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Cunningham PB, Naar S, Roberts JR, Powell J, Ledgerwood DM, Randall J, Lozano BE, Halliday CA, Madisetti M, Ghosh S. Study protocol for clinical trial of the FIT Families multicomponent obesity intervention for African American adolescents and their caregivers: Next step from the ORBIT initiative. BMJ Open 2024; 14:e074552. [PMID: 38355187 PMCID: PMC10868253 DOI: 10.1136/bmjopen-2023-074552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family Support (HBFS). This protocol paper describes the design of a randomised clinical trial testing the efficacy of the FIT intervention. The protocol will assess the efficacy of FIT to improve health status in African American adolescents with obesity (AAAO) and their primary caregivers on primary (percent body fat) and secondary (physical activity, metabolic control, weight loss) outcomes and its cost-effectiveness. METHODS 180 youth/caregiver dyads are randomised into FIT or HBFS, stratified by age, gender and baseline per cent overweight. The proposed study follows a two condition (FIT, HBFS) by four assessment time points. Tests will be conducted to identify potential relationship of baseline demographic and clinical variables to our dependent variables and see whether they are balanced between groups. It is hypothesised that youth/caregiver dyads randomised to FIT will show significantly greater reductions in percent body fat over a 12-month follow-up period compared with AAAO receiving HBFS. Preliminary findings are expected by November 2023. ETHICS This protocol received IRB approval from the Medical University of South Carolina (Pro00106021; see 'MUSC IRB 106021 Main Approval.doxc' in online supplemental materials). DISSEMINATION Dissemination activities will include summary documents designed for distribution to the broader medical community/family audience and submission of manuscripts, based on study results, to relevant peer-reviewed scientific high-impact journals. TRIAL REGISTRATION NUMBER NCT04974554.
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Affiliation(s)
- Phillippe B Cunningham
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, FSU College of Medicine, Florida State Univ, Tallahassee, Florida, USA
| | - James R Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer Powell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Jeff Randall
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian E Lozano
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen A Halliday
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samiran Ghosh
- Department of Biostatistics and Data Science, University of Texas School of Public Health, Houston, Texas, USA
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Becker SJ, DiClemente-Bosco K, Rash CJ, Garner BR. Effective, but underused: lessons learned implementing contingency management in real-world practice settings in the United States. Prev Med 2023; 176:107594. [PMID: 37385413 PMCID: PMC10753028 DOI: 10.1016/j.ypmed.2023.107594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023]
Abstract
Despite being one of the most effective adjunctive behavioral interventions in combination with medication for opioid use disorder, contingency management (CM) is one of the least available interventions in opioid treatment programs. This paradoxical state of affairs is perhaps the greatest example of the research-to-practice gap in the behavioral health field. Implementation science, a discipline that aims to identify replicable methods that can be used across settings and populations to bridge the gap between research and practice, can potentially help. Based on our team's experience implementing CM in opioid treatment programs, we detail five key lessons for researchers, clinicians, policy makers, and others seeking to implement and sustain CM in real-world settings. First, multiple barriers to CM implementation exist at both the counselor- and organization-levels, requiring multi-level solutions. Second, one-shot CM training alone is not sufficient for successful implementation: ongoing support is essential to achieve levels of intervention fidelity that will benefit patients. Third, assessing an organization's capacity for implementation prior to support provision can prevent costly mistakes. Fourth, implementors should plan for high staff turnover rates and expect the unexpected by developing detailed contingency plans. Finally, implementors should remember that the goal is to implement evidence-based CM and not simply incentives. We encourage colleagues to consider these lessons to increase the likelihood that CM can be implemented and sustained in a manner that improves the quality of care in opioid treatment programs.
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Affiliation(s)
- Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL 60611, United States of America.
| | - Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Northwestern Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL 60611, United States of America.
| | - Carla J Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health, 263 Farmington Avenue, Farmington, CT 06030, United States of America.
| | - Bryan R Garner
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Road, Columbus 43221, United States of America.
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Becker SJ, DiClemente-Bosco K, Scott K, Janssen T, Salino SM, Hasan FN, Yap KR, Garner BR. Implementing contingency management for stimulant use in opioid treatment programs: protocol of a type III hybrid effectiveness-stepped-wedge trial. Implement Sci 2023; 18:41. [PMID: 37705093 PMCID: PMC10498624 DOI: 10.1186/s13012-023-01297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Contingency management (CM) is an evidence-based intervention for stimulant use and is highly effective in combination with medication for opioid use disorder. Yet, uptake of CM in opioid treatment programs that provide medication for opioid use disorder remains low. This paradox in which CM is one of the most effective interventions, yet one of the least available, represents one of the greatest research-to-practice gaps in the addiction health services field. Multi-level implementation strategies are needed to address barriers to CM implementation at both the provider- and organization-level. This type III hybrid effectiveness-implementation trial was funded by the National Institute on Drug Abuse to evaluate whether a multi-level implementation strategy, the Science of Service Laboratory (SSL), can effectively promote CM implementation in opioid treatment programs. Specific aims will test the effectiveness of the SSL on implementation outcomes (primary aim) and patient outcomes (secondary aim), as well as test putative mediators of implementation outcomes (exploratory aim). METHODS Utilizing a fully powered type III hybrid effectiveness-implementation trial with a stepped wedge design, we propose to randomize a cohort of 10 opioid treatment programs to receive the SSL across four steps. Each step, an additional 2-3 opioid treatment programs will receive the SSL implementation strategy, which has three core components: didactic training, performance feedback, and external facilitation. At six intervals, each of the 10 opioid treatment programs will provide de-identified electronic medical record data from all available patient charts on CM delivery and patient outcomes. Staff from each opioid treatment program will provide feedback on contextual determinants influencing implementation at three timepoints. DISCUSSION Between planning of this protocol and receipt of funding, the landscape for CM in the USA changed dramatically, with multiple Departments of Health launching state-wide CM initiatives. We therefore accelerated the protocol timeline and offered some cursory training resources to all sites as a preparation activity. We also began partnering with multiple Departments of Health to evaluate their rollout of CM using the measures outlined in this protocol. TRIAL REGISTRATION This study protocol is registered via ClinicalTrials.gov Identifier: NCT05702021. Date of registration: January 27, 2023.
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Affiliation(s)
- Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA.
| | - Kira DiClemente-Bosco
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA
| | - Kelli Scott
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA
| | - Tim Janssen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Providence, RI, 02906, USA
| | - Sarah M Salino
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA
| | - Fariha N Hasan
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA
| | - Kimberly R Yap
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair Street, Chicago, IL, 60611, USA
| | - Bryan R Garner
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, 2050 Kenny Road, Columbus, 43221, USA
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Rash CJ. Implementing an evidence-based prize contingency management protocol for stimulant use. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 151:209079. [PMID: 37230390 PMCID: PMC10330855 DOI: 10.1016/j.josat.2023.209079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/29/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Contingency management (CM) is an efficacious treatment for stimulant use disorders. Support materials for the clinical delivery of prize-based CM are widely accessible, but few resources are available to support design and preparation for CM implementation. This guide aims to fill that gap. METHOD/RESULTS The article outlines a suggested prize CM protocol and discusses the best practices most aligned with the evidence base and acceptable-if-necessary modifications. This guide also highlights modifications that are not evidence-based and not recommended. In addition, I discuss practical and clinical aspects of preparing for CM implementation. CONCLUSIONS Deviations from evidence-based practices are common, and poorly designed CM is unlikely to impact patient outcomes. This article provides planning stage guidance to support programs' adoption of evidence-based prize CM for the treatment of stimulant use disorders.
