Nationwide dissemination of contingency management: The veterans administration initiative

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 paper 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 trainings 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.

Contingency management treatment for substance use disorders: How far has it come, and where does it need to go?

“…Contingency management is listed in the National Registry of Evidence Based Practices (http://legacy.nreppadmin.net/ViewIntervention.aspx?id=344), and the Veterans Administration is implementing it throughout the United States (Petry, DePhilippis, Rash, Drapkin, & McKay 2014). In the United Kingdom, it is included in the National Institute for Health and Clinical Excellence guidelines (NICE, 2007).…”

“…Kropp, Lewis, and Winhusen (2017) provide an example of an implementation effort to integrate CM with 12-step treatment, and voices from non-research perspectives may be more convincing to clinicians than technical research reports. Other examples of implementation efforts provide valuable information on how CM can be tailored to unique needs of a clinic and population (Fitzsimons, Tuten, Borsuk, Lookatch, & Hanks 2015; Hartzler 2015; Kellogg et al, 2005; Lott & Jencius 2009; Petry et al, 2014; Sigmon & Stitzer 2005; Squires et al, 2008; Walker et al, 2010). In implementation science more generally, Damschroder and Hagedorn (2011) likewise note the need to adapt evidence-based practices to the broader context, distinguishing the core from the adaptable components.…”

“…Clinician skill in administering CM impacts patient outcomes (Hartzler, Beadnell, & Donovan 2017; Petry et al, 2012a), and supervision can maintain fidelity over time (Petry et al, 2012ab). Most implementation efforts were developed in collaboration with research experts (e.g., Hartzler, 2015; Petry et al, 2014), and strategies that provide greater reach include web-based modules and phone consultation (Petry et al, 2014). …”

An economic evaluation of a contingency-management intervention for stimulant use among community mental health patients with serious mental illness

“…Information regarding the cost-effectiveness of CM is needed to inform policymakers who are increasingly making decisions about the availability of such treatments based on their clinical and cost effectiveness (Petry et al, 2014). Previous cost-effectiveness analyses (CEAs) on CM have been favorable, but have focused on its application to the treatment of specific drugs rather than co-occurring SMI and SUD, and have focused solely on clinical measures for the effectiveness outcome, such as abstinence or treatment completion (Olmstead and Petry, 2009; Olmstead et al, 2007a, 2007b, c; Sindelar et al, 2007a, 2007b).…”

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

“…Results of a nationwide training effort with VA clinic leaders suggests multi-day workshop exposure promotes conducive beliefs about CM (Rash, DePhillipis, McKay, Drapkin, & Petry, 2013). Further, many of the corresponding VA clinics reportedly attempted to institute CM in some form when provided initial funding support (Petry, DePhillipis, Rash, Drapkin, & McKay, 2014). However, this national VA initiative did not assess the nature, quality, or sustainment of those implementation efforts, and extant literature contains multiple examples of well-intentioned attempts to implement CM undermined or discontinued after encountering of logistical or procedural problems (Tuten, Svikis, Keyser-Marcus, O’Grady, & Jones, 2012; Walker et al, 2010).…”