The Cost of Implementing New Strategies (COINS): examples from the US and UK

Objectives This presentation will describe the Cost of Implementing New Strategies (COINS) method and provide examples from collaborations occurring within the United States and United Kingdom. When agencies, states, or other... [ view full abstract ]

Objectives
This presentation will describe the Cost of Implementing New Strategies (COINS) method and provide examples from collaborations occurring within the United States and United Kingdom. When agencies, states, or other entities decide whether or not to implement a new practice they are faced with considering the costs of delivering that practice along with the costs associated with going through the implementation process itself. This can be daunting, especially when implementation costs are likely to differ not only across evidence-based practices (EBPs), but also between different implementation strategies, and contexts. Although leading frameworks include conceptualization of implementation process costs, such costs are unstudied.
Child welfare agency decision-makers are particularly challenged to provide the highest quality services with limited resources and multiple competing policy initiatives and demands. Opportunity costs must be considered against the uncertainty of future benefits. Knowing when different types of costs can be expected during the implementation process could prove critical in helping decision makers map out a clear fiscal plan to ensure proper and timely resource allocation. Thus, standardized methods for assessing implementation costs that take into consideration different contextual landscapes are critical.
Method
The COINS method was developed to address the gap in standardized assessment of implementation costs. Implementation processes have been defined for a range of EBPs using the Stages of Implementation Completion (SIC). The SIC is an observational assessment of agencies adopting new EBPs, with items spanning 8 stages from Engagement in the implementation to achieving Competency in the delivery of the EBP. The COINS method was developed to operationalize the costs and human resources necessary to accomplish these activities at each of these stages
Three varieties of costs must be measured within each stage of the SIC to evaluate the total cost of implementation: (1) Direct cost of the implementation services to the site, including fees charged by the EBP purveyor; (2) indirect costs of site personnel time that is spent conducting the implementation (i.e., doing things that do not directly produce client services, and which will not be necessary once implementation is complete); and (3) ancillary costs made up of the actual infrastructure (and other) investments that are required for implementation.
Using a mixed approach of assessment of budgets, fixed fees from EBP developers, and qualitative interviews with agency leaders attempting to adopt EBPs, COINS data will be compared across a range of EBPs and contexts. A case example from the UK will be detailed to illustrate the challenges of collecting such data, yet the value in having a standardized structure for doing so.
Results
The COINS method demonstrates success in differentiating between implementation strategies as well as EBPs and is successful in detailing the amount of human resources necessary for successful implementation. The COINS method has been used successfully to explore the costs associated with the introduction of social pedagogy into UK foster care (the Head, Heart, Hands Programme). Cost information has been gathered and categorized according to the three varieties of costs outlined in the COINS method.
Conclusions
Strategies such as COINS could help clarify what resources are needed and when, decreasing the potential for both under- and overestimation of resource needs. This strategy also could inform decision-makers who already have sunk costs, and are weighing the value in continuing or not. COINS might lead to more informed decision-making rather than following the assumption that all implementation activity costs are “equal.” Furthermore, the experience of using the COINS method for the Head, Heart, Hands, social pedagogy programme has indicated the transferability of the approach to the UK context and also for a programme with philosophical roots, rather than an EBP.