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Ryan-Pettes SR, Morrison M, Randall J, Halliday C, Ledgerwood DM, Cunningham PB. Juvenile Probation Officer Perception of Contingency Management to Target Caregiver Engagement and Training Outcomes. JOURNAL OF OFFENDER REHABILITATION 2023; 62:315-335. [PMID: 38046203 PMCID: PMC10688515 DOI: 10.1080/10509674.2023.2213692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Few community-based substance use treatment programs are available or skilled in treating justice-involved youth, highlighting the need to equip juvenile probation officers with the skills to deliver evidence-based substance use treatment. Contingency management (CM) is evidence-based for treating substance use and shows promise for juvenile probation officers' successful uptake (positive opinions and trainability). However, research has not examined whether probation officers' positive beliefs and trainability generalize to target behaviors beyond those displayed by youth, but that nevertheless affect youth outcomes. This study examined probation officers' perceptions of using CM to engage caregivers and assessed probation officers' CM knowledge and CM delivery after training in a protocol-specific CM program for caregivers of substance-using youth on probation. Results showed probation officers were ambivalent about CM for caregivers. Results also showed that age, training format and how competency is assessed may be essential to consider. Implications for the dissemination of CM and future research are discussed.
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Affiliation(s)
- Stacy R. Ryan-Pettes
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Meghan Morrison
- Baylor University, Department of Psychology and Neuroscience, One Bear Place 97334, Waco, Texas 76798
| | - Jeff Randall
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - Colleen Halliday
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park, Detroit, MI 48201
| | - Phillippe B. Cunningham
- Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Family Services Research Center, Medical University of South Carolina, 176 Croghan Spur Rd., Ste 104, Charleston, SC 29407
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Henrich D, Glombiewski JA, Scholten S. Systematic review of training in cognitive-behavioral therapy: Summarizing effects, costs and techniques. Clin Psychol Rev 2023; 101:102266. [PMID: 36963208 DOI: 10.1016/j.cpr.2023.102266] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
With the steadily growing importance of psychotherapeutic care, there is also an increasing need for high-quality training. We analyze the literature published between 2009 and 2022 on the effectiveness of training in cognitive behavioral therapy. The review addresses current gaps in the literature by focusing on the description of specific training components and their associated costs, as well as examining therapist-level predictors of training effectiveness. Our findings confirm the effect of additional supervision on both therapist competence and patient outcomes. Instructor-led training and self-guided web-based training seem to moderately increase competence, especially when targeting specific and highly structured treatments or skills. The level of prior training and experience of a therapist appears to predict the strength of training-related gains in competence. Few studies analyzed the differential effect of certain elements of training (e.g., the amount of active learning strategies) and training costs were generally not reported. Future studies should replicate or expand the existing evidence on active ingredients and therapist-level predictors of training effectiveness. Costs should be systematically reported to enhance the comparability of different training strategies.
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Affiliation(s)
- Dominik Henrich
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| | - Saskia Scholten
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
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Sung ML, Viera A, Esserman D, Tong G, Davidson D, Aiudi S, Bailey GL, Buchanan AL, Buchelli M, Jenkins M, John B, Kolakowski J, Lame A, Murphy SM, Porter E, Simone L, Paris M, Rash CJ, Edelman EJ. Contingency Management and Pre-Exposure Prophylaxis Adherence Support Services (CoMPASS): A hybrid type 1 effectiveness-implementation study to promote HIV risk reduction among people who inject drugs. Contemp Clin Trials 2023; 125:107037. [PMID: 36460267 PMCID: PMC9918697 DOI: 10.1016/j.cct.2022.107037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND HIV disproportionally affects persons who inject drugs (PWID), but engagement with HIV pre-exposure prophylaxis (PrEP) is low. We describe the rationale and study design for a new study, "Contingency Management and Pre-Exposure Prophylaxis (PrEP) Adherence Support Services (CoMPASS)," a hybrid type 1 effectiveness-implementation trial to promote HIV risk reduction among PWID. METHODS In four community-based programs in the northeastern United States, PrEP-eligible PWID (target n = 526) are randomized to treatment as usual or Contingency Management (CM) and, as indicated, stepped up to PrEP Adherence Support Services (CoMPASS) over 24 weeks. During CM sessions, participants receive timely tangible rewards for verifiable activities demonstrating 1) PrEP initiation and adherence, and 2) engagement with medications for opioid use disorder (MOUD) and other OUD-related care. Participants who do not have high levels of biomarker-confirmed PrEP adherence at week 12 will be stepped up to receive PrEP Adherence Support Services (PASS) consisting of strengths-based case management over 12 weeks. Interventions are delivered by trained PrEP navigators, staff embedded within the respective sites. The primary outcome is sustained PrEP adherence by dried blood spot testing at 24 weeks. To inform future implementation, we are conducting implementation-focused process evaluations throughout the clinical trial. CONCLUSIONS Results from this protocol are anticipated to yield novel findings regarding the impact and scalability of CoMPASS to promote HIV prevention among PWID in partnership with community-based organizations. http://ClinicalTrials.gov identifier: NCT04738825.
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Affiliation(s)
- Minhee L Sung
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Guangyu Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Daniel Davidson
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Sherry Aiudi
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Genie L Bailey
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Stanley Street Treatment and Resources (SSTAR) Inc., Fall River, MA, USA
| | - Ashley L Buchanan
- College of Pharmacy, Department of Pharmacy Practice University of Rhode Island, South Kingston, RI, USA
| | | | - Mark Jenkins
- Connecticut Harm Reduction Alliance, Hartford, CT, USA
| | - Betsey John
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | | | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Laura Simone
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carla J Rash
- UConn Health School of Medicine, Farmington, CT, USA
| | - E Jennifer Edelman
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Dorey L, McGarrigle J, May R, Hoon AE, Dymond S. Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17101. [PMID: 36554983 PMCID: PMC9778966 DOI: 10.3390/ijerph192417101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.
