Contingency Management for Problematic Behavior Reduction in the Community
Phase: NA
Conditions: Schizophrenia, Bipolar Disorder, Anosognosia
Sponsor: Laureate Institute for Brain Research, Inc.

LIBR #2023-005 
12/22/2023 
 
 
 
Contingency Management for Problematic Behavior Reduction in the Community 
 
 
Martin P. Paulus, M.D. 
Scientific Director and President 
Laureate Institute for Brain Research 
6655 S Yale Ave 
Tulsa, OK 74136-3326 
Phone: 918 502 5120 
FAX: 918 502 5135 
email: mpaulus@laureateinstitute.org 
web: http://www.laureateinstitute.org 
 
 
Sponsor: Laureate Institute for Brain Research 
 
Funded By: Laureate Institute for Brain Research 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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A. Study Purpose 
 
This study aims to determine the feasibility and effectiveness of implementing a contingency 
management program in a small group of mentally ill, homeless individuals with schizophrenia 
or bipolar disorder and anosognosia (a lack of insight into their mental health) in the City of 
Tulsa. Tulsa’s homeless population grew nearly 7% last year to the highest numbers since the 
beginning of the COVID-19 pandemic according to Housing Solutions data, an organization that 
oversees many of the city’s efforts to address homelessness. The primary objective of the study 
is to decrease disruptive or problematic behaviors by homeless individuals in the community 
through monetary incentives.  
 
Specific Aim: To determine the safety and efficacy of contingency management to decrease the 
number of disruptive events in the Tulsa community over an 18-month timeframe (e.g. 
interactions with police, Tulsa Fire Department, Emergency Medical SA, and 911 interventions) 
 
B. Background and Significance 
 
Contingency management (CM) is a behavioral intervention strategy that has demonstrated 
promising results in various populations. It involves the provision of tangible incentives or 
rewards to individuals who demonstrate specific behavioral changes, such as adherence to 
treatment, abstaining from drug use, or engaging in positive life choices. Whereas 
controversial, the employment of financial incentives to achieve behavioral goals in persons 
with severe psychiatric disorders has been used previously (Noordraven et al., 2017; Priebe et 
al., 2010; Rosen et al., 2023). 
 
This study aims to determine the feasibility and effectiveness of implementing a CM program in 
a small group of homeless individuals with a mental health diagnosis. These individuals will also 
have the symptom of anosognosia, which is the lack of awareness of their disorder (a term 
often applied to conditions with structural pathology of the central nervous system, but present 
also in severe mental health disorders, in which is usually described as lack of insight). This 
symptom has long been recognized as a major predictor of nonadherence to treatments, 
poorer psychosocial functioning, aggression, and poorer course of illness overall. The 
association between anosognosia and treatment noncompliance is particularly strong among 
patients with chronic psychotic disorders, in whom lack of treatment is a major driver of most 
other adverse outcomes (e.g., Kim et al. 2020).   
 
The research will be conducted in accordance with the highest ethical standards, ensuring the 
safety, privacy, and wellbeing of all participants. Data collection will involve multiple sources, 
including self-report questionnaires, legal records, and housing status updates, allowing for a 
comprehensive evaluation of the CM program's efficacy in promoting disruptive behavior-free 
days for homeless individuals in Tulsa. 
 
C. Criteria for Subject Selection 

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Description and Recruitment of Population: 
Fifteen participants (10 completers estimating a very conservative attrition rate of 50%) will be 
recruited at the Tulsa Day Center (TDC), a private, non-for-profit organization in Tulsa, OK, 
continuously operating in the city for over 40 years. TDC offers shelter and daytime activities, 
including medical services, to about 250 homeless people every day. Participants will be pre-
selected for participation by TDC staff based on their history of problematic behaviors (Table 1). 
All participants will be between 18 and 65 years of age, inclusive. TDC staff will collect 
information from participants regarding their diagnoses, and after initial screening, records will 
be obtained from clinical records to confirm psychiatric diagnosis. In addition, information 
regarding disruptive behaviors necessitating intervention will be obtained for the 6 months 
prior to enrollment to establish a historical baseline of disruptive behaviors against which the 
efficacy of this study intervention will be compared. Clients with a history of at least one 
disruptive episode per week in at least 50% of the weeks in the 6-month period will be eligible 
for enrollment. At this early, feasibility stage, no stratification according to sex, gender, or 
ethnicity will be made. 
 
