Clinical trial NCT01090245: Using Incentives to Improve Parolee Participation and Attendance in Community Treatment
Official title: Using Incentives to Improve Parolee Participation and Attendance in Community Tx
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Substance Abuse
HIV Infections
Keywords: 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
Lead sponsor: University of California, Los Angeles
Sponsor class: OTHER
First posted: 2010-03-19
Enrollment: 202
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: 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: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: Community treatment admission
timeFrame: Within 7 days of release to parole
measure: Community treatment retention
timeFrame: 6 months
measure: Participation in HIV testing and counseling
timeFrame: 2 months
Secondary outcomes:
measure: Substance abuse
timeFrame: 18 months after release from prison
measure: Arrest and reincarceration
timeFrame: 18 months after release from prison
measure: psychosocial: employment, education, family relationships, psychological functioning, and HIV risk
timeFrame: 18 months after release from prison
Other outcomes:
Locations:
Study officials:
affiliation: University of California, Los Angeles
name: Michael L Prendergast, Ph.D.
role: PRINCIPAL_INVESTIGATOR
affiliation: University of California, Los Angeles
name: Elizabeth A Hall, Ph.D.
role: STUDY_DIRECTOR
References:
citation: Saxena P, Hall EA, Prendergast M. A Randomized Study of Incentivizing HIV Testing for Parolees in Community Aftercare. AIDS Educ Prev. 2016 Apr;28(2):117-27. doi: 10.1521/aeap.2016.28.2.117.