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Affiliation(s)
- Lucy Dorey
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
| | - Jack McGarrigle
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
| | - Richard May
- School of Psychology and Therapeutic Studies, University of South Wales, Pontypridd CF37 1DL, UK
| | - Alice E. Hoon
- Swansea University Medical School, Singleton Campus, Swansea SA2 8PP, UK
| | - Simon Dymond
- School of Psychology, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
- Department of Psychology, Reykjavík University, Menntavegur 1, Nauthólsvík, 101 Reykjavík, Iceland
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Hartzler B, Hinde J, Lang S, Correia N, Yermash J, Yap K, Murphy CM, Ruwala R, Rash CJ, Becker SJ, Garner BR. Virtual Training Is More Cost-Effective Than In-Person Training for Preparing Staff to Implement Contingency Management. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-10. [PMID: 36246531 PMCID: PMC9553630 DOI: 10.1007/s41347-022-00283-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/18/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022]
Abstract
Behavior therapy implementation relies in part on training to foster counselor skills in preparation for delivery with fidelity. Amidst Covid-19, the professional education arena witnessed a rapid shift from in-person to virtual training, yet these modalities' relative utility and expense is unknown. In the context of a cluster-randomized hybrid type 3 trial of contingency management (CM) implementation in opioid treatment programs (OTPs), a multi-cohort design presented rare opportunity to compare cost-effectiveness of virtual vs. in-person training. An initial counselor cohort (n = 26) from eight OTPs attended in-person training, and a subsequent cohort (n = 31) from ten OTPs attended virtual training. Common training elements were the facilitator, learning objectives, and educational strategies/activities. All clinicians submitted a post-training role-play, independently scored with a validated fidelity instrument for which performances were compared against benchmarks representing initial readiness and advanced proficiency. To examine the utility and expense of in-person and virtual trainings, cohort-specific rates for benchmark attainment were computed, and per-clinician expenses were estimated. Adjusted between-cohort differences were estimated via ordinary least squares, and an incremental cost effectiveness ratio (ICER) was calculated. Readiness and proficiency benchmarks were attained at rates 12-14% higher among clinicians attending virtual training, for which aggregated costs indicated a $399 per-clinician savings relative to in-person training. Accordingly, the ICER identified virtual training as the dominant strategy, reflecting greater cost-effectiveness across willingness-to-pay values. Study findings document greater utility, lesser expense, and cost-effectiveness of virtual training, which may inform post-pandemic dissemination of CM and other therapies.
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Affiliation(s)
- Bryan Hartzler
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631 USA
| | - Jesse Hinde
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
| | - Sharon Lang
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Nicholas Correia
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Julia Yermash
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Kim Yap
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Cara M. Murphy
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Richa Ruwala
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
| | | | - Sara J. Becker
- Brown University Center for Alcohol and Addiction Studies, Providence, RI 02912 USA
| | - Bryan R. Garner
- Research Triangle Institute International, Research Triangle Park, NC 27709 USA
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Contingency management for treatment attendance: A meta-analysis. J Subst Abuse Treat 2022; 133:108556. [PMID: 34210566 PMCID: PMC8702584 DOI: 10.1016/j.jsat.2021.108556] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/12/2021] [Accepted: 06/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment providers have applied contingency management (CM) treatment, an intervention that often rewards individuals for drug abstinence (i.e., ABS CM), to treatment engagement as well. However, we know little about the magnitude of treatment effects when providers target attendance behaviors (i.e., ATT CM). METHODS This study conducted a systematic search to identify studies that included ATT CM, either in isolation or in combination with ABS CM. The study used meta-analysis to estimate the effect size of ATT CM and ABS CM + ATT CM on treatment attendance and drug abstinence. We identified a total of 10 studies including 12 CM treatments (6 ATT CM and 6 ABS CM + ATT CM) with 1841 participants. RESULTS Results indicated a moderate effect (d = 0.47, 95% confidence interval (CI) [0.25, 0.69]) of ATT CM on attendance relative to non-reward active comparison conditions. Frequency of rewards was significantly associated with larger effect sizes. Results also indicated a small effect (d = 0.22, 95% CI [0.12, 0.33]) of ATT CM on abstinence outcomes relative to nonreward comparisons, p < 0.001. The study found no significant differences in attendance or abstinence between ATT CM and ABS CM + ATT CM (p's > 0.05). CONCLUSION Overall, the results supported ATT CM for increasing treatment engagement, with smaller effects on abstinence. Effects on abstinence were smaller than those observed in prior meta-analyses focused on ABS CM. No significant differences existed in attendance or abstinence outcomes between ATT CM and ABS + ATT CM. However, future studies are needed to experimentally compare ABS CM + ATT CM to ABS CM, and ATT CM to determine additive effects. Clinics implementing CM should consider the differential effects between ATT CM and ABS CM when selecting target behavior(s).
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Edelman EJ, Dziura J, Deng Y, Bold KW, Murphy SM, Porter E, Sigel KM, Yager JE, Ledgerwood DM, Bernstein SL. A SMARTTT approach to Treating Tobacco use disorder in persons with HIV (SMARTTT): Rationale and design for a hybrid type 1 effectiveness-implementation study. Contemp Clin Trials 2021; 110:106379. [PMID: 33794354 PMCID: PMC8478961 DOI: 10.1016/j.cct.2021.106379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Tobacco use disorder is a leading threat to the health of persons with HIV (PWH) on antiretroviral treatment and identifying optimal treatment approaches to promote abstinence is critical. We describe the rationale, aims, and design for a new study, "A SMART Approach to Treating Tobacco Use Disorder in Persons with HIV (SMARTTT)," a sequential multiple assignment randomized trial. METHODS In HIV clinics within three health systems in the northeastern United States, PWH with tobacco use disorder are randomized to nicotine replacement therapy (NRT) with or without contingency management (NRT vs. NRT + CM). Participants with response (defined as exhaled carbon monoxide (eCO)-confirmed smoking abstinence at week 12), continue the same treatment for another 12 weeks. Participants with non-response, are re-randomized to either switch medications from NRT to varenicline or intensify treatment to a higher CM reward schedule. Interventions are delivered by clinical pharmacists embedded in HIV clinics. The primary outcome is eCO-confirmed smoking abstinence; secondary outcomes include CD4 cell count, HIV viral load suppression, and the Veterans Aging Cohort Study (VACS) Index 2.0 score (a validated measure of morbidity and mortality based on laboratory data). Consistent with a hybrid type 1 effectiveness-implementation design and grounded in implementation science frameworks, we will conduct an implementation-focused process evaluation in parallel. Study protocol adaptations related to the COVID-19 pandemic have been made. CONCLUSIONS SMARTTT is expected to generate novel findings regarding the impact, cost, and implementation of an adaptive clinical pharmacist-delivered intervention involving medications and CM to promote smoking abstinence among PWH. ClinicalTrials.govidentifier:NCT04490057.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Sean M Murphy
- CHERISH Center, Weill Cornell Medicine, New York, NY, United States of America
| | - Elizabeth Porter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Keith M Sigel
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jessica E Yager
- State University of New York Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - David M Ledgerwood
- Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale Center for Implementation Science, Yale School of Medicine, New Haven, CT, United States of America
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12
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Becker SJ, Murphy CM, Hartzler B, Rash CJ, Janssen T, Roosa M, Madden LM, Garner BR. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial. Addict Sci Clin Pract 2021; 16:61. [PMID: 34635178 PMCID: PMC8505014 DOI: 10.1186/s13722-021-00268-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). METHODS A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff's extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff's intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). DISCUSSION There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. TRIAL REGISTRATION This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1.
