Intervention

Barriers and facilitators (sometimes called "contextual determinants") are factors that make it harder or easier to implement buprenorphine. These factors span multiple levels. Click the buttons on the left to read more about common barriers and facilitators for buprenorphine. In addition, view the RASC guides on Contextual Determinants Affecting Implementation and the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) to learn practical ways to assess these constructs.

Barriers to Contingency Management implementation include its complexity, the need for strict fidelity, and the frequency of sessions, whereas facilitators include its adaptability, focus on positive reinforcement, and brevity.

Barriers

Although easy to learn, Contingency Management (CM) is more complex to deliver and track than many behavioral interventions, as programs need to store the incentives, recall how much each patient can earn in each session, and have a system for administering the incentives. CM also requires detailed tracking and documentation of the protocol and the administration of audits to lower the risk of organizational audits.

CM needs to be delivered with strict fidelity to protocols, both to ensure its effectiveness and potency and to reduce the risk that the program will be audited. The need for strict fidelity to the protocol necessitates systems for monitoring the quality and consistency of ongoing CM delivery.

The fact that CM should be delivered at least weekly, and often two or more times per week, is a barrier relative to other evidence-based interventions. Fitting multiple encounters per week into the workflow can be challenging.

Facilitators

The flexibility of CM, in terms of target behavior, duration, frequency, and the style of CM used (voucher vs. prize-based), is a facilitator of its implementation, allowing programs to select design elements that suit their needs.

Many providers and patients find CM appealing because they appreciate the focus on positive reinforcement. Substance use treatment has historically been negative or punitive, and the positive approach is often a facilitator of implementation and of patient engagement.

While the frequency of CM delivery is a barrier, its brevity is a facilitator. Each CM encounter is only about 5 minutes.