1. What’s So Great About Incentives ? What’s So Great About Incentives ? Brought to you by the CTN Mid-Atlantic Node Christine Higgins Dissemination Specialist 410-550-4316chiggin2@jhmi.edu

2. Who Uses Behavioral (Contingency) Management?

3. * 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

4. Google Search Incentives Healthcare –States provide significant financial incentives to provide services –CDC – AFIX Assessment Feedback Incentives Exchange Incentives are techniques used to motivate individuals or organizations to change behaviors Immunizations Who is the recipient of the incentives? CLINIC staff Resource materials Web Site Information Assistance in QA plan development Plaques Award luncheons Tuition/paid registration to educational conferences The word SANCTION was never mentioned in Top 20 hits

5. Google Search Incentives Drug Treatment Kentucky Drug Courts – 10 Key Components –Coordinated Strategy Governs Drug Court Responses to Participants’ Compliance Sanctions and incentives are developed jointly and are imposed after conferring with the Drug Court Team Imposed sanctions are graduated and are proportional with the infraction Ithaca Drug Treatment Court –Phase I – Sanctions –Phase II – Mandatory attendance, verification –Phase III – Supervision, unannounced home visits THEN: 24 weeks later -- INCENTIVES AFTER graduation

6. What’s so great about incentives? Broadly applicable across target behaviors. An evidence-based intervention. Patients like them!

7. Advantages of Incentives Add-on to existing treatment Adds structure; clarifies expectations Gives patients a reason to abstain Shifts focus away from sanctions Fosters celebration of success

8. Ten goal areas and related activities  Education  college application, homework  Employment  resume, turn in application  Family  write letter, outing with kids  Health  make or attend appt.  Housing  get/complete application  Legal  go to court, probation appointment  Personal improvement  journal, come on time  Sobriety (12-Step)  attend meeting(s), get sponsor  Social/recreational  bowling, library, church  Transportation  sign up at transportation program

9. Remember these steps: 1.Pick a behavior you want to change 2. Pick a reinforcer 3. Design a monitoring system 4. Design an incentive delivery schedule 5. Ensure consistent application

10. It’s the CONTINGENCY that matters………. BEHAVIOR REWARD Giving things away, like donuts or pizza, for free does NOT change behavior Remember:

11. Choice of Reinforcer  Higher magnitude reinforcers engender greater abstinence (Silverman et al, 1999; Stitzer et al., 1984).  Make sure your reinforcer is adequate enough to compete with reinforcement derived from target behavior.  Look for reinforcers of “high magnitude” but not high cost. but not high cost.  Always ask the patients what they like. Dunkin Donuts, KFC or 7-11? Dunkin Donuts, KFC or 7-11?

12. REACH 4 IT! Attend Orientation Groups and Win Prizes!$!$!$!! Starting March 20th, 2006 Earn a GRAND PRIZE raffle ticket each time you attend. Attend all 4 groups in 30 days and double your chances to win. Open to everyone!

13. Giveaways Intro to R.E.A.C.H.—Pens Disease of Addiction –Bracelets Medicine—Water Bottles HIV/AIDS—Gift bag w/condoms (male & female), candy, mints. female), candy, mints. Purchased with a stationery line item in the budget. Patients get a raffle ticket and receive one giveaway each time they attend.

14. Incentives Raffles at 4, 8 & 12 weeks Week 4 -- 2 striped camping chairs Week 8 -- charcoal grill & camping chair Week 12– cooler (filled by REACH staff with dollar store picnic items) with dollar store picnic items)

15. Get Ready for Summer! Patients need to see the prizes!

16. Incentives are Fiscally Sound ! A treatment center in Baltimore, MD began using incentives in their IOP program to increase attendance and increase revenue by billing for folks in the seats. began using incentives in their IOP program to increase attendance and increase revenue by billing for folks in the seats. Patients enjoyed the chance to win and the ritual of the low-cost fishbowl ritual of the low-cost fishbowl method! method!

17. 24 “Applause” 8 "Keep it Up!" 12 "Good Job" 4 "Keep Coming Back" 8 "Hear from your Peers“ 35 "Small" 15 "Medium" 5 "Large" 1 "Jumbo“ (pt’s choice) 56 no-cost tickets, and 56 cost tickets for a total of 112. Fishbowl Method

18. Incentives at work! Fishbowl contains: Applause Hear from your peers Small Medium Large Jumbo (patient’s choice) Prize cabinet is bookshelf kept 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

19. Attendance Spreadsheet

20. Total Patient Contacts Non-Incentive vs. Incentive Period AM Group (Tuesday, Wednesday, Friday ) June 2007 – October 2008 Lane Treatment Center IOP Incentive Period Non-Incentive Period

21. Incentive Period Non-Incentive Period Average Patients Per Group Non-Incentive vs. Incentive Period AM Group (Tuesday, Wednesday, Friday ) June 2007 – October 2008 Lane Treatment Center IOP

22. Incentive Period Non-Incentive Period Average Groups Attended Per Patient Non-Incentive vs. Incentive Period AM Group (Tuesday, Wednesday, Friday ) June 2007 – October 2008 Lane Treatment Center IOP

23. Income Incentive Cost Incentives Incentive Period Non-Incentive Period Monthly Insurance Income vs. Incentive Cost Non-Incentive vs. Incentive Period AM Group (Tuesday, Wednesday, Friday) June 2007 – October 2008 Lane Treatment Center IOP Income vs. Incentive

24. For more info: Download the PAMI (Promoting Awareness of Motivational Incentives) Blending Product at: www. nattc.org/pami/ Learn more about incentives by visiting the CTN Dissemination Library at: www.ctndisseminationlibrary.