Institute for Behavioral Health

Schneider Institutes for Health Policy

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Brandeis Maine Addiction Treatment Study


Phase 2 – Clinician and Front Line Staff Incentives Study

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Frequently Asked Questions

  1. What is the purpose of the study?

  2. What are the benefits to participating in the study?

  3. Who is eligible to participate?

  4. Do I have to do anything different?

  5. Do you have suggestions for what we can change to improve our performance?

  6. My clients are more challenging than my colleagues’ clients.

  7. Is there a penalty if I don’t participate in the study or if we don’t meet our targets?

  8. Can I change my mind about participating once I’ve signed up?

  9. Can I sign up after the study has started?

  10. What does signing up include?

  11. How long does the study last?

  12. Do all staff in my program have to participate?

  13. My program is very small. Can we still participate?

  14. What if I leave during the study?

  15. I work part-time. Can I still participate?

  16. I mostly do group work. Can I still participate?

  17. What about confidentiality? Will my boss know if I decide to participate?

  18. I’m not so certain that my colleagues will take this seriously and try to do better.

  19. Who is funding this study?

  20. What is the role of Maine’s Office of Substance Abuse and Mental Health Services (SAMHS)?

  21. What is the reward based on?

  22. What are the target performance levels? How much do we need to improve to get a reward?

  23. How much money can I earn?

  24. How will you know if the rewards work?

  25. What happens when this study ends?

  26. Will this affect my salary or other benefits?

  27. What else is involved?


Questions with Answers

1.       What is the purpose of the study?

We are looking for new ways to improve the quality of care, since we know that treatment can work but many people still relapse. Financial rewards to individual providers have appeared to work in other areas, but have not yet been tested in the addiction treatment field. We hope that this study will give us and you additional information to improve treatment and outcomes for people with addictions.

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2.       What are the benefits to participating in the study?

You have the opportunity to earn up to $2500 in the next year, although you may earn no rewards, depending on your program’s performance.  You may find that this approach is successful in improving access to care and retention in care for your clients, and that in turn may improve their outcomes.  You have the opportunity to be a front-runner in the nation by participating in research that is new to the addictions field. We have tried to design the study so there is no downside to you, your program, or your clients.

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3.       Who is eligible to participate?

All staff with direct client contact are eligible to participate. This includes clinicians, intake staff, receptionists, nurses, psychiatrists. Supervisors or other management staff may participate if they also have clinical interactions with clients as part of their job.

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4.       Do I have to do anything different?

No, you are not required to do anything differently than you do now.  We are not asking you to collect any new data, fill out any new forms, or anything else like that. Part of the reward is based on reaching a target level of performance and your program may reach that target without changing anything. Part of the reward is based on improving from the prior year. It is likely that you would need to change something in the way you practice to show improvement. How you do that is up to you and your program.

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5.       Do you have suggestions for what we can change to improve our performance?

What you do is up to you (individually and/or with your colleagues).  Some ways that other programs have tried to improve their performance include:  changing counselor caseload, adding walk-in hours for intakes or appointments, expanding hours the program is open (e.g., weekends or evenings), switching meeting times in anticipation of inclement weather, centralizing appointment scheduling, adding non-treatment services such as childcare, and using more or different evidence-based practices.  These are just examples. You should try what seems to make the most sense to you and your program.

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6.       My clients are more challenging than my colleagues’ clients. 

We understand that different caseloads may have different challenges.  However, your reward in this study will be based on the performance of your program overall.  That means that the more challenging clients will be included with the less challenging clients, to get an average performance at your program.  Each person with direct client contact at your program will receive the same reward amount.

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7.       Is there a penalty if I don’t participate in the study or if we don’t meet our targets?

No, there are no penalties.  If you choose not to participate, you will not receive the reward if your program improves.  If your program does not meet the performance target and does not improve, there will be no reward for that quarter even if you are participating, but there is no penalty. 

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8.       Can I change my mind about participating once I’ve signed up?

If you signed up and no longer want to participate, just contact us (mstewart@brandeis.edu), and we will remove you from the study. You will no longer be eligible to receive rewards from the time that you are removed. You may ask us to remove you from the study at the beginning of the next quarter so you receive the reward for the quarter you started in.

