Using the Contingency Management Tracker as Both an Implementation Strategy and an Implementation Research Tool

SARA BECKER
RTI International, Brown University

Contingency management (CM) is one of the only behavioral interventions shown to improve patient abstinence from opioids when combined with FDA-approved pharmacotherapy. Nonetheless, the implementation of CM in opioid treatment programs (OTPs) remains low. Furthermore, research suggests that when CM is implemented in real-world treatment settings, it is implemented with poor adherence. The objective of this poster is to describe the development and use of the Contingency Management Tracker, which was developed to serve the dual purpose of a research tool for standardizing the assessment of CM implementation and an implementation strategy (develop and implement tools for quality monitoring) to improve fidelity.

Eighteen OTPs in the New England region of the United States recruited thus far for a 30-site, multi-cohort trial.

Funded by the National Institute on Drug Abuse, Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) is a cluster-randomized type 3 implementation-effectiveness hybrid trial testing strategies for helping OTPs and their staff implement CM. As part of Project MIMIC, the maximum number of CM sessions is 12 and the maximum number of prize draws is 78. Beyond general implementation data, the CM Tracker was designed to collect and store data specific to the escalating prize-based CM protocol being implemented as part of Project MIMIC. By providing simple inputs about CM sessions, staff receive a user-friendly dashboard that provides visual information to support CM implementation with patients.

To date, 47 CM staff across 16 OTPs have used the project’s CM Tracker for documenting CM implementation. Of the project’s 284 patient participants, CM was initiated by 229 (81%). Per data collected in the CM Tracker, there have been 1,486 CM sessions to date. The median number of CM sessions implemented per initiated patient was 6 (out of 12 possible sessions). OTPs varied widely in their implementation, with the number of initiated patients ranging from 0 to 31. Across OTPs with at least one initiated patient (n = 16), the average number of CM sessions per initiated patient ranged from 3.1 to 11.5. Across OTPs with at least one initiated patient, the average number of CM prize draws per initiated patient was 23.7 and ranged from 4.8 to 61.5.

The CM Tracker is an innovative tool that can simultaneously serve a research tool and an implementation strategy. Future research is needed to examine the extent to which OTPs sustain the implementation of CM, as well as examine the extent to which they develop their own tools for monitoring quality of CM implementation.