What’s So Great About What’s So Great About Incentives ?Incentives ?

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CTN Mid-Atlantic NodeCTN Mid-Atlantic Node

Christine HigginsChristine Higgins

Dissemination SpecialistDissemination Specialist

410-550-4316410-550-4316

chiggin2@jhmi.educhiggin2@jhmi.edu

Who UsesBehavioral

(Contingency)Management?

* Used in every content area of education (preschool

through college/university)* Used in business to improve productivity,

decrease tardiness, increases sales volume* Used by communities to control littering,

encourage recycling, promote energy conservation* Used in health promotion to improve treatment

compliance, promote healthy living, deal with

aging* Used by therapists to treat anxiety, obsessions,

depression, obesity, marital problems, chronic pain, sleep disorders

Behavior Management

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Incentives HealthcareIncentives Healthcare– States provide significant financial incentives to States provide significant financial incentives to

provide servicesprovide services– CDC – AFIXCDC – AFIX

Assessment Feedback Incentives ExchangeAssessment Feedback Incentives ExchangeIncentives are techniques used to motivate individuals Incentives are techniques used to motivate individuals or organizations to change behaviors or organizations to change behaviors ImmunizationsImmunizations

Who is the recipient of the incentives?Who is the recipient of the incentives?CLINIC staffCLINIC staff

Resource materialsResource materialsWeb Site InformationWeb Site InformationAssistance in QA plan developmentAssistance in QA plan developmentPlaquesPlaquesAward luncheonsAward luncheonsTuition/paid registration to educational Tuition/paid registration to educational

conferencesconferencesThe word SANCTION was never mentioned in Top 20 hits

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Incentives Drug TreatmentIncentives Drug TreatmentKentucky Drug Courts – 10 Key ComponentsKentucky Drug Courts – 10 Key Components– Coordinated Strategy Governs Drug Court Responses to Coordinated Strategy Governs Drug Court Responses to

Participants’ ComplianceParticipants’ ComplianceSanctions and incentives are developed jointly and are imposed Sanctions and incentives are developed jointly and are imposed after conferring with the Drug Court Teamafter conferring with the Drug Court TeamImposed sanctions are graduated and are proportional with the Imposed sanctions are graduated and are proportional with the infractioninfraction

Ithaca Drug Treatment CourtIthaca Drug Treatment Court– Phase I – Sanctions Phase I – Sanctions – Phase II – Mandatory attendance, verificationPhase II – Mandatory attendance, verification– Phase III – Supervision, unannounced home visitsPhase III – Supervision, unannounced home visitsTHEN: 24 weeks later -- INCENTIVES THEN: 24 weeks later -- INCENTIVES

AFTER graduationAFTER graduation

What’s so great about incentives?What’s so great about incentives?

Broadly applicable Broadly applicable across target across target behaviors.behaviors.

An evidence-based An evidence-based intervention.intervention.

Patients like them! Patients like them!

Advantages of IncentivesAdvantages of Incentives

Add-on to existing treatmentAdd-on to existing treatmentAdds structure; clarifies expectationsAdds structure; clarifies expectationsGives patients a reason to abstain Gives patients a reason to abstain Shifts focus away from sanctionsShifts focus away from sanctionsFosters celebration of successFosters celebration of success

Ten goal areas and related Ten goal areas and related activitiesactivities

EducationEducation college application, college application,

homeworkhomework

EmploymentEmployment resume, turn in applicationresume, turn in application

FamilyFamily write letter, outing with kidswrite letter, outing with kids

HealthHealth make or attend appt.make or attend appt.

HousingHousing get/complete applicationget/complete application

LegalLegal go to court, probation appointmentgo to court, probation appointment

Personal improvementPersonal improvement journal, come on timejournal, come on time

Sobriety (12-Step)Sobriety (12-Step) attend meeting(s), get sponsorattend meeting(s), get sponsor

Social/recreationalSocial/recreational bowling, library, churchbowling, library, church

TransportationTransportation sign up at transportation programsign up at transportation program

Remember these steps:Remember these steps:

1.Pick a behavior you want to change1.Pick a behavior you want to change

2. Pick a reinforcer 2. Pick a reinforcer

3. Design a monitoring system3. Design a monitoring system

4. Design an incentive delivery schedule4. Design an incentive delivery schedule

5. Ensure consistent application5. Ensure consistent application

It’s the It’s the CONTINGENCYCONTINGENCY that matters……….that matters……….

BEHAVIORBEHAVIOR REWARDREWARD

Giving things away,Giving things away,like donuts or pizza, for free like donuts or pizza, for free does NOT change behaviordoes NOT change behavior

Remember:

Choice of ReinforcerChoice of Reinforcer

Higher magnitude reinforcers engender Higher magnitude reinforcers engender greater abstinence (Silverman et al, 1999; greater abstinence (Silverman et al, 1999; Stitzer et al., 1984). Stitzer et al., 1984).

Make sure your reinforcer is adequate Make sure your reinforcer is adequate enough to compete with reinforcement enough to compete with reinforcement derived from target behavior.derived from target behavior.

Look for reinforcers of “high magnitude”Look for reinforcers of “high magnitude” but not high cost.but not high cost.