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9.      Can I sign up after the study has started?

Yes. At the beginning of each quarter we will ask all eligible staff if they want to participate, if they are not already signed up.  This includes staff who chose not to participate at an earlier time and staff who are new to the program.  You will only receive a reward after you have signed up for the study.

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10.   What does signing up include?

Since this is a research study, you must provide “informed consent” to participate. This is a document that you sign, which describes the study, the risks and benefits, and asks if you agree to participate.  We will also need a mailing address and an email address. Because we will be paying you, you will also need to complete a confidential W-9 tax form that includes your name, address and social security number to be submitted to Brandeis University.

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11.   How long does the study last?

The study will last almost one year, with rewards calculated and paid each quarter.  We expect to start in February 2015 and finish at the end of December 2015. The last possible payment should be made in January 2016.

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12.   Do all staff in my program have to participate?

No one has to participate, but we hope everyone will.  Since the performance and rewards are based on overall program performance, across all clients and all staff, we think it is most likely to succeed if all eligible staff are engaged with the study.  However, that is not a requirement. If you sign up, you will receive the reward if the program performance meets the targets or shows improvement, and those who did not sign up will not receive the reward.

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13.   My program is very small. Can we still participate?

Your program is invited to participate, no matter how few staff or clients. The reward is based on your own past performance as well as the target, so the size of your program does not matter.

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14.   What if I leave during the study?

A staff member who leaves the program during the study will be considered to have dropped out of the study. We will adjust the amount of the reward you would have received for that quarter based on the month that you left. For example, if the quarter started in April and you left this agency in May, you would receive 1/3 of the expected reward, since you only were involved for 1 full month out of the 3 months in the quarter.  If you start working at another program that is part of this study, you will have the opportunity to join the study at that program at the beginning of the new quarter.

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15.   I work part-time. Can I still participate?

All eligible staff may participate, regardless of how much they work at the program.  However, the amount of the reward will be adjusted based on their FTE status.  For example, if a clinician works half-time, and the reward for the quarter is $100, the half-time clinician would receive $100 x .5 = $50.  

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16.   I mostly do group work. Can I still participate?

Yes, all eligible staff can participate, regardless of the type of client contact they have.  The only adjustment is based on whether you work part-time or full-time.

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17.   What about confidentiality? Will my boss know if I decide to participate?

We will do everything we can to protect your confidentiality regarding your participation (or not) in this study.  Neither your program director nor anyone at SAMHS or elsewhere will learn from us who has signed up, although your program director has agreed to let us conduct the study and facilitated our initial contact with you. We encourage you to give us a non-work mailing address and email so any contact from us is not at your program.

Your email address is used for ongoing information-sharing about the study. Your mailing address and social security number are only kept for the purposes of payment. Your contact information will be kept on a password-protected computer that is only accessible to the Brandeis study team. Your social security number (submitted only on the W-9 form) is submitted directly to the accounting department at Brandeis, which keeps the information confidential, and is not maintained by study personnel.

When we analyze our data, we will never identify individuals, programs or agencies by name or otherwise, and will only present our findings in the aggregate. 

That all said, we know that some programs are very small and that your participation may become known in some way.  We have tried to design the study so there is no downside to your choice to participate or not to participate, as an additional protection.

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18.   I’m not so certain that my colleagues will take this seriously and try to do better.

We understand that not everyone will choose to or be able to make changes that are likely to drive improvement.  We hope that the financial reward will be enough encouragement for that to happen. You can also try to work as a team to improve, motivating your colleagues, and coming up with new approaches collectively. 

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19.    Who is funding this study?

This study is funded by the National Institute on Drug Abuse (NIDA) which is part of the National Institutes of Health.  All of the money to pay rewards for this study come from the research grant.  No money comes from SAMHS, Maine, your agency, or other sources.

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20.   What is the role of Maine’s Office of Substance Abuse and Mental Health Services (SAMHS)?

