Community implementation of contingency management to address stimulant use

Abstract

IntroductionContingency management (CM) is efficacious for reinforcing stimulant abstinence, and technical assistance (TA) is increasingly sought to aid its community-based implementation. In an interagency partnership involving a sponsoring single-state authority and statewide treatment agency in Oregon, an intermediary purveyor organization provided a robust TA package to support design, implementation, and evaluation of CM programming for an opioid treatment program (OTP) over the course of a 12-month implementation service project. MethodsIn addition to an online training offering OTP leaders and staff conceptual foundation for CM, the TA package included purveyor-led activities to: 1) engage leaders in collaborative design to customize CM programming; 2) assemble a local implementation team to logistically prepare OTP systems for CM delivery; 3) provide virtual coaching-to-criterion to assure readiness of counseling staff to deliver CM programming; 4) compile a tailored CM resource library of implementation support materials; and 5) avail ongoing consultation during implementation. Stimulant abstinence was targeted via a voucher-based protocol with escalating reinforcement, for which gift cards from local vendors served as reinforcers. Virtual coaching eventuated in individual role-play assessments, wherein staff delivery of CM programming with a standardized patient was scored via Likert scale (1 = Very Poor, 7 = Excellent) on six CM fidelity dimensions. This observational cohort design subsequently assessed clinical effectiveness during active implementation via OTP records review for CM-exposed and comparison client groups. ResultsIn role-play assessments, all counseling staff exceeded an a priori fidelity benchmark signifying implementation readiness (M = 31.33, SD = 3.72). Among 73 clients enrolled in the CM programming, rate of stimulant-free urine drug screens was 11 % greater than among 120 clients serving as historical controls (p < .01; Cohen's D = 0.40). The study also identified secondary therapeutic benefit in six-month treatment retention, with clients enrolled in CM retained at a 14 % greater rate than 162 CM-ineligible clients concurrently enrolled in OTP services (p < .05). ConclusionsFindings from this interagency partnership offer reason for optimism regarding community-based implementation. Beyond the demonstrated empirical support for this TA package and resulting clinical effectiveness of the CM programming, an eventual sustainment decision by OTP leadership strengthens the rationale for customizing CM to clinical settings' local needs and resources.