Contingency management

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For use in management theory, see Contingency theory.

Contingency management is a type of treatment used in the mental health or substance abuse fields. Patients are rewarded (or, less often, punished) for their behavior; generally, adherence to or failure to adhere to program rules and regulations or their treatment plan. With children with conduct disorder, token systems are highly successful but do not help the children achieve normal functioning unless combined with a response cost program negative punishment [1]. As an approach to treatment, contingency management emerged from the behavior therapy and applied behavior analysis traditions in mental health. By most evaluations, contingency management procedures produces one of the largest effect sizes out of all mental health and educational interventions [2].

Contents

[edit] Token Economies

One form of contingency management is the token economy system[3]/ Token systems can be used in an individual or group format [4]Token systems have been shown to be successful with a diverse array of populations including those suffering from addiction[5] , those with retardation[6] and delinquents [7]; however, recent research questions the use of token systems with very young children [8]. The exception ot the last would be the treatment of stuttering [9] The goal of such systems is to gradually be thinned and to help the person begin to access the natural community of reinforcement (the reinforcement typically received in the world for performing the behavior[10]

Walker (1990) presents an excellent overview of token systems and combining such procedures with other interventions in the classroom[11]) He relates the comprehensiveness of system to the child's level of difficulty.

[edit] Voucher Programs

Another form of contingency management system are voucher programs. This form of contingency management is frequently used in methadone maintenance treatment. Patients are permitted to "earn" take-home doses of their methadone in exchange for increasing, decreasing, or ceasing certain behaviors. For example, a patient may be given one take-home dose per week after submitting negative drug screens (generally via urine testing) for three months. (It is worth noting that take home-doses (or "bottles") are seen as desirable rewards because they allow patients to come to the clinic less often to obtain their medication.)

Other types of treatment programs may provide patients with vouchers for things such as food or clothing in exchange for objective proof of abstinence from a certain drug or from all psychoactive substance[12].

In behaviour therapy, behavior modification and applied behavior analysis, contingency management includes techniques such as Shaping, time-out, making contracts between therapist and patient, and token economy.

[edit] Level Systems

Level systems are often employed as a form of contingency management system. level systems are designed such that once one level is achieved, then the person earns all the privileges for that level and the levels lower then it. [13]

Often in a behavior modification facility, it is common to use point or level systems to maintain order.

[edit] Effectiveness in addiction programs

A recent meta-analysis of contingency management in drug programs showed that it has a large effect[14]. These contingencies are delivered based on abstance and attendance goals[15][16] and can take the form of vouchers or privileges. They have been used with single problem addictions as well as dual diagnosis [17][18] and homeless[19].Overall contingency management has been found to be an effective and cost effective addition to drug treatment[20]

[edit] See also

[edit] References

  1. ^ Walker, H. (1990) The acting out child. Soporis West.
  2. ^ Forness, S.R., Kavale, K.A., Blum, I.M., & Llyod, J.W. (1997). Mage-analysis of meta-analysis: What works in special education and related services? Teaching Exceptional Children, 29, 4-9.
  3. ^ Zlomke, L. (2003). Token Economies. The Behavior Analyst Today, 4 (2), 177-184link BAO
  4. ^ Axelrod, S. (1973) "Comparison of individual and group contingencies in two special classes". Behavior Therapy, 4, 83-90.
  5. ^ Petry,N.M. (2001) Contingent reinforcement for compliance with goal-related activities in HIV-positive substance abusers. The Behavior Analyst Today, 2 (2), 78
  6. ^ Birnbrauer, J. S., Wolf, M. M., Kidder, J. D., & Tague, C. E. (1965). "Classroom behavior of retarded pupils with token reinforcement". Journal of Experimental Child Psychology, 2, 219-235
  7. ^ Braukmann, C. J., Fixsen, D. L., Kirigin, K. A., Phillips, E. A., Phillips, E. L., & Wolf, M. M. (1975)."Achievement place: The training and certification of teaching parents". In W. S. Wood (Ed.), Issues in evaluating behavior modification. Champaign, Ill.: Research Press, 131-152
  8. ^ Filcheck, H.A, & McNeil, C.B. (2004). The Use of Token Economies in Preschool Classrooms: Practical and Philosophical Concerns. JEIBI 1 (1), 95-99 BAO
  9. ^ Ryan,B.P. (2004) Contingency Management and Stuttering in Children, The Behavior Analyst Today, 5 (2), 144-169 BAO
  10. ^ Baer, D. M., & Wolf, M. M. (1970). "The entry into natural communities of reinforcement". In R. Ulrich, T. Stachnik, & J. Mabry (Eds.), Control of human behavior: Volume II. Glenview, Ill.: Scott,Foresman.
  11. ^ Walker, H.(1990). The Acting Out Child. Soporis West.
  12. ^ Prendergast ML, Hall EA, Roll J, Warda U.(2007).Use of vouchers to reinforce abstinence and positive behaviors among clients in a drug court treatment program. J. Subst Abuse Treat.
  13. ^ Cancio, E. & Johnson, J.W. (2007). Level Systems Revisited: An Impact Tool For Educating Students with Emotional and Behavioral Disorders. International Journal of Behavioral Consultation and Therapy, 3(4), 512-527.BAO
  14. ^ Schumacher JE, Milby JB, Wallace D, Meehan DC, Kertesz S, Vuchinich R, Dunning J, Usdan S.(2007). Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990-2006). J Consult Clin Psychol.75(5):823-8.
  15. ^ Stitzer ML, Petry N, Peirce J, Kirby K, Killeen T, Roll J, Hamilton J, Stabile PQ, Sterling R, Brown C, Kolodner K, Li R.(2007).Effectiveness of abstinence-based incentives: interaction with intake stimulant test results. J Consult Clin Psychol. 75(5).805-11
  16. ^ Petry NM, Alessi SM, Hanson T, Sierra S.(2007).Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. J Consult Clin Psychol. 75(6). 983-991
  17. ^ Drebing CE, Van Ormer EA, Mueller L, Hebert M, Penk WE, Petry NM, Rosenheck R, Rounsaville B.(2007).Adding contingency management intervention to vocational rehabilitation: Outcomes for dually diagnosed veterans. J Rehabil Res Dev.,44(6):851-66
  18. ^ Ghitza UE, Epstein DH, Preston KL.(Nov. 17 2007) Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients.Addict Behav.
  19. ^ Lester KM, Milby JB, Schumacher JE, Vuchinich R, Person S, Clay OJ.(2007).Impact of behavioral contingency management intervention on coping behaviors and PTSD symptom reduction in cocaine-addicted homeless.J Trauma Stress. 20(4):565-75.
  20. ^ Olmstead TA, Sindelar JL, Petry NM.(2007).Clinic variation in the cost-effectiveness of contingency management. Am J Addict. 16(6). 457-60