What’s So Great About
Incentives ?
Brought to you by the
CTN Mid-Atlantic Node
Christine Higgins
Dissemination Specialist
410-550-4316
chiggin2@jhmi.edu
Who Uses
Behavioral
(Contingency)
Management?
Behavior 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
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
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
What’s so great about incentives?
Broadly applicable
across target
behaviors.
An evidence-based
intervention.
Patients like them!
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
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
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
Remember:
It’s the CONTINGENCY
that matters……….
BEHAVIOR
REWARD
Giving things away,
like donuts or pizza, for free
does NOT change behavior
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.
 Always ask the patients what they like.
Dunkin Donuts , KFC or 7-11?
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!
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.
Purchased with a stationery line item in the
budget. Patients get a raffle ticket and receive
one giveaway each time they attend.
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)
Get Ready for Summer!
Patients need to see
the prizes!
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.
Patients enjoyed the chance to win and the
ritual of the low-cost fishbowl
method!
Fishbowl Method
24
8
12
4
8
“Applause”
"Keep it Up!"
"Good Job"
"Keep Coming Back"
"Hear from your Peers“
35
15
5
1
"Small"
"Medium"
"Large"
"Jumbo“ (pt’s choice)
56 no-cost tickets, and
56 cost tickets for a total of
112.
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
Attendance Spreadsheet
Total Patient Contacts
Non-Incentive vs. Incentive Period
AM Group (Tuesday, Wednesday, Friday )
June 2007 – October 2008
Lane Treatment Center IOP
200
180
160
140
120
100
80
60
40
20
0
Non-Incentive Period
Incentive Period
Average Patients Per Group
Non-Incentive vs. Incentive Period
AM Group (Tuesday, Wednesday, Friday )
June 2007 – October 2008
Lane Treatment Center IOP
16
14
12
Non-Incentive Period
10
8
6
4
2
0
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
8
7
6
Non-Incentive Period
5
Incentive Period
4
3
2
1
0
Monthly Insurance Income vs. Incentive Cost
Non-Incentive vs. Incentive Period
AM Group (Tuesday, Wednesday, Friday)
June 2007 – October 2008
Lane Treatment Center IOP
$20,000
$18,000
Income vs. Incentive
$16,000
Income
$14,000
$12,000
$10,000
Incentive
Cost
Incentives
Non-Incentive Period
$8,000
$6,000
$4,000
$2,000
$0
Incentive
Period
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.