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.