Inclusion Criteria: 
1. Age 18-65 years old 
2. Diagnosis of Schizophrenia Spectrum, Bipolar, or Related Disorders 
3. Presence of Anosognosia (SUMD: Minimum combined score of 4 on questions 1) and 2); 
Recent (at least <6 months) history of disruptive behaviors (at least 1 disruptive 
behavior per week in >50% of weeks in the 6-month period prior to enrollment) 
4. Receive case management services through TDC 
5. Ability to comply with study procedures 
6. Willingness to participate in contingency management intervention 
 
Exclusion Criteria: 
Based on assessment by the client’s case manager, the presence of: 
1. Inability to provide informed consent 
2. Unstable medical conditions that would interfere with participation 
3. Cognitive impairment that would interfere with participation in the study 
4. History of severe aggression or violent behavior posing a risk to study staff or other 
participants 
5. Active suicidal ideation or a history of suicide attempts within the past 12 months 
 
D. Research Design and Methods 
 
Description of Study Intervention: 
Subjects will be selected by Tulsa Day Center (TDC) staff based on inclusion criteria. Participants 
will meet weekly for 30 minutes with their case manager to discuss progress on life goals and 
determine of the bonus payment has been earned. The participant will receive $10 for their 
time spent with the case manager each week. The goal is for the participant to maintain seven 

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days with no disruptive behaviors (or “trouble-free days”*) per week at each visit. This goal will 
be verified by the case manager and lead study manager prior to the participant’s visit each 
week using the sources of data information described below. When the goal is achieved for a 
certain week, the participant will receive payment. The payment starts at $20 and each week 
the amount paid per goal/week will increase by $1. Any week with disruptive behaviors will 
result in returning to the $20 baseline amount. 
 
*”Trouble free days” definition: Trouble-free days are days during which an individual with a 
severe mental disorder demonstrates no occurrence of problematic behaviors and maintains a 
stable mental state without causing harm or disruption to themselves or others. 
 
Table 1: Possible Sources of Data for Baseline and Ongoing Trouble-Free Day Information: 
• Homeless Management Information System: Shows current case manager, overnight 
shelter stays (recorded daily), VI SPIDAT scores. 
• Vulnerability Index Service Prioritization Decision Assistance Tool (VI SPIDAT): records 
self-reported periods of homelessness, evictions, emergency room visits (physical 
reasons), hospitalizations (physical reasons), incarcerations, crisis care admissions, 
hospitalizations (mental health reasons), and substance use. 
• Oklahoma State Courts Network (OSCN): Shows legal records including evictions, 
arrests, charges and disposition of cases.  
• City of Tulsa Jail Hub: Shows City of Tulsa Municipal Court charges (trespassing, erecting 
an abode unlawfully, etc.) 
• Tulsa Police Department: Source for arrest records  
• Tulsa Fire Department CARES program: Tracks number of calls to 911 
• Tulsa City and County court records: Data base for civil commitment municipal  
• Tulsa Center for Behavioral Health: Inpatient stays 
• Grand Addiction Recovery Center and Grand Mental Health: Participation in recovery 
programs 
• Landlords: Mental Health Association Oklahoma, Hudson Villas, Tulsa Housing Authority 
• David L Moss Inmate Search: Arrests and charges 
• MyHealth Access Network: Emergency room visits, hospital visits, diagnoses, medical 
care, prescribed medications, etc. 
• Julotta System: will house information on hospital admissions, arrests, case 
management notes, medical history, list of medications prescribed, diagnosis, insurance 
info, ER visits in past 12 months, 911 calls in past 12 months, push notifications, referrals 
to other programs, program enrollments, past employment, strengths and abilities, 
financial assessment, past substance abuse. Julotta access will be dependent on 
implementation in the local community. 
• Other community-based services as needed (e.g. Salvation Army, social security office, 
etc.) 

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Study Duration: 
The involvement of each participant in this study will last 18 months. The study will last 
approximately 2 years.  
 
Outcome: 
Participants will decrease the frequency of disruptive behaviors, as defined above, in 
comparison with the 6-month period immediately prior to recruitment.  
 
Sample Size:  
This study exploring feasibility of the CM approach to resolve social dysfunctional behaviors will 
include up to 15 participants with the goal to obtain 10 completers.  
 
Description of Sites/Facilities Enrolling Participants: 
Tulsa Day Center in Tulsa, Oklahoma provides of full range of services and tools to assist clients 
in overcoming anticipated, situational and chronic homelessness. Their priority is to address 
client’s basic needs: shelter, food, clothing and bathing. They offer rapid rehousing services, 
emergency shelter, medical assistance, and legal aid to help ensure all of those needs can be 
met. https://tulsadaycenter.org/   
 
The Blue Team initiative at Tulsa Day Center was launched in September 2022, with the primary 
focus of working with a subset of the homeless population in Tulsa who have difficulty 
obtaining and maintaining safe housing due to anosognosia. 
 
Baseline Assessment: The initial status of participants' target disruptive behaviors will be 
obtained from the 6 months prior to recruitment. This information will be used as a historical, 
preliminary comparator to the 6 months of CM intervention. 
 
To evaluate the inclusion and exclusion criteria, the following procedures will be implemented: 
• 
Diagnoses will be obtained from clinical records obtained by Tulsa Day Center. 
• 
Anosognosia Assessment: Utilize standardized instruments such as the Scale to Assess 
Unawareness of Mental Disorder (SUMD) to evaluate the presence of anosognosia in 
potential participants. 
• 
Legal Involvement and Impulsive Behaviors: Review participants' legal records and self-
reported incidents within the past six months to assess their history of legal involvement 
or impulsive behaviors. 
• 
Housing Status Assessment: Obtain information on participants' housing history through 
self-report or case management records to determine the stability of their housing 
situation over the past six months. 
• 
Informed Consent: Ensure participants can provide informed consent by assessing their 
understanding of the study's purpose, procedures, risks, and benefits through a written 
or verbal quiz. 
• 
Study Procedures Compliance: Assess participants' willingness and ability to comply with 
study procedures during the screening and informed consent process. 

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• 
Participation in Other Interventions: Inquire about potential participants' involvement in 
any other intervention studies targeting the same population or addressing similar 
issues. 
 
Clinical and Demographic Information 
• Age 
• Race/ethnicity 
• Gender 
• Psychiatric diagnosis 
• Legal history 
• Housing status 
• Medical, mental health and substance use treatment history 
• Housing/shelter 
• Legal involvement 
• Participation in programming 
• Emergency Medical Services Authority (EMSA) visits 
• Community Outreach Psychiatric Emergency Services (COPES) 
 
Interview and Self-Report Questionnaires 
The Scale to Assess Unawareness of Mental Disorder (SUMD): The SUMD has been 
validated in schizophrenia and schizoaffective disorder and uses a structured interview 
administered by trained raters. The SUMD derives from Amador’s complex model of 
(Dumas et al. 2013) and includes a symptom checklist in addition to general items 
related to awareness of illness, attribution of symptoms to a mental disorder, 
awareness of effects of medication, and awareness of social consequences of illness. 
Furthermore, SUMD scoring includes subscales that relate the general items to specific 
symptom constellations.  
 
