Using Incentives to Improve Parolee Participation and Attendance in Community Treatment

Study Overview
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Brief Summary
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Under funding from the National Institute on Drug Abuse, the UCLA Integrated Substance Abuse Programs (ISAP), in collaboration with Walden House and the California Department of Corrections and Rehabilitation, is conducting a five-year study that will involve a randomized test of the use of incentives with parolees in a community-based residential substance abuse treatment program to increase treatment admission and treatment retention, and thereby increase the likelihood of improved outcomes. Study participants will be recruited from clients in a prison-based treatment program who have a referral to the Walden House community program. The Admission Phase of the study assesses the effect of an incentive (voucher) on enrolling in the Walden House program. The Attendance Phase assesses the effect of incentives on treatment attendance and on post-treatment drug use, crime, and psychosocial behaviors, including HIV risk behaviors. In addition, an incentive protocol will test whether an incentive will encourage participation in HIV testing and counseling. The intervention will last for six months. Hypothesis 1. The use of incentives will significantly increase subject enrollment in community treatment. Hypothesis 2. The use of incentives will significantly increase subject retention in community treatment. Huypothesis 3. The use of incentives will significantly increase subject participation in HIV testing and counseling. Study participants will be interviewed at baseline and at 12 months following the intervention. Treatment and criminal justice data will be obtained. Data on acceptability, satisfaction, and sustainability will be collected from focus groups with staff and clients.

Detailed Description
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A considerable body of research indicates that prison-based treatment followed by continuing treatment in the community is effective in reducing drug abuse and crime among drug-abusing offenders. However, the impact of providing treatment is less than optimal because offenders often fail to follow through on treatment referrals, leave treatment early, or have poor engagement in treatment activities. In particular, participation in prison-based treatment alone is seldom effective in reducing drug use or recidivism unless it is followed by participation in community treatment. For correctional systems that provide a continuum of care model from prison to community, low rates of admission and retention result in poor outcomes and poor resource utilization. One way to address this problem is to provide incentives to parolees for community treatment participation. Although research supports the effectiveness of behavioral reinforcement, mainly in the form of contingency management (CM), for general substance abuse populations, CM has not yet been tested or adapted for use in community-based programs for offender populations, particularly to encourage treatment attendance. In addition, recent research has documented elevated rates of HIV infection among incarcerated populations compared to the general population, with prevalence of HIV among inmates in US prisons being estimated to be 6 to 10 times higher than in the general population. Upon release from prison, parolees often immediately resume high-risk behaviors that they engaged in prior to incarceration. Because of the high level of exposure to HIV infection that accompanies drug use, particularly by injection, drug treatment programs for high-risk offenders can serve as a valuable setting for preventing the spread of HIV, both through HIV prevention/education activities and through access to HIV testing and counseling. Under funding from the National Institute on Drug Abuse, the UCLA Integrated Substance Abuse Programs (ISAP), in collaboration with Walden House and the California Department of Corrections and Rehabilitation, is conducting a five-year study that will involve a randomized test of the use of incentives with parolees in a community-based residential substance abuse treatment to increase treatment admission and treatment retention, and thereby increase the likelihood of improved outcomes. Study participants will be recruited from clients in a prison-based treatment program who have a referral to the Walden House community program. The Admission Phase of the study assesses the effect of an incentive (voucher) on enrolling in the Walden House program. The Attendance Phase assesses the effect of incentives on treatment attendance and on post-treatment drug use, crime, and psychosocial behaviors, including HIV risk behaviors. In addition, an incentive protocol will test whether an incentive will encourage participation in HIV testing and counseling. The intervention will last for six months. Hypothesis 1. The use of incentives will significantly increase subject enrollment in community treatment. Hypothesis 2. The use of incentives will significantly increase subject retention in community treatment. Huypothesis 3. The use of incentives will significantly increase subject participation in HIV testing and counseling. Study participants will be interviewed at baseline and at 12 months following the intervention. Treatment and criminal justice data will be obtained. Data on acceptability, satisfaction, and sustainability will be collected from focus groups with staff and clients.

Official Title
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Using Incentives to Improve Parolee Participation and Attendance in Community Tx

Conditions
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Substance Abuse, HIV Infections

Intervention / Treatment
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* Behavioral: Contingency management: voucher/monetary incentives for treatment attendance
* Behavioral: Information


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 18 years of age English speaking Within one month of parole Able to provide informed consent to participate in the study Received a referral to the Walden House Los Angeles Transitional Treatment Center Exclusion Criteria: Potential subjects will be excluded from participating if they have serious cognitive problems that preclude their ability to provide informed consent or understanding of the questionnaire items, if they are a sexually violent predator or a child molester or if they have severe mental health problems.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Attendance Information Group<br>Participants in the Attendance Information Group will receive an individual information session along with a pamphlet describing the benefits of remaining in treatment after release from prison and on the benefits of HIV prevention and testing. In addition, they will receive the standard treatment offered by the Walden House Los Angeles program. | Behavioral: Information<br>* Attendance Information Group will receive an individual information session along with a pamphlet describing the benefits of remaining in treatment after release from prison and on the benefits of HIV prevention and testing.<br>|
| Experimental: Attendance Incentive Group<br>Participants in the Attendance Incentive Group could receive up to $841.50 in incentives for their treatment attendance and the standard treatment offered by the Walden House Los Angeles program. | Behavioral: Contingency management: voucher/monetary incentives for treatment attendance<br>* Contingency management: Escalation with reset for non-attendance. Daily. Up to $841.50 in incentives for treatment attendance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Community treatment admission |  | Within 7 days of release to parole | 
| Community treatment retention |  | 6 months | 
| Participation in HIV testing and counseling |  | 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Substance abuse |  | 18 months after release from prison | 
| Arrest and reincarceration |  | 18 months after release from prison | 
| psychosocial: employment, education, family relationships, psychological functioning, and HIV risk | employment, education, family relationships, psychological functioning, and HIV risk | 18 months after release from prison | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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contingency management, substance abuse treatment, criminal justice populations, substance abuse treatment retention, HIV prevention in criminal justice settings, voucher based reinforcement therapy, Parole treatment admission for substance abusing parolees, Parole treatment retention for substance abusing parolees, HIV testing and counseling for substance abusing parolees