The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

Katherine A Hirchak¹, Holly Echo-Hawk², Sara Parent³, K Michelle Peavy³, Kellie Webb⁴, Kelsey Bajet³, Meenakshi Richardson³, Alexandria Granbois³, Jalene L Herron⁵, Krista Catron², Keli King², Ed Parsells², Thomas E Freese⁶, Lisa Rey Thomas⁷, Richard Rawson⁸, H Westley Clark⁹, John Roll⁷, Michael G McDonell³

Affiliations

¹ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA. Electronic address: Katherine.hirchak@wsu.edu.
² Kauffman and Associates, Inc., Spokane, WA, USA.
³ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA.
⁴ Doya Natsu Healing Center, Fort Washakie, WY, USA.
⁵ Department of Psychology, University of New Mexico, Albuquerque, NM, USA.
⁶ University of California-Los Angeles, Los Angeles, CA, USA.
⁷ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
⁸ University of Vermont, Burlington, VT, USA; Motivational Incentives Policy Group, USA.
⁹ Motivational Incentives Policy Group, USA.

PMID: 37573952
PMCID: PMC10840817
DOI: 10.1016/j.ypmed.2023.107662

The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

Katherine A Hirchak et al. Prev Med. 2023 Nov.

. 2023 Nov:176:107662.

doi: 10.1016/j.ypmed.2023.107662. Epub 2023 Aug 11.

Authors

Affiliations

¹ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA. Electronic address: Katherine.hirchak@wsu.edu.
² Kauffman and Associates, Inc., Spokane, WA, USA.
³ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Promoting Research Initiatives in Substance Use and Mental Health Collaborative, Washington State University, Spokane, WA, USA.
⁴ Doya Natsu Healing Center, Fort Washakie, WY, USA.
⁵ Department of Psychology, University of New Mexico, Albuquerque, NM, USA.
⁶ University of California-Los Angeles, Los Angeles, CA, USA.
⁷ Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
⁸ University of Vermont, Burlington, VT, USA; Motivational Incentives Policy Group, USA.
⁹ Motivational Incentives Policy Group, USA.

PMID: 37573952
PMCID: PMC10840817
DOI: 10.1016/j.ypmed.2023.107662

Abstract

In two randomized controlled trials, culturally adapted contingency management (i.e., incentives provided for substance-negative urine samples) was associated with reduced alcohol and drug use among geographically diverse American Indian and Alaska Native (AI/AN) adults. In response to interest in contingency management from other Tribal and AI/AN communities, our research team in collaboration with AI/AN behavioral health experts, translated the research into practice with new AI/AN community partners. Tenets of community-based participatory research were applied to develop, pilot, and refine contingency management training and implementation tools, and identify implementation challenges. In partnership with the AI/AN communities, four members of the university team developed tools and identified implementation and policy strategies to increase the successful uptake of contingency management in each location. Through our collaborative work, we identified policy barriers including inadequate federal funding of contingency management incentives and a need for further clarity regarding federal anti-kickback regulations. Adoption of contingency management is feasible and can strengthen Tribal communities' capacity to deliver evidence-based substance use disorder treatments to AI/AN people. Unfortunately, non-evidence-based limits to the use of federal funding for contingency management incentives discriminate against AI/AN communities. We recommend specific federal policy reforms, as well as other practical solutions for Tribal communities interested in contingency management.

Keywords: Access; American Indian and Alaska Native adults; Anti-kickback statute; Contingency management; Culturally responsive treatment; Health equity; Stimulant use disorder.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Michael McDonell has received funding from a Tribally owned for-profit clinic to evaluate outcomes related to the impact of cannabis on health. This Tribe and clinic were not involved in the current study. Dr. Michael McDonell also has a conflict-of-interest management plan at Washington State University for consulting on evidence-based interventions. The other authors report no conflicts of interest.

Figures

**Fig. 1.**
Medicine wheel contingency management treatment visit workflow.

**Fig. 2.**
The number and type of contingency management training activities completed by the university team from 2021 to 2023.

See this image and copyright information in PMC

References

1. Benishek LA, Dugosh KL, Kirby KC, et al., 2014. Prize-based contingency management for the treatment of substance abusers: a meta-analysis. Addiction. 109 (9), 1426–1436. 10.1111/add.12589. - DOI - PMC - PubMed
1. Centers for Medicare & Medicaid Services. About Section 1115 Demonstrations. Medicaid.gov. Accessed January 19, 2023. https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-sect....
1. De Crescenzo F, Ciabattini M, D’Alò GL, et al., 2018. Comparative efficacy and acceptability of psychosocial interventions for individuals with cocaine and amphetamine addiction: a systematic review and network meta-analysis. PLoS Med. 15 (12), e1002715 10.1371/journal.pmed.1002715. - DOI - PMC - PubMed
1. Department of Health and Human Services, Office of Inspector General, 2020. Medicare and State Health Care Programs: Fraud and Abuse; Revisions to Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements. Federal Register. Published December 2. Accessed January 19, 2023. https://www.federalregister.gov/documents/2020/12/02/2020-26072/medicare....
1. Department of Health Care Services, 2022. Medi-Cal Contingency Management Pilot Program Policy Design. DHCS. Published January. Accessed January 19, 2023. https://www.dhcs.ca.gov/Documents/Contingency-Management-Policy-Paper.pdf.

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The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

Affiliations

The urgent need for contingency management among Tribal communities in the United States: Considerations for implementation, policy, and sovereignty

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources