University of Connecticut Health School of Medicine.
Psychol Addict Behav. 2020 Feb;34(1):89-98. doi: 10.1037/adb0000496. Epub 2019 Jul 25.
Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers ( = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
关于奖励计划在现实世界中的物质使用治疗环境中是如何实施的，以及关于行为矫正术（CM）培训（一种经验支持的基于奖励的干预措施）是否会影响其设计质量，人们知之甚少。CM 信念、培训和与治疗中使用有形奖励相关的实践，提供者（= 214）完成了评估。对于报告他们之前在治疗中没有使用过奖励的提供者（54%，= 116），我们评估了他们对基于奖励的方案的接受程度和采用奖励的意愿。对于那些支持以前有过奖励经验的提供者（46%，= 98），我们评估了奖励的特征和提供方式，以及奖励干预培训与 CM 疗效的 4 个相关参数之间的关系：强化幅度、即时性、频率和递增。在没有奖励经验的提供者中，对 CM 的支持性陈述的认可预测了他们对采用基于奖励的方案的兴趣。有奖励经验的提供者最常针对治疗出勤率，并且采取了可能降低干预效果的行为，包括使用低幅度（≤ 25 美元/客户）、延迟强化、未能增加奖励价值，以及每周提供不到一次奖励机会。培训时间较长的提供者更有可能采取与有效的 CM 一致的行为，包括更大幅度的奖励和立即发放奖励。结果表明，现实世界中的治疗诊所正在使用基于奖励的方案，但方式不符合研究方案。较长的培训暴露与更符合 CM 方案设计的某些方面的一致性有关。即使进行了培训，其他基于证据的设计特征也没有得到实施。（PsycINFO 数据库记录（c）2020 APA，保留所有权利）。
