Counselor Incentives to Improve Client Retention in an Outpatient Substance Abuse Aftercare Program

Abstract

Pay for performance, the provision of financial incentives for favorable performance, is increasingly under study as an evidence-based practice. This study estimated the improvement in client retention from offering incentives to 11 substance abuse counselors providing outpatient aftercare treatment. During the incentive period, a counselor could earn a bonus of $100, in addition to his regular compensation, for each client who completed at least five aftercare sessions (the "milestone" which we considered the minimum adequate dose of the aftercare curriculum). We evaluated this and a similar, 12-session incentive using a logistic regression in which the retention "milestone" was the dependent variable and the proportion of time in the incentive condition was the independent variable. Among the 123 clients offered this aftercare program, their probability of completing at least 5 sessions was 59% with the incentive compared to 33% beforehand (odds ratio 4.1, P<.01). These findings suggest that counselor incentives are an effective strategy to improve client retention in substance abuse treatment.

Continuing care research: What we have learned and where we are going

“…The work of Lash et al (2007), Chutuape et al (2001), and Shepard et al (2006) suggests that engagement and retention in continuing care can be increased with relatively low cost, low effort approaches, which can be applied to virtually any continuing care protocol. This points to the potential benefit of conducting research to identify evidence based practices that are easily exported, in addition to the continued search for evidence based continuing care treatments.…”

“…Schmitt, Phibbs, and Piette (2003) found that patients who lived within 10 miles of a continuing care facility were 2.6 times more likely to seek treatment there following discharge from residential treatment than those who lived at least 50 miles from the facility. Finally, Shepard and colleagues found that providing continuing care counselors with a $100 bonus for each of their patients who attended at least 5 sessions of continuing care raised the percentage of patients who achieved that milestone from 33% to 59% (Shepard et al, 2006). …”

Exposure to Adolescent Community Reinforcement Approach treatment procedures as a mediator of the relationship between adolescent substance abuse treatment retention and outcome

“…One method recommended by the Institute of Medicine (IOM; Institute of Medicine, 2007) to improve the quality of healthcare is pay-for-performance (P4P). Shepard and colleagues (2006) showed that providing financial incentives to therapists could be an effective and cost-effective approach to improve client retention. Although these practices have become increasingly common in healthcare, few studies have examined the impact of P4P methods experimentally (Dudley, 2005).…”

The Washington Circle continuity of care performance measure: Predictive validity with adolescents discharged from residential treatment

“…Contingent upon further predictive validation of its relationship to important client treatment outcomes (e.g., reduced substance use and criminal activity), achievement of continuity of care could potentially serve as an important target criterion upon which providers are not only held accountable for, but also rewarded for achieving (i.e., pay-for-performance [P4P]). Indeed, P4P is one approach that has been recommended by the Institute of Medicine (2007) and is has been applied in both general medicine (Rosenthal & Dudley, 2007; Rosenthal, Landon, Normand, Frank, & Epstein, 2006) and the substance abuse treatment field (Garner et al, 2009; McLellan, Kemp, Brooks, & Carise, 2008; Shepard et al, 2006). Second, as approximately 8 out of 10 AC participants met the WC criterion for continuing care initiation it suggests continuity of care can be achieved with significantly more adolescents than only those who are sufficiently motivated, organized, and resourced to attend clinic appointments.…”