SAMHS has been involved with the Brandeis-Maine Addiction Treatment Study from the beginning, but this is an independent research study conducted by Brandeis University.  SAMHS’ role is only to give us advice and access to the admission and discharge data that they collect from agencies.  SAMHS will not know if your program is participating or which counselors are participating. SAMHS is not determining the design of the study or the amount of rewards, and they will not know how much of a reward you receive. SAMHS is not involved with the data analysis, and will only see results in the aggregate form, once data analysis is complete.

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21.   What is the reward based on?

We will measure your program’s performance on three measures. These are essentially the same measures that SAMHS currently uses for your program.

(1)    access: time from 1st contact to 1st treatment session (measured in days). This measure is the same for outpatient and intensive outpatient programs. 

(2)    early retention for at least 4 sessions (outpatient) or 4 days (intensive outpatient).

(3)    retention for at least 90 days (outpatient) or treatment completion (intensive outpatient).

Your reward is based on a combination of achieving a target performance and improving from your 2013 baseline. You will be paid if your program meets target levels or if it improves from baseline. Payment is calculated separately for each measure. If you meet a target on any of the three measures or if you improve on any of the three measures, you will receive a reward. The exact amount depends on your program’s performance across the three measures.

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22.   What are the target performance levels? How much do we need to improve to get a reward?

There are two target levels (low and high) that have different reward amounts for meeting the target. Targets are based on actual program performance numbers from 2013.  The low target is based on how well at least half of the programs did in 2013. The high target is based on how well the top 10% of programs did in 2013. 

There is also a reward amount for improving on each measure, for each 2% improvement from your program’s baseline for the retention measures and each day improvement from baseline for the access measure.

The levels differ for outpatient and intensive outpatient.  The table shows what the rewarded levels are for each measure.

 

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23.   How much money can I earn?

While it is possible to get up to $2500 over the course of the year, we expect that in most cases you will not get more than $1000 and in some cases it could be much less. In some cases it could be nothing.  This answer is somewhat vague, because it depends on how well your program does each quarter, on each of the three rewarded measures.

For example, you will get $30 for each measure if your program hits the low target (that is, the baseline performance that at least half of programs did in 2013) and $50 for each measure if your program hits the high target (that is, the baseline performance that the top 10% of programs did in 2013).  In addition, you will get $5 for each 2% improvement from baseline for the retention measures and each day improvement for the access measure. If, for instance, your program has 10% more clients in treatment for 4 or more sessions than it did at baseline, you would receive $5 x 5 (10% = 2% x 5) = $25.

For each measure, we add the amount for meeting the target (if applicable) to the amount for improving (if applicable). We add up the amounts for each of the 3 measures to determine your total reward for the quarter.

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24.   How will you know if the rewards work?

We will look at your program’s performance on the three measures in 2013, the year before this part of the study started, and compare it to 2014, the year in which you are eligible for rewards. We will also compare the performance of the programs that were eligible to rewards to similar programs that were not eligible for rewards. If the rewards made a difference, we would expect to see better performance in those agencies that were eligible for rewards, compared to the prior year, and compared to the agencies not eligible for rewards.

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25.   What happens when this study ends?

When the study ends, your participation is over, and there will be no additional rewards from the research study. We will invite you to complete a final survey so we can learn from your experience with the rewards and the study overall.  You and your program may decide to maintain changes that you may have made during this study, but that is up to you. 

Once the study period is over and the data are analyzed, we will share a report of the findings with you and your program director.

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26.   Will this affect my salary or other benefits?

We have no standing to change your salary or benefits, and have every expectation that your program director will not use this information to do so.  Any rewards are from the research study, and are in addition to your usual income. Please note that for tax reporting purposes the payments you receive will be counted as income from Brandeis University; you will receive a 1099 tax form if you are paid more than $600. At the end of the study, we will pay you an additional 10% of what you earned over the study period, to contribute to any additional tax burden you might have due to this additional income.

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27.   What else is involved?

We will ask you to complete 2 surveys, one at the beginning of the study and one after the study ends. These surveys will ask about your program, your thoughts about quality of care and ways to improve access and retention, and your thoughts about rewards and the study overall.  We will invite you to participate by email, and you will receive $25 for each survey you complete. Although we would prefer that everyone complete the surveys, and see this as an opportunity for you to share your thoughts about this approach, you may choose not to, and it will not affect your participation in the rest of the study.

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