Two months ago, it looked like all was going well with our motivational incentives project. Given the chance to win prizes for attending their sessions, more clients were staying longer in treatment. It’s now been about four months and 200 people admitted since we began. The results? Retention is either unchanged, or as much as 10% lower.
Yes, you heard me right – this change we made isn’t working. What should we do? Scrap the new process and go back to our old way of doing things? Or do we press on and trust the research that says motivational incentives improve treatment outcomes? The stakes are high; real people with real drug and alcohol addictions are depending on us.
This is precisely why at BCI, we follow the NIATx model of organizational change: Plan, Do, Study, Act. With major change, some barriers are to be expected. Before we jump to any conclusions, we should question why we got the results we did.
Let’s look at the barriers we faced. First, our client volume was up during the last two months, with admissions and discharges both about 25% higher than normal. At the same time, our staff was down by two counselors, leaving us with six instead of eight. Not only were more clients coming in and out, but counselors had to deal with higher caseloads. Bad timing, but this is the real world, and these things happen.
But that isn’t all. The incentives procedure we had carefully planned out and trained our staff in wasn’t exactly going as planned. Sometimes, clients had to wait to get their prize because the counselor ran out of time. Counselors were faced with altering their preferred way of running a session. At least one counselor admitted he discouraged his clients from drawing for prizes because it was against his own philosophy of treatment.
Should we be surprised that the staff was not totally on board with the incentives? NIATx says no. Change is difficult. If we really want our project to succeed, we should acknowledge internal resistance and try to overcome it. We’re already looking at how to do this.
We’re also faced with other difficult questions. What caused our retention to go down? Was it the external things beyond our control, or the logistical issues that arose? Now that our census and staffing are back to normal, will we see better results? How much longer do we continue the incentives before declaring them a success or failure?
We want to hear your thoughts as well. And keep watching along with us to see what happens next.
Yes, you heard me right – this change we made isn’t working. What should we do? Scrap the new process and go back to our old way of doing things? Or do we press on and trust the research that says motivational incentives improve treatment outcomes? The stakes are high; real people with real drug and alcohol addictions are depending on us.
This is precisely why at BCI, we follow the NIATx model of organizational change: Plan, Do, Study, Act. With major change, some barriers are to be expected. Before we jump to any conclusions, we should question why we got the results we did.
Let’s look at the barriers we faced. First, our client volume was up during the last two months, with admissions and discharges both about 25% higher than normal. At the same time, our staff was down by two counselors, leaving us with six instead of eight. Not only were more clients coming in and out, but counselors had to deal with higher caseloads. Bad timing, but this is the real world, and these things happen.
But that isn’t all. The incentives procedure we had carefully planned out and trained our staff in wasn’t exactly going as planned. Sometimes, clients had to wait to get their prize because the counselor ran out of time. Counselors were faced with altering their preferred way of running a session. At least one counselor admitted he discouraged his clients from drawing for prizes because it was against his own philosophy of treatment.
Should we be surprised that the staff was not totally on board with the incentives? NIATx says no. Change is difficult. If we really want our project to succeed, we should acknowledge internal resistance and try to overcome it. We’re already looking at how to do this.
We’re also faced with other difficult questions. What caused our retention to go down? Was it the external things beyond our control, or the logistical issues that arose? Now that our census and staffing are back to normal, will we see better results? How much longer do we continue the incentives before declaring them a success or failure?
We want to hear your thoughts as well. And keep watching along with us to see what happens next.
2 comments:
Thanks for the update Matt. I am still skeptical the program has merit but I hope that I am proven wrong in time. However, I still think the lure of the prize may hook some into treatment so that when they are "ready", they will know where to come for help.
Good luck guys,
I believe motivational incentives can be a great useful tool in the counseling arena, but there are certain things that need to be considered when implementing them.
Perhaps the incentives are not useful for the type of population you serve? I'd ask clients directly what they would like if they completed certain requirements (within reason of course).
Also, maybe if not everyone is on the same page agreeing about this program, maybe there should only be one person who gives out the incentives to all eligible clients, like a receptionist or a senior staff member, that way no one has to compromise their beliefs and this system can still be tested.
Finally, in my opinion, as a counselor, I believe that even if 1 person is kept in treatment longer because of this incentive, it's a success, and it should be celebrated.
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