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Affiliation(s)
- Sara J. Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Cara M. Murphy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Bryan Hartzler
- Addictions, Drug, & Alcohol Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105 USA
| | - Carla J. Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Mat Roosa
- Roosa Consulting, LLC, 3 Bradford Drive, Syracuse, NY 13224 USA
| | - Lynn M. Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
| | - Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd.Research Triangle Park, P.O. Box 12194, Durham, NC 27709 USA
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13
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Stanger C, Kowatsch T, Xie H, Nahum-Shani I, Lim-Liberty F, Anderson M, Santhanam P, Kaden S, Rosenberg B. A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial. JMIR Res Protoc 2021; 10:e27109. [PMID: 33620330 PMCID: PMC7943343 DOI: 10.2196/27109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. OBJECTIVE In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a "core" intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. METHODS A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ≥ 8.0%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. RESULTS Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. CONCLUSIONS Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. TRIAL REGISTRATION ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27109.
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly Anderson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Sarah Kaden
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Briana Rosenberg
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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14
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Oluwoye O, Kriegel L, Alcover KC, McPherson S, McDonell MG, Roll JM. The dissemination and implementation of contingency management for substance use disorders: A systematic review. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:99-110. [PMID: 31259569 PMCID: PMC6938576 DOI: 10.1037/adb0000487] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is one of the most effective behavioral interventions for substance use. However, the implementation of contingency management has not been as widespread as might be expected given its efficacy. This review summarizes literature that examines the dissemination and implementation of contingency management for substance use in community (e.g., specialized substance use treatment) and clinical (e.g., primary care) settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases including Google Scholar, World of Knowledge, PsycINFO, and PubMed were searched. Search results yielded 100 articles and after the screening of titles and abstracts 44 were identified. Full-text articles were examined for eligibility and yielded 24 articles that were included in this review. Of the 24 articles included in the review, the majority (n = 11) focused on implementing contingency management in methadone clinics and opioid treatment programs. Training methods, implementation strategies, fidelity assessments, and attitudes toward the implementation of contingency management are discussed in greater detail. These findings highlight the importance of organizational input and ongoing supervision and consultation, and the need for additional research that is guided by theoretical frameworks and use rigorous study designs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Karl C Alcover
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane
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15
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Weinstock J, Petry NM, Pescatello LS, Henderson CE, Nelson CR. Randomized clinical trial of exercise for nontreatment seeking adults with alcohol use disorder. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:65-75. [PMID: 31424244 DOI: 10.1037/adb0000506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The vast majority of individuals with alcohol use disorder (AUD) do not seek professional help despite its significant consequences upon the individual and society. Current interventions for nontreatment seeking individuals with AUD (e.g., screening, brief intervention, and referral to treatment [SBIRT]) have limited efficacy and alternative nonstigmatizing approaches are needed. This randomized clinical trial examined the utility of exercise as an intervention for sedentary nontreatment seeking adults with AUD. Participants (N = 66) were randomized to receive (a) a 4-month YMCA gym membership only (MO) or (b) a 4-month YMCA gym membership plus a 16-week integrated motivational intervention for exercise consisting of motivational interviewing and contingency management (MI + CM). Participants in both study conditions significantly increased their exercise behavior compared to baseline, and the MI + CM participants exercised significantly more often and an overall larger volume of exercise than the MO participants (ds > 2.0). Significant reductions in drinking and alcohol-related consequences were noted over time but did not differ significantly by study condition and were not related to changes in exercise. Future interventions using exercise as an intervention for AUD may want to frame this type of intervention as "wellness," directly link the 2 behaviors, and compare this intervention to SBIRT. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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16
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Rash CJ, Alessi SM, Zajac K. Examining implementation of contingency management in real-world settings. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:89-98. [PMID: 31343197 DOI: 10.1037/adb0000496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers (N = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, n = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, n = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carla J Rash
- University of Connecticut Health School of Medicine
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17
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Forster SE, DePhilippis D, Forman SD. "I's" on the prize: A systematic review of individual differences in Contingency Management treatment response. J Subst Abuse Treat 2019; 100:64-83. [PMID: 30898330 DOI: 10.1016/j.jsat.2019.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/30/2019] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
Abstract
Contingency Management is an evidence-based treatment for substance use disorders with strong potential for measurement-based customization. Previous work has examined individual difference factors in Contingency Management treatment response of potential relevance to treatment targeting and adaptive implementation; however, a systematic review of such factors has not yet been conducted. Here, we summarize and evaluate the existing literature on patient-level predictors, mediators, and moderators of Contingency Management treatment response in stimulant and/or opioid using outpatients - clinical populations most frequently targeted in Contingency Management research and clinical practice. Our search strategy identified 648 unique, peer-reviewed publications, of which 39 met full inclusion criteria for the current review. These publications considered a variety of individual difference factors, including (1) motivation to change and substance use before and during treatment (8/39 publications), (2) substance use comorbidity and chronicity (8/39 publications), (3) psychiatric comorbidity and severity (8/39 publications), (4) medical, legal, and sociodemographic considerations (15/39 publications), and (5) cognitive-behavioral variables (1/39 publications). Contingency Management was generally associated with improved treatment outcomes (e.g., longer periods of continuous abstinence, better retention), regardless of individual difference factors; however, specific patient-level characteristics were associated with either an enhanced (e.g., more previous treatment attempts, history of sexual abuse, diagnosis of antisocial personality disorder) or diminished (e.g., complex post-traumatic stress symptoms, pretreatment benzodiazepine use) response to Contingency Management. Overall, the current literature is limited but existing evidence generally supports greater benefits of Contingency Management in patients who would otherwise have a poorer prognosis in standard outpatient care. It was also identified that the majority of previous work represents a posteriori analysis of pre-existing clinical samples and has therefore rarely considered pre-specified, hypothesis-driven individual difference factors. We therefore additionally highlight patient-level factors that are currently understudied, as well as promising future directions for measurement-based treatment adaptations that may directly respond to patient traits and states to improve Contingency Management effectiveness across individuals and over time.
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Affiliation(s)
- Sarah E Forster
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America.