Vulnerability Index- Service Prioritization Decision Assistance Tool (VI-SPIDAT): The VI-
SPDAT examines factors of current vulnerability and future housing stability. It was 
developed as a pre-screening tool for communities that are very busy and do not have 
the resources to conduct a full SPDAT assessment for every client. The tool was made in 
collaboration with Community Solutions, creators of the Vulnerability Index, as a brief 
survey that can be conducted to quickly determine whether a client has high, moderate, 
or low acuity. Communities need practical, evidence-informed tools that enhance their 
ability to satisfy federal regulations and quickly implement an effective approach to 
access and assessment. The VI-SPDAT is a first-of-its-kind tool designed to fill this need, 
helping communities end homelessness in a quick, strategic fashion. (Community 
Solutions: http://www.orgcode.com/product-category/training/spdat/) 
 
E. Gender and Racial/Ethnic Origin of Participants 
 

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Demographics for the population in Tulsa, Oklahoma from which participants will be selected 
from this study are approximately 9% Hispanic/Latino ethnicity. Gender will be approximately 
40% female/55% male/5% unreported. Racial composition will be approximately 52% White, 
14% Native American, 24% African American, 6% unknown, 1% Asian and 3% Pacific Islander. 
 
F. Participant Risks and Plans to Minimize Risks 
 
Potential Benefits: Potential benefits for study participation include 1) financial compensation 
for the participants, 2) decreased interaction with the legal system, and 3) increased 
engagement with the health care system.   
 
Potential Risks: This CM program has no known health risks. Time spent each week with the 
staff administering CM rewards can be a nuisance to certain participants. 
 
Protection Against Risks: The following risk mitigation strategies will be used during this study: 
1. Comprehensive training for staff: We will ensure that all staff involved in the study are 
thoroughly trained in recognizing signs of distress or potential harm to participants, as 
well as in managing crisis situations and de-escalating conflicts. 
2. Regular mental health assessments: The participating staff will conduct regular mental 
health assessments of participants to monitor their wellbeing and detect any potential 
risks or concerns early on. 
3. Clear communication of expectations and boundaries: The staff will clearly 
communicate the rules, expectations, and boundaries of the program to participants, 
ensuring they understand the goals and requirements of the study. 
4. Close collaboration with local support services: LIBR has established strong partnerships 
with local mental health, medical, and social services to ensure participants have access 
to appropriate resources and support when needed. 
5. Establish a safety protocol: The staff will follow a standard safety protocol in case of 
emergencies or incidents involving participants, including procedures for contacting 
appropriate authorities and support services. 
6. Confidentiality and data privacy: LIBR will ensure the privacy and confidentiality of 
participants' personal information and data collected during the study by implementing 
strict data handling and storage procedures. 
7. Continuous monitoring and evaluation: We will regularly monitor and evaluate the 
program's implementation and effectiveness in promoting safety and reducing 
disruptive behaviors, making adjustments as needed to enhance participant wellbeing 
and study outcomes. 
Ethical Considerations:  
All participants will provide written informed consent prior to enrollment in the study. 
Participants will complete a short quiz at the end of the consent process to demonstrate they 
understand the fundamental aspects of the study. Confidentiality of participant data will be 

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maintained throughout the study. Additionally, an independent medical monitor who is Board 
Certified in Psychiatry will review study progress. 
 
Clinical Monitoring:  
Clinical monitoring will be conducted to ensure that the rights and well-being of trial 
participants are protected, that the reported trial data are accurate, complete, and verifiable, 
and that the conduct of the trial is in compliance with the currently approved 
protocol/amendment(s), with International Conference on Harmonisation Good Clinical 
Practice (ICH GCP), and with applicable regulatory requirement(s).  
Overall external monitoring for this study will be performed by Dr. Matthew Meyer. Internally, 
the study PI or Dr. Salvador Guinjoan, a psychiatrist at LIBR, will engage in regular discussions of 
the study progress with the clinical monitor, perform random reviews of study endpoint, safety, 
and other key data to verify completeness of data acquisition. 
Reasons for Study Termination: 
The study will be terminated for the following reasons: 1) participant misses 3 consecutive case 
manager visits, 2) at the determination of the participant’s case manager when deemed 
necessary for safety reasons of the participant, staff, and milieu at TDC. 
 
