By the Northwest Addiction Technology Transfer Center
Contingency management (CM) is an evidence-based practice that uses behavioral reinforcement, like rewards, to shape client behavior toward a treatment goal, such as attending counseling sessions or abstinence.
As a therapeutic approach, CM has been studied extensively in addiction treatment settings for half a century and found reliably effective in the treatment of both opioid use disorder and methamphetamine use disorder, two major contributors to the current overdose epidemic in the U.S.
Increasing adoption of evidence-based practices by the addiction workforce is an ongoing goal–-and challenge. At the core of that challenge is determining the most useful and cost-effective ways to design and deliver training that not only increases workforce members’ awareness and knowledge of a given clinical practice but also enables their development of skills and competencies so that clinical practice may then be delivered with fidelity.
Historically, training workforce members to deliver CM has typically involved in-person, workshop-format events that pair observational and experiential learning (trainer demonstration, role plays, etc.) to enable workforce members to build and demonstrate CM delivery skills. However, as with many aspects of clinical practice, COVID-19 forced changes to traditional learning approaches, with many trainings moving to virtual platforms.
What are the impacts of this transition to virtual training? Were they as useful? Did they become more or less costly to deliver? Answers to such questions may broadly inform how training in a range of useful clinical practices, including contingency management, is approached.
How was this studied?
To address these questions, researchers from both the New England and Northwest ATTCs collaborated on this publication, as part of their ongoing NIDA-funded multi-site trial that is testing implementation strategies for CM in opioid treatment programs in HHS Region 1.
The effort to examine the comparative usefulness and cost-effectiveness of virtual vs. in-person training workshops was led by Bryan Hartzler, PhD a Research Associate Professor at the University of Washington’s Addictions, Drug and Alcohol Institute (ADAI). The research involved two workforce cohorts employed at 18 opioid treatment programs who received workshop training in CM (one group in-person, the other virtually).
The in-person cohort (26 workforce members) attended an 8.5-hour, one-day workshop with an entirely synchronous learning experience, whereas the virtual cohort (31 workforce members) participated in five-hour virtual training that included pre-recorded online content watched at their convenience (asynchronous) with two live Zoom meetings the cohort attended together (synchronous). Both training approaches involved the same facilitator, learning objectives, and educational strategies/activities.
After training, attendees submitted short audio-recorded role plays, in which their CM delivery skills were evaluated by independent raters using a validated fidelity tool. The researchers also gathered cost information associated with each type of training workshop.
Concerning the post-training role-plays, Hartzler and colleagues found clinical benchmarks for delivering CM were achieved at a 12 to 14percent higher rate among attendees of virtual training than by attendees of in-person training. Virtual training was also found to cost $399 less per attendee than in-person training.
Why is this important?
This study provides support for the use of virtual training in preparing workforce members to deliver an evidence-based practice like CM. In this study, virtual training was not only significantly less expensive than in-person training but also more useful in preparing workforce members to demonstrate skill in delivering CM with fidelity. These results may help inform post-pandemic approaches to dissemination not just of CM but of other therapies as well.
Citation: Hartzler B, et al. Virtual training is more cost-effective than in-person training for preparing staff to implement contingency management. Journal of Technology in Behavioral Science 2022 (in press).