| | - Dominick DePhilippis
- Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, United States of America; Perelman School of Medicine, University of Pennsylvania, United States of America
| | - Steven D Forman
- VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, United States of America; University of Pittsburgh, Department of Psychiatry, United States of America
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18
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Leickly E, Skalisky J, Angelo FA, Srebnik D, McPherson S, Roll JM, Ries RK, McDonell MG. Perspectives on a contingency management intervention for alcohol use among consumers with serious mental illness. Psychiatr Rehabil J 2019; 42:26-31. [PMID: 30475006 PMCID: PMC6506435 DOI: 10.1037/prj0000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study describes the perspectives of outpatients with serious mental illness (SMI) and alcohol dependence on their participation in a contingency management (CM) intervention for alcohol use. METHODS Thirty-five adults with SMI and alcohol dependence participated in a randomized trial of CM for alcohol use, where they were rewarded with prizes contingent on abstinence from alcohol. All participants were interviewed regarding their participation in CM with a consistent structure that included nine open-ended questions. Favored and disliked aspects of CM, perception of alcohol biomarker accuracy, and interest in participating in similar CM interventions provided by treatment centers, rather than researchers, were explored. RESULTS Participants spoke enthusiastically about receiving prizes, as well as how CM increased their awareness of drinking and helped support their abstinence from alcohol. Most participants felt the ethyl glucuronide biomarker urine tests used to measure alcohol use were accurate, and they were interested in enrolling in CM if it was offered as a clinical program. Research staff who implemented the intervention were well regarded by participants, and interactions with research staff were perceived positively. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Adults with SMI and alcohol dependence participating in a trial of CM for alcohol use reported overall positive perceptions of and experiences with CM. Receiving small tangible prizes and having positive interpersonal interactions with study staff were reported as especially impactful. These findings indicate that CM is well received by consumers, in addition to its empirical and practical benefits as an evidence-based, low-cost intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Emily Leickly
- Portland State University, Department of Psychology,
Portland, OR
| | - Jordan Skalisky
- Initiative for Research and Education to Advance Community
Health, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA
- Program for Excellence in Addiction Research, Washington
State University, Spokane, WA
| | - Frank A. Angelo
- School of Public Health, University of Washington, Seattle,
WA
| | - Debra Srebnik
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine, Seattle, WA
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA
- Program for Excellence in Addiction Research, Washington
State University, Spokane, WA
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine, Seattle, WA
- Providence Medical Research Center, Providence Health Care,
Spokane, WA
| | - John M. Roll
- Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA
- Program for Excellence in Addiction Research, Washington
State University, Spokane, WA
| | - Richard K. Ries
- Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine, Seattle, WA
| | - Michael G. McDonell
- Initiative for Research and Education to Advance Community
Health, Washington State University, Spokane, WA
- Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA
- Program for Excellence in Addiction Research, Washington
State University, Spokane, WA
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19
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Stanger C, Lansing AH, Scherer E, Budney A, Christiano AS, Casella SJ. A Web-Delivered Multicomponent Intervention for Adolescents with Poorly Controlled Type 1 Diabetes: A Pilot Randomized Controlled Trial. Ann Behav Med 2018; 52:1010-1022. [PMID: 30418521 PMCID: PMC6230973 DOI: 10.1093/abm/kay005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control. Purpose The purpose was to conduct an unblinded pilot randomized controlled parallel-group study of a web-delivered multicomponent intervention targeting self-monitoring of blood glucose, working memory, and parent supervision of diabetes care among adolescents with type 1 diabetes. Intervention components included high magnitude incentives for adolescents and parents, motivational and cognitive behavioral therapy and working memory training for adolescents, and training in contingency contracting for parents. Methods Adolescents (N = 114) with poorly controlled type 1 diabetes were screened, and N = 61 were randomized using minimum likelihood allocation to usual care (usual care, N = 31) or to a 25-week/15-session web-delivered intervention (WebRx, N = 30). Results At the end of treatment, adolescents in WebRx had higher self-monitoring of blood glucose (d = 0.58) (primary outcome), better visual spatial working memory (d = 0.48) and inhibition (d = 0.98), and lower HbA1c (d = 0.45) than those in usual care. WebRx parents reported more frequent review of the adolescent's glucometer (d = 1.30) and reduced family conflict (d = 0.56). Between-condition differences were maintained 6 months later in self-monitoring of blood glucose (d = 0.42), visual spatial working memory (d = 0.76), family conflict (d = 0.50), and HbA1c (d = 0.44). Conclusions Results showing sustained effects on self-monitoring of blood glucose and HbA1c support moving forward with a larger trial to test this innovative web-delivered and multicomponent intervention. ClinicalTrials.gov Number (NCT01722643).
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Amy Hughes Lansing
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alan Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Ann S Christiano
- Department of Pediatric Endocrinology, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Samuel J Casella
- Department of Pediatric Endocrinology, Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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20
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Petry NM, Alessi SM, Rash CJ, Barry D, Carroll KM. A randomized trial of contingency management reinforcing attendance at treatment: Do duration and timing of reinforcement matter? J Consult Clin Psychol 2018; 86:799-809. [PMID: 30265039 PMCID: PMC6166435 DOI: 10.1037/ccp0000330] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Contingency management (CM) interventions that reinforce attendance have rarely been evaluated in terms of reducing drug use. Using a sequential randomized design, this study examined the efficacy of three attendance CM conditions compared to usual care (UC) on drug use outcomes. It evaluated whether the duration (6 vs. 12 weeks) and timing (early vs. later treatment) of CM delivery impact treatment response. METHOD Upon initiating outpatient treatment, patients with cocaine use disorders (N = 360) were randomized to UC or CM for attending treatment for 6 weeks. At week 6, patients (n = 308) were rerandomized to UC or CM for another 6 weeks, with assignment stratified on current functioning. Samples were screened for illicit drugs twice weekly for 12 weeks. RESULTS Patients randomized to CM at both time-points attended more sessions and achieved more abstinence than those never randomized to CM. Relative to UC, receiving attendance CM in weeks 1-6 only was not efficacious, but those receiving attendance CM in weeks 7-12 only evidenced some benefits compared to those who never received CM. Twelve weeks of attendance CM was more efficacious than 6 weeks. No between-groups differences in drug use were noted at follow-ups, but days attended treatment and proportion negative samples during treatment were associated with long-term cocaine abstinence. CONCLUSIONS Attendance-based CM increases treatment participation and reduces drug use, with beneficial effects noted when CM is delivered over longer durations and during later phases of outpatient care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Danielle Barry
- University of Connecticut Health Center
- Edith Nourse Rogers Memorial VA Hospital
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21
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The national implementation of Contingency Management (CM) in the Department of Veterans Affairs: Attendance at CM sessions and substance use outcomes. Drug Alcohol Depend 2018; 185. [PMID: 29524874 PMCID: PMC6435332 DOI: 10.1016/j.drugalcdep.2017.12.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2011, the Department of Veterans Affairs launched an initiative to expand patients' access to contingency management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). METHODS Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients' CM attendance and urine test results also were collected from the 94 implementation sites. RESULTS The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%. CONCLUSION The VA's CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.
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Alessi SM, Barnett NP, Petry NM. Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients. Drug Alcohol Depend 2017; 178:417-424. [PMID: 28709081 PMCID: PMC5569301 DOI: 10.1016/j.drugalcdep.2017.05.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transdermal alcohol monitoring technology allows for new research on alcohol use disorders. This study assessed feasibility, acceptability, and adherence with this technology in the context of two clinical research trials. METHODS Participants were the first 100 community-based alcohol treatment outpatients enrolled in randomized studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) for 12 weeks. Study 1 participants were randomized to usual care (n=36) or usual care with contingency management incentives for treatment attendance (CM-Att; n=30). Study 2 participants were randomized to usual care (n=17) or usual care with CM for each day of no drinking per SCRAMx (CM-Abst; n=17). After 12 weeks, participants completed a survey about the bracelet. RESULTS Nine percent of individuals screened (54 of 595) declined participation because of the bracelet. Of participants, 84% provided 12weeks of data, and 96% of bracelets were returned fully intact. Ninety-four equipment tampers occurred, affecting 2% of monitoring days; 56% (67) of tampers coincided with detected drinking. Common concerns reported by participants were skin marks (58%), irritation (54%), and interfered with clothing choices (51%), but severity ratings were generally mild (60%-94%). Eighty-one percent of participants reported that the bracelet helped them reduce drinking, and 75% indicated that they would wear it for longer. A common suggestion for improvement was to reduce the size of the bracelet. CONCLUSIONS Results support the viability of transdermal monitoring in voluntary substance abuse treatment participants for an extended duration. Issues to consider for future applications of this technology are discussed.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA.