By implementing this detailed CM procedure, the study will be able to assess the feasibility and 
effectiveness of using positive reinforcement to promote behavior change among homeless 
individuals with psychotic disorders and anosognosia.  
 
G. Statistical Methods  
 
The statistical analysis for this study will be conducted using appropriate statistical software to 
ensure the validity and reliability of the results. The primary goal of the analysis is to evaluate 
the effectiveness of the CM program in preventing disruptive behaviors among homeless 
individuals with psychotic disorders and anosognosia. 
 
Descriptive statistics will be calculated for all variables, including demographics, clinical 
characteristics, and outcome measures. These statistics will include measures of central 
tendency (mean, median) and dispersion (standard deviation, interquartile range) for 
continuous variables, as well as frequencies and proportions for categorical variables. 
 
To compare the intervention and control historical period, we will employ Chi-square or Fisher's 
exact tests for the proportion of weeks free of disruptive behaviors. 
 
The primary outcome measure will be the proportion of disruptive behavior-free weeks in the 6 
months of the intervention compared with the previous 6 months. We will use linear or logistic 
regression models to analyze the relationship between these outcomes and the intervention, 

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adjusting for potential confounding factors such as age, gender, ethnicity, and baseline clinical 
characteristics, including psychiatric diagnosis. 
 
For all statistical tests, a two-sided p-value of less than 0.05 will be considered statistically 
significant. To account for multiple comparisons, we will apply appropriate correction methods, 
such as the Bonferroni or Benjamini-Hochberg procedures. 
 
In addition to the primary analysis, we will conduct exploratory subgroup analyses to assess the 
intervention's effectiveness among specific subpopulations, such as individuals with different 
levels of anosognosia severity, specific diagnoses within the Schizophrenia Spectrum or Bipolar 
and Related Disorders, or varying degrees of substance use. 
 
Finally, we will perform sensitivity analyses to assess the robustness of our findings and to 
evaluate the impact of missing data or potential biases on the study results. These analyses may 
involve multiple imputation, propensity score matching, or other relevant techniques. 
 
H. Data Storage and Confidentiality 
 
Data collection is the responsibility of the study staff under the supervision of the PI. The 
investigator is responsible for ensuring the accuracy, completeness, legibility, and timeliness of 
the data reported. Data collected for the study will be stored in REDCap, a 21 CFR Part 11-
compliant data capture system provided by LIBR staff. The data system includes password 
protection. 
 
Data safety and monitoring will be carried out to ensure and maintain the scientific integrity of 
this project and to protect the safety of participants. Only information that is required to fulfill 
the objectives of the study will be collected. Records of the subject’s participation in this study 
will be held confidential except as disclosure is required by law or as described in the informed 
consent document (under "Confidentiality").  The study doctor, the sponsor or persons working 
on behalf of the sponsor, and under certain circumstances, the Institutional Review Board (IRB), 
will be able to inspect and copy confidential study-related records that identify the subject by 
name. Therefore, absolute confidentiality cannot be guaranteed. 
 
Each subject will be given a unique identifier with a code. Information for each participant is 
entered into the Laureate Institute for Brain Research subject database and they are 
automatically given a LIBR ID e.g. AA001. The code key that links the unique identifier to the 
subjects’ names is kept in a separate file. Other than the PI, there is no need for personally 
identifying information to be known to other investigators. If the results of this study are 
published or presented at meetings, the subjects will not be identified. All data analysis is 
performed on de-identified data. Subjects will not be identified in any reports or publications.  
 
