Those in the substance abuse treatment field sometimes use contingency management to increase client retention. Contingency management is, essentially, a positive incentive program for clients to help keep them in treatment longer. And the longer those are in treatment, the more effective that treatment is and the more likely they will complete treatment. While some may argue that contingency management sounds a whole lot like bribing, those who use such a program have seen favorable results, including Crossroads for Women.
What is key to these type of programs is that incentives are positive. We use positive reinforcements every day by giving away awards and prizes to kids, adults and even pets for doing something good. In contrast, there are many negative contingencies related to substance abuse treatment. Getting arrested, going to jail, paying a fine, being mandated into treatment or being fired from a job are some examples. Thus, in order to be effective in a treatment setting, incentive programs must be positive and relate directly to a desired behavior, such as showing up for a group or counseling session.
As part of the Strengthening Treatment Access and Retention-State Implementation (STAR-SI) grant in Maine, Crossroads for Women has implemented such a program with the aim of increasing client retention during the first 30 days of treatment in its outpatient and intensive outpatient programs. For a period of 18 days, clients were allowed to choose a small gift from a gift basket if they attended 3 sessions in one week at the intensive outpatient program (IOP) level or after their 4th session in outpatient counseling. The most popular gift was that of inexpensive, handmade earrings generously donated by Visibility in Portland, ME.
Comparing the retention rates between the pre- and post-incentive program dates, retention increased from 55% without the incentive program to 78% during the period the incentive program was implemented. When broken down by program, outpatient counseling showed a bigger jump in retention from 33% to 71%, while IOP retention rates rose from73% to 82%.
Research has shown that such contingency management can be effective in increasing attendance in treatment, client retention and a reduction in substance use. Due to the positive results in its own test, Crossroads for Women is looking to continue such a program in the future.