| | - Nancy M Petry
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
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Weinstock J, Petry NM, Pescatello LS, Henderson CE. Sedentary college student drinkers can start exercising and reduce drinking after intervention. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:791-801. [PMID: 27669095 PMCID: PMC5687258 DOI: 10.1037/adb0000207] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavy drinking by college students is exceedingly harmful to the individuals and to the overall college environment. Current interventions to reduce drinking and negative consequences are infrequently utilized. This randomized clinical trial examined an alternative approach that sought to increase exercise behavior, a substance free activity, in sedentary heavy drinking college students. Participants (N = 70) were randomized to an 8-week exercise intervention: (a) motivational interviewing plus weekly exercise contracting (MI + EC) or (b) motivational interviewing and weekly contingency management for exercise (MI + CM). Follow-up evaluations occurred at posttreatment (2 months) and 6 months post baseline. Participants in both interventions significantly increased exercise frequency initially, and the MI + CM participants exercised significantly more than the MI + EC intervention participants during the intervention period (d = 1.70). Exercise behavior decreased during the follow-up period in both groups. Significant reductions in drinking behaviors and consequences were noted over time, but were not related to changes in exercise or the interventions (ds ≤ 0.01). This study underscores the complex nature of promoting 1 specific health behavior change with the goal of changing another. (PsycINFO Database Record
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Affiliation(s)
| | - Nancy M Petry
- Department of Medicine, University of Connecticut Health Center
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Hartzler B, Peavy KM, Jackson TR, Carney M. Finding harmony so the music plays on: pragmatic trial design considerations to promote organizational sustainment of an empirically-supported behavior therapy. Addict Sci Clin Pract 2016; 11:2. [PMID: 26801244 PMCID: PMC4724112 DOI: 10.1186/s13722-016-0049-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Pragmatic trials of empirically-supported behavior therapies may inform clinical and policy decisions concerning therapy sustainment. This retrospective trial design paper describes and discusses pragmatic features of a hybrid type III implementation/effectiveness trial of a contingency management (CM) intervention at an opioid treatment program. Prior reporting (Hartzler et al., J Subst Abuse Treat 46:429–438, 2014; Hartzler, Subst Abuse Treat Prev Policy 10:30, 2015) notes success in recruiting program staff for voluntary participation, durable impacts of CM training on staff-level outcomes, provisional setting implementation of the intervention, documentation of clinical effectiveness, and post-trial sustainment of CM. Methods/design Six pragmatic design features, and both scientific and practical bases for their inclusion in the trial, are presented: (1) a collaborative intervention design process, (2) voluntary recruitment of program staff for therapy training and implementation, (3) serial training outcome assessments, with quasi-experimental staff randomization to either single or multiple baseline assessment conditions, (4) designation of a 90-day period immediately after training in which the setting implemented the intervention on a provisional basis, (5) inclusive patient eligibility for receipt of the CM intervention, and (6) designation of two staff as local implementation leaders to oversee clinical/administrative issues in provisional implementation. Discussion Each pragmatic trial design feature is argued to have contributed to sustainment of CM. Contributions implicate the building of setting proprietorship for the CM intervention, culling of internal staff expertise in its delivery, iterative use of assessment methods that limited setting burden, documentation of setting-specific clinical effectiveness, expanded penetration of CM among staff during provisional implementation, and promotion of setting self-reliance in the oversight of sustainable implementation procedures. It is hoped this discussion offers ideas for how to impact local clinical and policy decisions via effective behavior therapy dissemination.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - K Michelle Peavy
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - T Ron Jackson
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
| | - Molly Carney
- Alcohol and Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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Hartzler B, Beadnell B, Donovan D. Predictive Validity of Addiction Treatment Clinicians' Post-Training Contingency Management Skills for Subsequent Clinical Outcomes. J Subst Abuse Treat 2015; 72:126-133. [PMID: 26733276 DOI: 10.1016/j.jsat.2015.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/03/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
In the context of a contingency management (CM) implementation/effectiveness hybrid trial, the post-training implementation domains of direct-care clinicians (N=19) were examined in relation to a targeted clinical outcome of subsequently CM-exposed clients. Clinicians' CM skillfulness, a behavioral measure of their capability to skillfully deliver the intended CM intervention, was found to be a robust and specific predictor of their subsequent client outcomes. Analyses also revealed CM skillfulness to: (1) fully mediate an association between a general therapeutic effectiveness and client outcome, (2) partially mediate an association of in-training exposure to CM and client outcome, and (3) be composed of six component clinical practice behaviors that each contributed meaningfully to this behavior fidelity index. Study findings offer preliminary evidence of the predictive validity of post-training CM skillfulness for subsequent client outcomes, and inform suggestions for the design and delivery of skills-focused CM training curricula for the addiction treatment workforce.
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Hartzler B. Building a bonfire that remains stoked: sustainment of a contingency management intervention developed through collaborative design. Subst Abuse Treat Prev Policy 2015; 10:30. [PMID: 26243132 PMCID: PMC4526292 DOI: 10.1186/s13011-015-0027-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community dissemination of empirically-supported behavior therapies is fostered by collaborative design, a joint process pooling expertise of purveyors and treatment personnel to contextualize a therapy for sustainable use. The adaptability of contingency management renders it an exemplary therapy to model this collaborative design process. METHODS At conclusion of an implementation/effectiveness hybrid trial conducted at an opiate treatment program, a group elicitation interview was conducted with the setting's five managerial staff to cull qualitative impressions of a collaboratively-designed contingency management intervention after 90 days of provisional implementation in the setting. Two independent raters reviewed the audio-recording and conducted a phenomenological narrative analysis, extracting themes and selecting excerpts to correspond with innovation attributes (i.e., relative advantage, compatibility, complexity, trialability, observability) of a well-known implementation science framework. RESULTS This qualitative analysis suggested the intervention was regarded as: (1) cost-effective and clinically useful relative to prior practices, (2) a strong fit with existing service structure and staffing resources, (3) procedurally uncomplicated, with staff consistently implementing it as intended, (4) providing site-specific data to sufficiently inform decisions about its sustainment, and (5) offering palpable benefits to staff-patient interactions. CONCLUSIONS The current work complements prior reports of positive implementation outcomes and intervention effectiveness for the parent trial, mapping qualitative managerial accounts of this contingency management intervention to a set of attributes thought to influence the speed and effectiveness with which an innovative practice is disseminated. Findings support the incorporation of collaborative design processes in future efforts to transport contingency management to the addiction treatment community.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, , 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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Andrade-González N, Fernández-Liria A. Spanish adaptation of the Revised Helping Alliance Questionnaire (HAq-II). J Ment Health 2015; 24:155-61. [PMID: 25989492 DOI: 10.3109/09638237.2015.1036975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The working or helping alliance is one of the most widely studied constructs in psychotherapy process research. AIM The aim of this study was to adapt the patient and therapist forms of the Revised Helping Alliance Questionnaire II (HAq-II-P and HAq-II-T, respectively) into Spanish. METHOD The two measurement instruments were adapted through a systematic translation process, a pilot study and a clinical study. The psychometric properties were examined following the third psychotherapy session. RESULTS Mean scores on the Spanish-language HAq-II-P and HAq-II-T were high. The corrected item-total correlations for >94% of the items were >0.30. Cronbach's α values for internal consistency were 0.88 and 0.93, respectively. Correlations for convergent validity with the respective versions of the Spanish-language Working Alliance Inventory were 0.80 and 0.87, respectively. In terms of predictive validity, there was a significant correlation between HAq-II-T and the patients' residual gain scores on the Spanish-language Beck Depression Inventory after the tenth psychotherapy session. CONCLUSIONS These results are consistent with studies using the original English versions of the HAq-II.