Any electronic data will have all identifiable information encrypted and be stored in a firewalled 
and password-protected database on a secure server managed by the Laureate Institute for 

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Brain Research. All research documents, such as paper copies of consents, screening forms, the 
Research Privacy Form, testing results, and any other forms or papers containing Personally 
Identifiable Information (PII), as well as collected research data, will be stored electronically on 
the LIBR Network and/or REDCap (Research Electronic Data Capture), and/or in locked cabinets 
at the Laureate Institute for Brain Research. Access to the LIBR Network and to REDCap is 
granted only to authorized personnel; only approved study personnel will have access to any 
records that have identifying information. The LIBR Network is protected by the Palo Alto PA- 
5250 Layer 7 firewall with licenses for Wildfire, AV, Threat Prevention, and URL filtering. All 
LIBR Network data is stored on site. REDCap is a secure web application for building and 
managing online surveys and databases. The REDCap Consortium, a vast support network of 
collaborators, is composed of thousands of active institutional partners in over one hundred 
countries who utilize and support REDCap in various ways. Vanderbilt University, in collaboration 
with consortium partners, developed REDCap as a toolset and workflow methodology for 
electronic collection and management of research and clinical trial data. While REDCap can be 
used to collect virtually any type of data (including 21 CFR Part 11, FISMA, and HIPAA-compliant 
environments), it is specifically geared to support online or offline data capture for research 
studies and operations. REDCap data collection projects rely on a thorough study-specific data 
dictionary defined in an iterative self-documenting process by all members of the research team 
with planning assistance from the information technology staff. The iterative development and 
testing process results in a well-planned data collection strategy for individual studies. REDCap 
servers are housed in a local data center at Laureate Institute for Brain Research and all web-
based information transmission is encrypted.  REDCap was developed specifically around HIPAA-
Security guidelines and is recommended to LIBR researchers by both our Privacy Office and the 
Western Institutional Review Board (WIRB). REDCap has been disseminated for use locally at 
other institutions and currently supports 240+ academic/non-profit consortium partners on six 
continents and over 26,000 research end-users (www.project-redcap.org). 
 
To further protect the privacy of the participants, the researchers will obtain a Certificate of 
Confidentiality from the United States Department of Health and Human Services (DHHS). With 
this Certificate, the researchers cannot be forced (for example, by court order or subpoena) to 
disclose information that may identify a participant in any federal, state, local, civil, criminal, 
legislative, administrative, or other proceedings. The researchers will use the Certificate to 
resist any demands for information that would identify a participant, except to prevent 
serious harm to the participant or others. 
 
Continuous, close monitoring of participant safety will prompt reporting of safety data (i.e., 
adverse/serious adverse events) to the local IRB. Serious adverse events will be reported to the 
IRB within 48 hours of the time project staff become aware of the incident. The PIs will 
provide a summary of the safety conduct in a written report required by the IRB as part of 
the annual IRB renewal. Should the protocol or data collection plans be amended as a 
result of data review, the relevant IRBs will be notified, and the amendment approved prior 
to study amendment implementation. In addition, the participants will be notified of any 
significant new findings that develop during the course of research (e.g., other potential risks) 

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that may affect their wish to continue participation in the study. Study information will be 
made available to the subjects when there has been sufficient data analysis to make 
reasonable aggregate conclusions. We can share general study characteristics (how many 
people were recruited, age, primary disorder etc.) early in the process, but will not share 
study results with subjects until the quality of the data is close to publication level. If the PI 
leaves LIBR, an agreement will be made between LIBR and the PI’s new institution to 
transfer the data so that the study can continue. 
 
