Community treatment adoption of contingency management: a conceptual profile of U.S. clinics based on innovativeness of executive staff.

BACKGROUND

Community adoption of contingency management (CM) varies considerably, and executive innovativeness may help explain variance due to its presumed influence on clinic decision-making.

METHODS

Sixteen U.S. opioid treatment programs (OTPs) were visited, with ethnographic interviewing used in casual contacts with executives to inform their eventual classification by study investigators into one of Rogers' (2003) five adopter categories. Audio-recorded interviews were also conducted individually with the executive and three staff members (N = 64) wherein they reported reactions to clinic CM implementation during the prior year, from which study investigators later identified salient excerpts during interview transcript reviews.

RESULTS

The executive sample was progressive, with 56% classified as innovators or early adopters. Implementation reports and corresponding staff reactions were generally consistent with what might be expected according to diffusion theory. Clinics led by innovators had durably implemented multiple CM applications, for which staff voiced support. Clinics led by early adopters reported CM exposure via research trial participation, with mixed reporting of sustained and discontinued applications and similarly mixed staff views. Clinics led by early majority adopters employed CM selectively for administrative purposes, with staff reticence about its expansion to therapeutic uses. Clinics led by late majority adopters had either deferred or discontinued CM adoption, with typically disenchanted staff views. Clinics led by a laggard executive evidenced no CM exposure and strongly dogmatic staff views against its use.

CONCLUSION

Study findings are consistent with diffusion theory precepts, and illustrate pervasive influences of executive innovativeness on clinic practices and staff impressions of implementation experiences.