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Affiliation(s)
- Nelson Andrade-González
- Faculty of Medicine and Health Sciences, University of Alcalá , Alcalá de Henares , Madrid, Spain
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Hartzler B. Adapting the helpful responses questionnaire to assess communication skills involved in delivering contingency management: preliminary psychometrics. J Subst Abuse Treat 2015; 55:52-7. [PMID: 25770870 DOI: 10.1016/j.jsat.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/15/2022]
Abstract
A paper/pencil instrument, adapted from Miller and colleagues' (1991) Helpful Responses Questionnaire (HRQ), was developed to assess clinician skill with core communicative aspects involved in delivering contingency management (CM). The instrument presents a single vignette consisting of six points of client dialogue to which respondents write 'what they would say next.' In the context of an implementation/effectiveness hybrid trial, 19 staff clinicians at an opiate treatment program completed serial training outcome assessments before, following, and three months after CM training. Assessments included this adaptation of the HRQ, a multiple-choice CM knowledge test, and a recorded standardized patient encounter scored for CM skillfulness. Study results reveal promising psychometric properties for the instrument, including strong scoring reliability, internal consistency, concurrent and predictive validity, test-retest reliability and sensitivity to training effects. These preliminary findings suggest the instrument is a viable, practical method to assess clinician skill in communicative aspects of CM delivery.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA.
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Petry NM, DePhilippis D, Rash CJ, Drapkin M, McKay JR. Nationwide dissemination of contingency management: the Veterans Administration initiative. Am J Addict 2014; 23:205-10. [PMID: 24724876 DOI: 10.1111/j.1521-0391.2014.12092.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/10/2013] [Accepted: 05/10/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Contingency management (CM) is an empirically validated intervention but one not often applied in practice settings in the US. OBJECTIVES The aim of this article is to describe the Veterans Administration (VA) nationwide implementation of CM treatment. METHODS In 2011, the VA called for integration of CM in its intensive outpatient substance abuse treatment clinics. As part of this initiative, the VA funded training and ongoing implementation support, and it provided direct funds for reinforcers and other intervention costs. RESULTS Over 100 clinics received this funding in 2011, and CM has been implemented in over 70 substance abuse treatment clinics since August 2011. CONCLUSIONS This training and implementation experience has been highly successful and represents the largest scale training in evidence-based treatments for substance use disorders in the VA health care system to date. SCIENTIFIC SIGNIFICANCE This program may serve as a model for training in evidence-based treatments.
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Affiliation(s)
- Nancy M Petry
- University of Connecticut School of Medicine, Farmington, Connecticut
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Hagoel L, Rennert G, Feder-Bubis P. Laypersons' views of material incentives for enhancing colorectal cancer screening. Health Expect 2013; 18:1194-203. [PMID: 23745608 DOI: 10.1111/hex.12094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) early detection improves health outcomes; screening programmes invest efforts in initiating invitations to target populations to be tested. Enhanced adherence is essential for reduction of morbidity and mortality. Participation rates in Israel are still relatively low. OBJECTIVE To explore lay views regarding the concept of receiving material incentives in exchange for enhanced adherence to CRC screening. RESEARCH DESIGN Qualitative study. Between November 2009 and February 2010 six focus group discussions were carried out in two urban, middle and low socio-economic status primary care clinics in a Northern city in Israel. Participants were eligible individuals for CRC screening, aged 50-68 (N = 24). Data analysis followed the principles of grounded theory, supported by qualitative software. RESULTS Participants found administering incentives in exchange for CRC screening inappropriate on rational and moral grounds. They valued their relations with the medical team and the health system more than the potential gain expected. Individuals eligible for CRC screening perceived themselves as responsible for their health, admitting difficulties in realizing this responsibility. Incentives were reported unsuitable for solving reported screening difficulties and a potential harm to the doctor-patient relationship. CONCLUSIONS Focus group participants expressed an unconventional voice towards the use of material incentives. They pointed to the need for focused support of health behaviour change and valued their autonomy. While a proportion of the invitees in the target population see the importance of screening and appreciate the HMO's initiative to invite them for testing, they also expressed their need for support from the HMO in realizing the recommended health behaviour.
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Affiliation(s)
- Lea Hagoel
- Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion and Carmel Medical Center, Haifa, Israel
| | - Gad Rennert
- Department of Community Medicine and Epidemiology, Faculty of Medicine, Technion and Carmel Medical Center, Haifa, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Rash CJ, Dephilippis D, McKay JR, Drapkin M, Petry NM. Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort. J Subst Abuse Treat 2013; 45:306-12. [PMID: 23856601 DOI: 10.1016/j.jsat.2013.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/22/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
In 2011, the Veterans Administration called for nationwide implementation of contingency management (CM) in its intensive outpatient substance use disorders treatment programs, and this study evaluated the impact of the initial 1 and ½ day training workshops on knowledge and perceptions about CM among 159 clinical leaders from 113 clinics. Workshop attendance significantly increased CM-related knowledge (d=1.88) and changed attendees' perceptions of CM (ds=0.26-0.74). Endorsement of barriers to CM adoption decreased and positive impressions of CM increased. These perceptions about CM emerged as key correlates of post-training preparedness to implement CM. Results suggest that training workshops can be an effective avenue for increasing CM-related knowledge, as well as addressing persistent misperceptions about CM that may impede adoption efforts. Continued efforts to introduce educational materials and offer training and consultation opportunities may increase understanding about this evidence-based intervention among clinicians, thereby leading to improved patient outcomes.
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Affiliation(s)
- Carla J Rash
- Calhoun Cardiology Center - Behavioral Health, University of Connecticut Health Center, Farmington, CT 06030-3944, USA.
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Contingency management delivered by community therapists in outpatient settings. Drug Alcohol Depend 2012; 122:86-92. [PMID: 21981991 PMCID: PMC3290694 DOI: 10.1016/j.drugalcdep.2011.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/13/2011] [Accepted: 09/15/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few community-based clinicians have been trained to deliver contingency management (CM) treatments, and little data exist regarding the efficacy of CM when administered by clinicians. METHOD Fifteen clinicians from four intensive outpatient treatment programs received training in CM. Following a didactics seminar and a period in which clinicians delivered CM to pilot patients while receiving weekly supervision, clinicians treated 43 patients randomized to standard care or CM, without supervision. In both treatment conditions, urine and breath samples were collected up to twice weekly for 12 weeks, and CM patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting drug-free samples. Primary treatment outcomes were sessions attended, unexcused absences, longest continuous period of abstinence, and proportion of negative samples submitted. RESULTS All therapists completed the training and supervision phase, and 10 treated randomized patients. Patients randomized to CM achieved significantly greater durations of abstinence than patients randomized to standard care (5.0±3.8 weeks versus 2.6±3.7 weeks) and had fewer unexcused absences (4.3±1.2 versus 8.1±5.4), but proportion of negative samples submitted and attendance did not differ significantly between groups. Therapist adherence and competence in CM delivery decreased when supervision was no longer provided, and competence in CM delivery was associated with duration of abstinence achieved and attendance. CONCLUSIONS Community-based clinicians can effectively administer CM, and outcomes relate to competence in CM delivery. These data call for further training and supervision of community clinicians in this evidence-based treatment.
