Reason to Expand the Contingency Management Workforce: Coaching-to-Criterion Results for Addiction Professionals and Peer Specialists

Abstract

Background: Given well-established efficacy of contingency management (CM), demand grows for effective implementation support. Coaching-to-criterion is a strategy for assuring workforce capability to deliver CM programming with fidelity. To what extent this preparative strategy is comparably useful for addiction professionals and peer specialists is unknown.

Methods: Two ongoing endeavors-state opioid response-funded implementation support for 7 sites implementing CM programming and an National Institute of Health-funded hybrid type 1 effectiveness/implementation trial testing peer-delivered CM at 9 sites-share a coaching-to-criterion process as common methodology. For workforce members, participation in serial group coaching sessions eventuated in completion of an observed standardized patient encounter with Likert-rating of 6 CM Competence Scale domains (1 = very poor, 7 = excellent). A coach provides immediate, performance-based feedback, and if an a priori benchmark ("adequate" ratings of 4) is not initially reached, a skill-specific replay opportunity is undertaken. Non-inferiority analysis tested scale score equivalence of addiction professionals (n = 51) and peer specialists (n = 64), relative to a 0.25 standard deviation (SD) margin. Comparative resourcing of coaching efforts, scale psychometrics, and patterns of CM skillfulness were also examined.

Results: As intended, all workforce members (N = 115) met the criterion, and the mean scale score (M = 29.74, SD = 3.67) exceeded the benchmark by +1.56 SDs. Independent-samples t-test confirmed absence of between-group difference, with effect magnitude (Cohen's d = 0.13) well within the non-inferiority margin. Similar resourcing of coaching efforts was evident, with a majority (61%-66%) of addiction professionals and peer specialists achieving the criterion on initial attempt. Psychometric analyses confirmed robust item-scale correlations (r = 0.58-0.66), and no consistent pattern was found in domain-specific skills.

Conclusions: As demand grows for CM implementation, so too will the diversity of workforce needed to capably deliver it. This report documents that a coaching-to-criterion process sufficiently prepared both addiction professionals and peer specialists to deliver CM and that resulting skill among these groups did not appreciably differ nor did the required coaching efforts.

Keywords: behavior therapy; education; workforce.