Examining contingency management delivery in specialty addiction treatment programs: a multisite analysis of implementation determinants
Abstract
AimsDespite strong evidence, contingency management (CM) remains underutilized due to multilevel implementation challenges. Digital CM delivery has shown promise in overcoming barriers to in-person delivery, but there is limited understanding of how factors affecting delivery differ across digital and in-person modalities. This study compared implementation determinants across two cohorts of outpatient specialty addiction treatment programs delivering CM through digital or in-person modalities to inform future delivery decisions and guide implementation strategies to support CM scale in real-world treatment.MethodsTen outpatient specialty addiction treatment programs received a multilevel implementation strategy to assist with CM uptake via a digital platform (n = 6) or in person (n = 4). During pre-implementation, both cohorts completed the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), a 27-item questionnaire that assesses the valence and importance of implementation determinants across four domains: outside the organization, within the organization, the intervention, and intervention recipients. Program staff were administered the IFASIS as a team-based assessment, with teams verbalizing their rationale for ratings. Transcripts of IFASIS recordings were analyzed using a rapid qualitative approach. Quantitative ratings were aggregated into median scores within and across programs.ResultsFindings revealed several commonalities in perceived barriers and facilitators across cohorts. Similar barriers included limited system-level support for CM and absence of internal implementation policies, while common facilitators included external organizational partnerships, leadership-supported CM training, perceived fit, and equitable patient benefits. Notable differences also emerged. The digital cohort identified financial means to implement as a barrier, whereas the in-person cohort rated this as less of a constraint. Staff flexibility and adaptability was rated as neutral in the digital cohort, but as a strong facilitator in the in-person cohort. Additionally, the digital cohort viewed monitoring of inequities as an important facilitator, while the in-person cohort perceived this as a minor barrier.ConclusionsDeterminants of CM implementation were largely consistent across cohorts, particularly perceptions of system-level support, organizational policy, perceived fit, and benefit for patients. Differences in financial constraints, staff flexibility and adaptability, and the role of data in assessing inequities highlight the need for context-responsive implementation strategies to support CM scale in real-world practice settings.
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BibTeX
@article{vroom2026examining,
title = {{Examining contingency management delivery in specialty addiction treatment programs: a multisite analysis of implementation determinants}},
author = {Enya B. Vroom and Milan F. Satcher and Caroline G. Pitts and Stephanie Sangita Hayes and Kira DiClemente-Bosco and Briana M. Patrick and Lia Chin-Purcell and Sara J. Becker},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1995962},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1995962},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Examining contingency management delivery in specialty addiction treatment programs: a multisite analysis of implementation determinants
AU - Enya B. Vroom
AU - Milan F. Satcher
AU - Caroline G. Pitts
AU - Stephanie Sangita Hayes
AU - Kira DiClemente-Bosco
AU - Briana M. Patrick
AU - Lia Chin-Purcell
AU - Sara J. Becker
PY - 2026
DA - 2026/11/05
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1995962
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1995962
AB - AimsDespite strong evidence, contingency management (CM) remains underutilized due to multilevel implementation challenges. Digital CM delivery has shown promise in overcoming barriers to in-person delivery, but there is limited understanding of how factors affecting delivery differ across digital and in-person modalities. This study compared implementation determinants across two cohorts of outpatient specialty addiction treatment programs delivering CM through digital or in-person modalities to inform future delivery decisions and guide implementation strategies to support CM scale in real-world treatment.MethodsTen outpatient specialty addiction treatment programs received a multilevel implementation strategy to assist with CM uptake via a digital platform (n = 6) or in person (n = 4). During pre-implementation, both cohorts completed the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), a 27-item questionnaire that assesses the valence and importance of implementation determinants across four domains: outside the organization, within the organization, the intervention, and intervention recipients. Program staff were administered the IFASIS as a team-based assessment, with teams verbalizing their rationale for ratings. Transcripts of IFASIS recordings were analyzed using a rapid qualitative approach. Quantitative ratings were aggregated into median scores within and across programs.ResultsFindings revealed several commonalities in perceived barriers and facilitators across cohorts. Similar barriers included limited system-level support for CM and absence of internal implementation policies, while common facilitators included external organizational partnerships, leadership-supported CM training, perceived fit, and equitable patient benefits. Notable differences also emerged. The digital cohort identified financial means to implement as a barrier, whereas the in-person cohort rated this as less of a constraint. Staff flexibility and adaptability was rated as neutral in the digital cohort, but as a strong facilitator in the in-person cohort. Additionally, the digital cohort viewed monitoring of inequities as an important facilitator, while the in-person cohort perceived this as a minor barrier.ConclusionsDeterminants of CM implementation were largely consistent across cohorts, particularly perceptions of system-level support, organizational policy, perceived fit, and benefit for patients. Differences in financial constraints, staff flexibility and adaptability, and the role of data in assessing inequities highlight the need for context-responsive implementation strategies to support CM scale in real-world practice settings.
SN - 2296-2565
ER -