Michael Levy, Vice President Clinical Services CAB Health & Recovery Services/Health & Education Services
Peabody, MA
Target Population: Residential
Target Behavior: Compliance & Cooperation

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We have ongoing incentive programs that are integral to the design and structure of our three residential programs, and rather than giving out tangible rewards like gift cards, we use program privileges. In two separate Women and Children programs there is 24/7 direct care and staff and patients alike appreciate our level system. The women are eligible to earn up to 300 points a week. The patients can earn points for such tasks as attending group, participating in group, cleaning up the house, and exhibiting good parenting skills. The earned points determines the level of care they obtain, which in turn, leads to a variety of privileges, such as a weekend pass.

We are also using this points system in a Residential Adolescent Treatment Program. The young men can earn up to 100 pts. for such things as keeping their room clean, participating in groups, and observing rules. The privilege or rewards provide them with the ability to participate in outside activities or earning a weekend pass. When they encountered an issue in the Adolescent Program with destruction of property and graffiti, they offered an incentive to the entire group of a pizza party for a clean inspection and it worked They also use the Fishbowl method in this program for tasks like keeping their rooms clean. Rewards can include: no chores for the day, or getting to sleep a little later.

Tracy Schulden, Director
Universal Counseling
Services, Inc.
Baltimore, MD
Target Behavior:
90-day retention
Target Audience: All new clients

We are an outpatient and substance abuse program with 104 patients in the substance abuse program; we offer IOP, OP and suboxone. We started as a private pay clinic, but now we have predominately medical assistance and some block grant support along with continued private pay. We started using incentives about two years ago.

Our target population was clients in the first 90 days of treatment. We started out with block grant people, but it soon expanded to everyone. Our block grant promised to provide 5% incentive over the original award amount, so we knew we could make $13,000 if we were successful. We decided to invest up front in order to have a larger reward. The first thing we did was buy some inexpensive rubber bracelets to give away at intake. Clients were told when they came back for orientation they would receive a $5 gift card to an on-site snack shop. After that, it’s lottery tickets and a big prize is given at the end of a week. We made a honor board in the lobby. It features a winding road up the hill, and, each person can see their progress. The clients choose symbols in order to protect their confidentiality. It’s a great visual for everybody.

I have personally taken on the task of collecting and tracking the data for this initiative, but it’s worth it to me. Retention is way up, and while counselors were initially resistant, they now suggest targeting other behaviors: attendance at group, and even urinalysis.

Jim Beiting, Executive Director Community Behavioral Health, Inc. Hamilton, Ohio

Target Population:Participants in Psycho Educational Groups
Target Behavior:Group Attendance

After I completed the PAMI (Promoting Awareness of Motivational Incentives)Training of Trainers in 2008, I was feeling enthusiastic about Contingency Management and decided to initiated several motivational incentive programs at Community Behavorial Health. One of my “bright ideas” was to purchase a Craftsman Tool Cart from a local home improvement store. The cart is used to provide incentives at psycho-educational groups. The beauty of the cart is that it can be locked to protect the prizes, and it wheels which means it can be easily moved from one group room to another. The cart is filled with incentives ranging from small trinkets to AA materials. The AA books and materials are highly prized by group members. There is one person whose job it is to ensure the cart ends up the room. She has affectionately become known as the “cart lady”.

Kathy Ulm, Director
Rushford Treatment Center
Rushford, CT
Target Population: All Patients
Target Behavior: Retention in Treatment

Rushford Center is a Behavioral Healthcare organization with a large specialty in substance abuse service under the umbrella of a larger hospital system. Our reason for beginning our current program was to address high no-show and dropout rates. We chose the 50 clients in 3 of our outpatient programs and our target behavior was increased attendance. Our first challenge was to do the cost calculations to how income vs. expenditure would balance out. And it took some time to get clinicians on board. Rushford has an Employee Fund program to benefit our clients which I think is a unique and exciting idea. The substance abuse programs can receive up to $1200 per quarter and the money must be spent to directly benefit clients. Donations to the Employee Fund are made through a payroll deduction plan.

Here’s how our program works: On Day 1, clients receive a Dunkin’ Donut gift card for completing their assessment. After that, clients place a ticket into a fishbowl each time they attend, and these tickets remain in the bowl as long as they are in treatment. Draws are held on Friday. Each client gets one draw and there are 5 winners every Friday. Of course, the probability of winning a prize depends on the number of tickets you have in the bowl. We keep track of the behavior using our Attendance Roster, and we have a closet where we keep gift cards and “marketing items” such as t-shirts and mugs. Another advantage is that we have an EMR system that has enhanced record keeping and allows data feedback on performance outcomes. We know the incentive program is working because data can be obtained from EMR. In fact, a no-show rate of 50% from intake to clinical appointment has reduced to less than 35 percent. And our retention rates have improved. Even though, we had to overcome some resistance, our counselors like the program. They know with more certainty how many will be in attendance. And their workload is more manageable; it eliminates the need to overbook appointments. Of course, our patients like it too. It’s amazing how many people are proudly wearing our treatment center t-shirts around Middletown, CT.

Bernice Layton, Fianacial Mgr.
Man Alive, Inc.
Baltimore, Maryland
Target Population: Patients who have MCO or PAC insurance
Target Behavior: Up to date insurance coverage

Man Alive is the second oldest methadone maintenance clinic in the United States, and the first one established in the state of Maryland. I’ve worked here for over twenty years, wearing several hats. One of my biggest challenges over the years has been asking patients to keep their insurance coverage current. Even though Social Security contacts these patients by mail, that it is time to come in for a re-con, we do not receive the same information. Most patients delay going to their appointment since it is a long wait, and an unpleasant task when they go there. I got the idea to incentivize patients to bring in their letter that tells when their appointment is scheduled. Before when I asked, they would promise to and then forget. But when I offered a $5 gift card to make a copy of the letter, they were much more likely to remember.

The disadvantage to Man Alive was that if a patient’s insurance lapsed, we would not be paid on time for the services delivered. And it often overlapped—we would request reimbursement, only to find out that the coverage had lapsed. It was hard to stay on top of patients to complete this task because we didn’t know the date of their one year anniversary. When patients started to bring in the letters, I was able to make a database that gave me important details about their case. Then I decided that I would offer patients a $10 gift card if they brought me the letter that said they had kept their appointment and what they’re re-up was based on status changes. I could then track these as well. The benefit to the smooth operation of this task allows me to focus on other things and establish good rapport with our patients.