Training led by Contingency Management (CM) experts is the most common implementation strategy. Training topics include CM principles, delivery methods, and the research that supports them. These trainings can vary in length and content, including workshops and ongoing consultations.

A study funded by the National Institue on Drug Abuse (NIDA) called “Maximizing the Implementation of Motivational Incentives (MIMIC)” used a didactic training approach that contained a self-paced “foundations of CM” video, live training that consisted of ample opportunity for experiential learning and practice delivering CM, and a “nuts and bolts” training that consisted of workflow planning and time spent thinking through the logistics of CM delivery. In the Veterans Health Administration CM initiative, VA substance use providers attended a 1.5-day training workshop where they participated in didactics, demonstrations, and group exercises. In California, the Recovery Incentives Program virtual didactic trainings included both asynchronous and live sessions. Similar to the MIMIC study, the approach in California covered the fundamentals of CM, opportunities to practice CM delivery, and support thinking through the logistics of CM delivery.

Virtual training options have been shown to be cost-effective relative to face-to-face training. In response to the COVID-19 pandemic, the MIMIC team translated their
7-hour in-person training to a series of three 1-2 hour virtual training sessions; a direct comparison of the face-to-face and virtual training approaches found that the virtual approach was more cost-effective. The California Recovery Incentives Program uses virtual training due to the large number of programs and far geographic reach.

Augmenting didactic training with performance feedback or ongoing monitoring is considered a best practice. The MIMIC project and the California Recovery Incentives Program both had CM providers complete a role-play using a standardized patient scenario to ensure competence in CM delivery. The MIMIC project also required providers to submit audio recordings of one patient encounter per month to monitor the fidelity of delivery over time. Ideally, CM delivery should be monitored with a fidelity rating scale such as the CM Competence Scale.

Didactic training should also be augmented with ongoing consultation or coaching. Prior to the start of implementation, consultation or coaching can help programs to finalize their CM targets and workflows and prepare their reinforcement protocols. During the implementation phase, consultation or coaching can help programs troubleshoot emergent barriers to implementation. In most CM implementation initiatives, ongoing consultation is provided on a monthly basis. A study by Becker and colleagues found that didactic training, combined with performance feedback and ongoing consultation, was associated with up to 13 times higher odds of CM adoption than didactic training alone. The combined package of didactic training, performance feedback, and ongoing coaching is sometimes referred to as the Addiction Technology Transfer Center (ATTC) Strategy and sometimes as the Science to Service Laboratory.

Incentivization, also known as pay-for-performance, is an implementation strategy in which providers earn monetary rewards for meeting key performance measures. Project MIMIC is testing whether adding incentivization and facilitation to the ATTC Strategy can improve the quality and consistency of CM delivery. The results of Project MIMIC have been shared at national conferences and appear promising, but have not yet been published.

The ISF is an implementation strategy in which providers participate in monthly meetings with a trained facilitator external to the project. These meetings focus on helping programs plan for each stage of implementation. As noted above under Incentivization, Project MIMIC is testing whether adding incentivization and facilitation to the ATTC Strategy can improve the quality and consistency of CM delivery. The results of Project MIMIC have been shared at national conferences and appear promising, but have not yet been published.

Readiness assessments have been used in several CM implementation initiatives. The goal of these assessments is to help sites develop policies and protocols that enable the successful implementation of CM. In an ongoing CM initiative called Project MIMIC2, supported by the Center for Dissemination and Implementation at Stanford (C-DIAS), CM providers work through a Protocol Development Worksheet with the CM trainer in order to iron out the site’s workflow and troubleshoot any potential obstacles to implementation. The California Recovery Incentives Program employs a similar approach, in which sites complete a self-study to document their CM protocols, ensuring readiness for implementation.