Confound It! Outside Forces Interfere with Incentives Experiment

The question: Will clients stay longer in addiction treatment if we reward them for attendance? The answer: Well, we don’t know. And I’m not being smart, that is an actual scientific explanation. Let me explain.

Our attendance is still below normal since we changed how we give incentives. We could say the new incentives caused attendance to drop – if that was the only thing that changed. But it wasn’t. Over the same time period, record-high numbers of people came in for an intake, and our census increased by 50. On top of that, two counselors and one supervisor were out for several weeks. (One was stuck on the other side of the world – trust me, you don’t want to know.) There were fewer staff to see more clients. If you were a client, which change would be more noticeable to you?

In scientific terms, we manipulated an independent variable (new incentives vs. old incentives) and measured the effect on a dependent variable (retention). Ideally, we would hold all other conditions constant. But our experiment was in a real treatment program, not a laboratory. And wouldn’t you know it, you can’t control external forces in the real world. A condition that offers an alternative and plausible explanation for the results of an experiment is called a confounding variable.

Census and staffing acted as confounding variables in our experiment. This means we can’t call the incentives a success or failure yet. But now things have stabilized and we will keep going. So bear with us, we may get a real answer to our question soon.

Some new developments to report:

• Our new marketing slogan is in place: Participation = Celebration!
• We’ll be adding prize drawings in groups because the more frequent the reward, the better at reinforcing attendance. Until now, clients got credit for group attendance but had to wait until their next individual session to get their reward.
• Counselors held a focus group to share challenges they had in implementing the program and solutions they had found. Since prize drawings took valuable minutes away from sessions, we moved the prize cabinet closer to counselors’ offices. We also learned that counselors are accustomed to using incentives to reward accomplishments and meet individual needs, so it is a real change to reward participation. A refresher training is planned, and we’ve invited an incentives expert to meet with the staff.