Always ask the patients what they like. Always ask the patients what they like. Dunkin Donuts , KFC or 7-11?Dunkin Donuts , KFC or 7-11?

REACH 4 IT! REACH 4 IT! Attend Orientation Groups and Attend Orientation Groups and

Win Prizes!$!$!$!!Win Prizes!$!$!$!!Starting March 20th, 2006Starting March 20th, 2006

Earn a GRAND PRIZE raffle ticket Earn a GRAND PRIZE raffle ticket each time you attend. each time you attend.

Attend all 4 groups in 30 daysAttend all 4 groups in 30 daysand double your chances to win.and double your chances to win.

Open to everyone!Open to everyone!

Giveaways Giveaways

Intro to R.E.A.C.H.—PensIntro to R.E.A.C.H.—Pens

Disease of Addiction –BraceletsDisease of Addiction –Bracelets

Medicine—Water BottlesMedicine—Water Bottles

HIV/AIDS—Gift bag w/condoms (male &HIV/AIDS—Gift bag w/condoms (male &

female), candy, mints. female), candy, mints.

Purchased with a stationery line item in the Purchased with a stationery line item in the budget. Patients get a raffle ticket and receive budget. Patients get a raffle ticket and receive one giveaway each time they attend. one giveaway each time they attend.

IncentivesIncentives

Raffles at 4, 8 & 12 weeksRaffles at 4, 8 & 12 weeks

Week 4 -- 2 striped camping chairsWeek 4 -- 2 striped camping chairs

Week 8 -- charcoal grill & camping chairWeek 8 -- charcoal grill & camping chair

Week 12– cooler (filled by REACH staffWeek 12– cooler (filled by REACH staff

with dollar store picnic items) with dollar store picnic items)

Get Ready for Summer!Get Ready for Summer!

Patients need to see the prizes!

Incentives are Fiscally Sound !Incentives are Fiscally Sound !

A treatment center in Baltimore, MDA treatment center in Baltimore, MD

began using incentives in their IOP program to began using incentives in their IOP program to increase attendance and increase revenue by increase attendance and increase revenue by billing for folks in the seats. billing for folks in the seats.

Patients enjoyed the chance to win and the Patients enjoyed the chance to win and the

ritual of the low-cost fishbowl ritual of the low-cost fishbowl

method! method!

24 “Applause”24 “Applause”8      "Keep it Up!"8      "Keep it Up!"12    "Good Job"12    "Good Job"4      "Keep Coming Back"4      "Keep Coming Back"8      "Hear from your Peers“8      "Hear from your Peers“

35     "Small"35     "Small"15     "Medium"15     "Medium"5       "Large"5       "Large"1       "Jumbo“ (pt’s choice)1       "Jumbo“ (pt’s choice)

  56 no-cost tickets, and 56 no-cost tickets, and 56 cost tickets for a total of 56 cost tickets for a total of 112.112.

Fishbowl MethodFishbowl Method

Incentives at work!Incentives at work!

Fishbowl contains:•Applause•Hear from your peers•Small•Medium•Large•Jumbo (patient’s choice)

Prize cabinet is bookshelfkept in locked office.

Prize cabinet is re-stocked with patient input, so prizes change to keep interest going.

Target audience: IOP participants

Target behavior:Consistent attendance

Attendance SpreadsheetAttendance Spreadsheet

Total Patient ContactsTotal Patient ContactsNon-Incentive vs. Incentive PeriodNon-Incentive vs. Incentive Period

AM Group (Tuesday, Wednesday, Friday )AM Group (Tuesday, Wednesday, Friday )June 2007 – October 2008June 2007 – October 2008Lane Treatment Center IOPLane Treatment Center IOP

Incentive Period

Non-Incentive Period

Incentive Period

Non-Incentive Period

Average Patients Per Group Average Patients Per Group Non-Incentive vs. Incentive Period Non-Incentive vs. Incentive Period

AM Group (Tuesday, Wednesday, Friday )AM Group (Tuesday, Wednesday, Friday )June 2007 – October 2008June 2007 – October 2008Lane Treatment Center IOPLane Treatment Center IOP

Incentive Period

Non-Incentive Period

Average Groups Attended Per PatientNon-Incentive vs. Incentive Period

AM Group (Tuesday, Wednesday, Friday )June 2007 – October 2008Lane Treatment Center IOP

Income

Incentive Cost

Incentives

Incentive Period

Non-Incentive Period

Monthly Insurance Income vs. Incentive CostNon-Incentive vs. Incentive Period

AM Group (Tuesday, Wednesday, Friday)June 2007 – October 2008Lane Treatment Center IOP

Income vs. Incentive

For more info:For more info:

Download the PAMI (Promoting Awareness Download the PAMI (Promoting Awareness of Motivational Incentives) Blending of Motivational Incentives) Blending Product at: www. nattc.org/pami/Product at: www. nattc.org/pami/

Learn more about incentives by visiting the Learn more about incentives by visiting the CTN Dissemination Library at: CTN Dissemination Library at: www.ctndisseminationlibrary. www.ctndisseminationlibrary.