implementation of the program, (funded through program and in-kind) is estimated at $1,382,669 (2022 US$). The costs for the three main activity domains for this project are: project management $135,822, community engagement $364,216 and design and execution $756,934. Overall, the cost drivers for the first year of this intervention were: hiring and onboarding staff, in-person community building/learning sessions, communications and marketing, and intervention delivery.

Conclusion: Implementation of community-based mental health promotion and prevention programs, when utilizing a participatory approach, requires a significant amount of upfront investment in program planning and development. A large proportion of this investment tends to be human capital input. Developing partnerships is a successful strategy for defraying costs.

Keywords: Activity-based costing; Community based behavioral health program; Implementation costing; Mental health promotion; Microcosting; Preventive/preventative program planning; Start-up costs.