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Hartzler B, Lash SJ, Roll JM. Contingency management in substance abuse treatment: a structured review of the evidence for its transportability. Drug Alcohol Depend 2012; 122:1-10. [PMID: 22153943 PMCID: PMC3307900 DOI: 10.1016/j.drugalcdep.2011.11.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
AIMS Extant literature on contingency management (CM) transportability, or its transition from academia to community practice, is reviewed. The Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) guides the examination of this material. METHODS PsychInfo and Medline database searches identified 27 publications, with reviewed reference lists garnering 22 others. These 49 sources were examined according to CFIR domains of the intervention, outer setting, inner setting, clinicians, and implementation processes. RESULTS Intervention characteristics were focal in 59% of the identified literature, with less frequent focus on clinicians (34%), inner setting (32%), implementation processes (18%), and outer setting (8%). As intervention characteristics, adaptability and trialability most facilitate transportability whereas non-clinical origin, perceived inefficacy or disadvantages, and costs are impediments. Clinicians with a managerial focus and greater clinic tenure and CM experience are candidates to curry organizational readiness for implementation, and combat staff disinterest or philosophical objection. A clinic's technology comfort, staff continuity, and leadership advocacy are inner setting characteristics that prompt effective implementation. Implementation processes in successful demonstration projects include careful fiscal/logistical planning, role-specific staff engagement, practical adaptation in execution, and evaluation via fidelity-monitoring and cost-effectiveness analyses. Outer setting characteristics-like economic policies and inter-agency networking or competition-are salient, often unrecognized influences. CONCLUSIONS As most implementation constructs are still moving targets, CM transportability is in its infancy and warrants further scientific attention. More effective dissemination may necessitate that future research weight emphasis on external validity, and utilize models of implementation science.
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Affiliation(s)
- Bryan Hartzler
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Petry NM, Alessi SM, Ledgerwood DM. A randomized trial of contingency management delivered by community therapists. J Consult Clin Psychol 2012; 80:286-98. [PMID: 22250852 PMCID: PMC3725552 DOI: 10.1037/a0026826] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings. METHOD Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot patients, a randomized trial evaluated the efficacy of CM when delivered entirely by clinicians. Sixteen clinicians treated 130 patients randomized to CM or standard care. In both conditions, urine and breath samples were collected twice weekly for 12 weeks. In the CM condition, patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting samples negative for cocaine and alcohol. Primary treatment outcomes were retention, longest continuous period of abstinence, and proportion of negative samples submitted. RESULTS Patients randomized to CM remained in the study longer (9.5 ± 3.6 vs. 6.7 ± 5.0 weeks), achieved greater durations of abstinence (4.7 ± 4.7 vs. 1.7 ± 2.7 weeks), and submitted a higher proportion of negative samples (57.7% ± 40.0% vs. 29.4% ± 33.3%) than those assigned to standard care. CONCLUSIONS These data indicate that, with appropriate training, community-based clinicians can effectively administer CM. This study suggests that resources ought to be directed toward training and supervising community-based providers in delivering CM, as patient outcomes can be significantly improved by integrating CM in methadone clinics.
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Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT 06030-3944, USA.
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Petry NM, Weinstock J, Alessi SM. A randomized trial of contingency management delivered in the context of group counseling. J Consult Clin Psychol 2012; 79:686-96. [PMID: 21806297 DOI: 10.1037/a0024813] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Contingency management (CM) is efficacious in reducing drug use. Typically, reinforcers are provided on an individual basis to patients for submitting drug-negative samples. However, most treatment is provided in a group context, and poor attendance is a substantial concern. This study evaluated whether adding CM to group-based outpatient treatment would increase attendance and drug abstinence relative to standard care. METHOD Substance abusing patients (N = 239) initiating outpatient treatment at 2 community-based clinics were randomized to standard care with frequent urine sample monitoring for 12 weeks (SC) or that same treatment with CM delivered in the context of group counseling sessions. In the CM condition, patients earned opportunities to put their names in a hat based on attendance and submission of drug-negative samples. At group counseling sessions, therapists selected names randomly from the hat, and individuals whose names were drawn won prizes ranging from $1 to $100. RESULTS Patients assigned to CM earned a median of $160 in prizes, and they attended significantly more days of treatment (d = 0.25), remained in treatment for more continuous weeks (d = 0.40), and achieved longer durations of drug abstinence (d = 0.26) than patients randomized to SC. Group adherence and therapeutic alliance also improved with CM. In addition, HIV risk behaviors were significantly lower in CM relative to SC patients during early phases of treatment and at the 12-month follow-up. CONCLUSIONS These data demonstrate that CM delivered in the context of outpatient group counseling can increase attendance and improve drug abstinence.
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Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT 06030-3944, USA.
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Ondersma SJ, Svikis DS, Lam PK, Connors-Burge VS, Ledgerwood DM, Hopper JA. A randomized trial of computer-delivered brief intervention and low-intensity contingency management for smoking during pregnancy. Nicotine Tob Res 2011; 14:351-60. [PMID: 22157229 DOI: 10.1093/ntr/ntr221] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Implementation of evidence-based interventions for smoking during pregnancy is challenging. We developed 2 highly replicable interventions for smoking during pregnancy: (a) a computer-delivered 5As-based brief intervention (CD-5As) and (b) a computer-assisted, simplified, and low-intensity contingency management (CM-Lite). METHODS A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and randomly assigned to CD-5As (n = 26), CM-Lite (n = 28), CD-5As plus CM-Lite (n = 30), or treatment as usual (n = 26). Self-report of smoking, urine cotinine, and breath CO were measured 10 weeks following randomization. RESULTS Participants rated both interventions highly (e.g., 87.5% of CD-5As participants reported increases in likelihood of quitting), but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence. CD-5As led to increased abstinence as measured by cotinine (43.5% cotinine negative vs. 17.4%; odds ratio [OR] = 10.1, p = .02) but not for CO-confirmed 7-day point prevalence (30.4% abstinent vs. 8.7%; OR = 5.7, p = .06). Collapsing across CM-Lite status, participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking (60.5% vs. 30.8%; OR = 3.0, p = .02). CONCLUSIONS Low-intensity participant-initiated CM did not affect smoking in this sample, but the CD-5As intervention was successful in increasing abstinence during pregnancy. Further research should seek to replicate these results in larger and more diverse samples. Should CD-5As continue to prove efficacious, it could greatly increase the proportion of pregnant smokers who receive an evidence-based brief intervention.
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Affiliation(s)
- Steven J Ondersma
- Merrrill Palmer Skillman Institute, Wayne State University, Detroit, MI 48202, USA.
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