I. Process and Documentation of Consent 
 
Informed Consent will be obtained by members of the research team that have received 
training from the PI to obtain consent for this study. All participant interactions including 
consenting will be conducted in private interview/exam rooms.  
Documented Consent: Documented informed consent will be obtained once the consent has 
been reviewed and the individual agrees to participate using the appropriate approved 
informed consent document. Participants will be provided with a copy of the consent. All 
volunteers will be at least 18 years old and will be asked to give fully informed documented 
consent following approved consent procedures. Care is taken to appropriately describe IRB-
approved consent forms as documented by signature of the person giving permission and the 
person obtaining informed consent.  
Measures to decrease coercion of participants: The researcher will remind the subject that 
participation is strictly voluntary and remind them that they have the right to withdraw at any 
time without penalty. Family members will be allowed to be present and discuss the consenting 
process with the participant if requested. When recruited, subjects will be asked to arrive 30 
minutes early in order to have sufficient time to consent and answer questions. 
• Subject Capacity: All subjects enrolled in this study will have the capacity to consent. As noted 
previously, individuals with moderate to severe neurocognitive disorders will be excluded from 
the study.  
• Subject/Representative Comprehension: During the written informed consent process, the 
subject’s understanding of the study protocol will be assessed using a questionnaire with open-
ended questions. If they are unable to communicate understanding of the protocol, they will 
not be enrolled in the study. 
• Costs to the Subject. The only anticipated expense to participants is the amount of time spent 
conducting the experiment. The total time involved in this experiment will be approximately 30 
minutes per session. 
J. Payment for Participation 
 
Participants will be paid $10 each week for their time spent in the 30-minute case manager 
meeting. In addition, participants will be paid for “trouble free days” as part of the contingency 
management (CM) component. The payment starts at $20 and will increase by $1 each week 

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for maintaining trouble-free days. The maximum amount for CM at the end of the 18 months 
(76 weeks) is $95 during the final week of the study. Over the course of 18 months, the 
maximum amount a participant may receive is $5390 if they attend every meeting with the case 
manager ($770) and maintain “trouble-free” days throughout the study ($4620). Any week with 
disruptive behaviors will result in returning to the $20 baseline amount with $1 increments for 
future weeks. 
 
If participants do not complete each part of the session, the payment will be prorated according 
to the payment information above.  Participants will be paid with a ClinCard (similar to a check 
card) after each study visit. The compensation on the ClinCard will be available for use within 
approximately 24 hours of the study visit. 
 
K. Bibliography 
 
Dumas R, Baumstarck K, Michel P, Lançon C, Auquier P, Boyer L. Systematic review reveals 
heterogeneity in the use of the Scale to Assess Unawareness of Mental Disorder (SUMD). Curr 
Psychiatry Rep. 2013 Jun;15(6):361. doi: 10.1007/s11920-013-0361-8. PMID: 23636985. 
 
Kim J, Ozzoude M, Nakajima S, Shah P, Caravaggio F, Iwata Y, De Luca V, Graff-Guerrero A, 
Gerretsen P (2020): Insight and medication adherence in schizophrenia: An analysis of the 
CATIE trial. Neuropharmacology 168:107634. doi: 10.1016/j.neuropharm.2019.05.011. 
 
Noordraven EL, Schermer MHN, Blanken P, Mulder CL, Wierdsma AI (2017): Ethical acceptability 
of offering financial incentive for taking antipsychotic depot medication: patients’ and 
clinicians’ perspectives after a 12-month randomized controlled trial. BMC Psychiatry 17:313. 
Doi: 10.1186/s12888-017-1485-x 
 
Priebe S, Sinclair J, Burton A, Marougka S, Larsen J, Fim M, Ashcroft R (2010): Acceptability of 
offering financial incentives to achieve medication adherence in patients with severe mental 
illness: a focus study group. J Med Ethics 36: 463-468. Doi:10.1136/jme.2009.035071. 
 
Rosen AD, Brosnan HK, Gomih A, Chang AH, Thomas EH (2023): Financial incentives for COVID-
19 vaccines among people experiencing homelessness. Am J Prev Med, in press. 
https://doi.org/10.1016/j.amepre.2023.01.020.