Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment program

Abstract

Guided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost, feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study’s collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.

Adapting the Helpful Responses Questionnaire to Assess Communication Skills Involved in Delivering Contingency Management: Preliminary Psychometrics

“…This was an implementation/effectiveness hybrid trial design (Curran, Bauer, Mittman, Pyne, & Stetler, 2012), for which implementation and clinical effectiveness outcomes have been comprehensively reported (Hartzler et al, 2014). The trial included: 1) recruitment of interested staff clinicians to participate in CM training and implement a contextualized CM intervention with targeted clients on their caseload for a 90-day period, and 2) serial completion of training outcome assessments prior to, following, and three months after training.…”

“…A full description of this CM intervention and its collaborative design process is available (Hartzler et al, 2014). Briefly, and at the clinic director’s specification, the CM intervention featured: 1) a target population of patients in their initial 90 days of clinic services, 2) a target behavior of individual counseling visit attendance, 3) $5 gift cards and take-home medication doses as reinforcers, and 4) a ‘point-based’ reinforcement system.…”

“…All procedures were approved by university IRB, and those detailing the 16-hour staff training process and 90-day provisional implementation of this CM intervention are available elsewhere (Hartzler et al, 2014). Staff clinicians were recruited at an on-site presentation where voluntary participation was emphasized by the investigator and program director.…”

“…This was informed by previously-reported findings (Hartzler et al, 2014) suggesting this clinician sample to be a capable, experienced, and ecologically-valid reference group. Findings included: 1) robust, durable CM training impacts on clinician skills in CMCS-rated SP encounters completed before, after, and 90 days following training, 2) impacts of the resulting clinician implementation ( d = .46–.53) exceeded the mean effect size reported in a published meta-analysis of CM efficacy trials (Prendergast et al, 2006), 3) an absence of clinician effects in these analyses, suggesting consistency in both quality of implementation and clinical impact, and 4) each clinician had exceeded a competency threshold suggested by CMCS developers when completing the SP encounter at trial conclusion.…”

“…A recent CM implementation/effectiveness trial at a community opiate treatment program (Hartzler, Jackson, Jones, Beadnell, & Calsyn, 2014), which principally evaluated impacts of training among staff clinicians, offered opportunity to develop and evaluate psychometric properties of a pencil/paper skill assessment instrument. This instrument, adapted from the Helpful Responses Questionnaire [HRQ; (Miller et al, 1991)] originally developed to assess clinician skill in communicating empathy, sought to provide a practical way to assess core communicative skills involved in delivery of contemporary CM interventions.…”