Implementing contingency management to improve engagement among justice-involved clients referred for substance use disorder services.

INTRODUCTION

Criminal justice involvement is prevalent among persons with substance use disorders (SUDs), for whom contingency management (CM) has been shown to increase treatment adherence. To support CM implementation by SUD organizations serving justice-involved clientele, effective technical assistance (TA) approaches are needed. This community case study details the sustainable implementation of CM that was achieved through support of an empirically supported TA approach.

METHODS

In the context of an interagency partnership, a university-based team employed a phased TA approach to support CM implementation by an SUD organization. This included the collaborative design of customized CM programming for clients referred by a local treatment court, with reinforcement targeting service initiation and engagement. Treatment staff completed preparatory training and skills-based coaching, and prepared facility systems (e.g., accounting, clinical records, and staff supervision) for a 6-month implementation period. Independent evaluation of clinical impacts compared CM-enrolled clients (n = 53) with a historical control group (n = 212). An eventual decision about sustainment of the CM programming among routine services was elicited from SUD organization leaders.

RESULTS

All 10 treatment staff exceeded a priori benchmarks for CM knowledge and skill at the conclusion of the training and coaching processes. Direct evidence of the CM programming's clinical utility includes its influence in more than doubling the completion rate for intake assessments and increasing group therapy attendance by 11%. A secondary therapeutic benefit to the milieu was an 11% increase in the CM-enrolled clients' fulfillment of court-assigned SUD service requirements. This set of effects, along with a positive overall implementation experience, informed organization leaders' decision to sustain the CM programming within routine services thereafter.

DISCUSSION: This community case study demonstrates how SUD organizations may sustainably implement CM programming customized to local clinical needs and resources. Key aspects of the interagency partnership, funding for implementation costs, and the eventual sustainment decision are presented. We hope this will aid others in implementing CM to address local challenges posed by justice-involved clientele.