From leadership research to district action: A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Obtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives. Methods Our study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives. Results Based on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget). Conclusions Previous research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives. Trial registration ClinicalTrials.gov NCT04752189. Registered on 12 February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-023-00511-6.

Study methods

The current study focuses on reporting costs related to deploying implementation strategies for the Michigan Model for Health™ universal prevention curriculum as part of a group RCT. Specifically, we focus on quantifying the incremental implementation costs of deploying the Enhanced REP implementation strategy bundle. We use an experimental embedded mixed method design to obtain a more in-depth understanding of the results (see Fig. 2), focusing on applying qualitative results to support the expansion and explanation of quantitative results. We also estimate the costs of replicating Enhanced REP for universal prevention in other school settings by determining the budget impact of reallocating costs to likely interested parties based on shareholder input.

Limitations

While we estimated costs related to the implementation strategy within the education sector and outside (e.g., personal time costs) when these could be reasonably estimated for this pragmatic evaluation, this did not fully capture all costs. Teacher time costs do not fully reflect the opportunity cost of time to participate in Enhanced REP as we could not capture the full scope of all such costs. While important, these costs are also complex and challenging to capture due to the high participant burden. The costs relate to time costs potentially diverted from other work activities that can impact productivity and outside work (e.g., impact on personal time costs). However, pragmatic costing of implementation studies requires a balance between accurate estimates and shareholder burden. In the current pilot study, it was not feasible to estimate all costs comprehensively at all levels. The level of accuracy of reported costs, especially the non-IF costs, may vary as some of the costs were based on recall of past events. We focused on greater precision with the IF costs within the education sector, using weekly time logs, as this was a demonstrated influential parameter in previous research [65].

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Andria B. Eisman; Jacob Whitman; Lawrence A. Palinkas; Judy Fridline; Christina Harvey; Amy M. Kilbourne; David W. Hutton. A mixed methods partner-focused cost and budget impact analysis to deploy implementation strategies for school-based prevention. Implementation Science Communications (2023-11-09). https://doi.org/10.1186/s43058-023-00511-6

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.