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Title: Peter Coleman, M'S', CASAC


1
CONTINGENCY MANAGEMENT APPROACH IMPLEMENTATION
AND OUTCOMES
  • Peter Coleman, M.S., CASAC
  • Marylee Burns, M.Ed., M.A., CRC
  • Scott Kellogg, Ph.D.

2
Workshop Outline
  • Overview of NYC Health and Hospitals and the
    Foundations of Change
  • The Latest Research on Contingency Management
  • The HHC Experience Implementation and Outcomes

3
Overview of NYC Health and Hospitals
Corporation and the Foundations of Change
4
NYC Health and Hospitals Corporation (HHC)
  • Largest municipal health care provider in United
    States
  • Provides services to 1.3 million NYC residents
  • Offers full array of health, mental health, and
    chemical dependency services
  • 8 Inpatient Detox Units
  • 8 Methadone Treatment Programs
  • 19 Outpatient Chemical Dependency Programs
  • 2 Halfway Houses
  • 4 Hospital Intervention Programs, and
  • Case Management Program

5
Contingency ManagementWhy Should We Change
Anything?
  • Weve been providing drug treatment for years and
    our patients do fine!

6
Addiction is a major public health issue
providing effective treatment a major challenge
  • It is estimated that only 20 of those addicted
    to opiates are engaged in treatment.
  • 50 of non-funded MTP programs in NYS report that
    fewer than 54 of those entering treatment are
    retained for more than 1 year.
  • 50 of non-funded MTP programs in NYS report that
    less than 32 of patients discharged have
    discontinued use of heroin.

7
Addiction May be Considered a Medical Condition,
but
  • It is often viewed as a moral weakness that is
    self inflicted and best dealt with through the
    criminal justice system.
  • While it is a chronic disorder, it is often
    treated as an acute condition with expectations
    of immediate resolution.
  • Patients are often stigmatized by society,
    medical providers and treatment program staff,
    and by family, friends and peers.

8
External Pressures for Change
  • Increased focus on program accountability,
    measurement of progress and clinical outcomes
  • Welfare reform and related financial
    ramifications
  • Demand for individualized treatment, respectful
    of patient rights
  • CSAT program accreditation requirements

9
The Truth About Change
  • Change typically requires a systems approach
  • Change is not easy and is a long-term process
  • Change requires a vision and commitment on behalf
    of the entire organization
  • Change involves trial and error as well as
    ongoing evaluation
  • Change requires strong leadership, but it is best
    accomplished when done with input and
    participation of patients and staff

10
Foundations of Change at HHC
  • 1998 OASAS Vocational Initiative
  • 1999 mayoral scrutiny of methadone treatment
  • 2000 OASAS/HRA Vocational Initiative
  • 2001 New CSAT regulations for opioid treatment
  • Desire to incorporate
  • self sufficiency and
  • employment as major
  • treatment goals
  • Conscious decision to
  • improve quality of care,
  • patient satisfaction, and
  • treatment outcomes

11
Initial Actions and Results
  • Initial Actions
  • Vocational Rehab staff added and Career Centers
    established
  • MTP Workgroup
  • established
  • Practice Guidelines and Manuals developed
  • Reporting mechanisms put in place
  • Initial Results
  • Nature of clinics changed but culture didnt
  • Treatment approach had punitive feel
  • Patients did not respond and retention declined
  • Staff disenchanted
  • Improvements unsustained

12
Reinvigorating the Process
  • Workgroups
  • expanded and
  • continued to meet
  • Administrative support increased
  • Staff polled regarding attitudes and needs
  • Patient satisfaction surveys undertaken
  • Training Initiatives
  • Thinking Outside the Box
  • Transtheoretical Model
  • of Behavioral Change
  • Project Invest
  • Management Training Successfully
  • Supervising People

13
Moving in the Right Direction- Leadership
invigorated- Staff attitudes improved-
Treatment began to shift away from punitive
policies- Improved therapeutic environment
  • But patient outcomes, particularly in relation to
    self sufficiency and employment, had still not
    improved to desired levels

14
Patient Motivation and Recognition Initiative
  • Based on research which supported use of tokens
    to encourage and motivate patients towards
    treatment goals
  • Used recognition of patient achievements as
    mechanism for improving self image and peer
    support
  • Focused on advancement in treatment and
    attainment of goals as well as vocational issues

15
Programs were required to submit a plan that
included
  • Specific, measurable objective benchmarks
  • Description of motivational supports
  • Description of patient recognition activities
  • Timeline for implementation and integration
  • Mechanism for staff training and patient
    education
  • Proposed methods for supplemental and ongoing
    support
  • Method of tracking outcomes and accounting for
    supports

16
9 programs responded and were ultimately awarded
an average of 12,900 each plus a supply of
Metrocards and gift certificates
  • Contingency Management
  • was on its way!

17
Science Meets Practice
  • As an outgrowth of a Contingency Management Panel
    (Kellogg and Stitzer) presented at the NIDA
    Blending Conference held in New York in March,
    2002
  • As a direct result of the Blending Conference, a
    collaboration developed between Ms. Marylee Burns
    and Mr. Peter Coleman of the Office of Behavioral
    Health of the New York City Health and Hospitals
    Corporation (HHC), and Scott Kellogg, PhD of The
    Rockefeller University and the CTN.

18
The Collaboration
  • Staff were provided with papers by Drs. Stitzer,
    Petry, and Higgins
  • Dr. Kellogg presented research on contingency
    management to Substance Abuse Directors Meeting
  • Ms. Burns and Dr. Kellogg went to participating
    programs to meet with staff, speak about the
    research, and critique the initial efforts to
    develop Contingency Management components within
    the programs

19
Where are we in 2004?
  • 8 of the original 9 programs (6 MTPs and 2 O/P)
    were allocated additional funds which averaged
    19,166
  • 5 additional O/P programs were allocated funds
    which averaged 10,000
  • Additional training resources were provided
  • Day-long Contingency Management Conference
    Science in the Trenches

20
Successful implementation of Contingency
Management at HHC reflects the sum of the
various parts
21
Setting the StageFactors In Success
  • Commitment of the system to long term process for
    treatment improvement
  • Availability of initial funding and potential for
    additional funds
  • The adoption of science for the clinical paradigm
    and framework
  • Leadership direction and oversight

22
  • Teamwork between program leadership and line
    staff which empowered staff and encouraged
    creativity
  • Patient participation, recognition, enthusiasm
    and empowerment
  • Therapeutic environment which focused on
    positives and moved from sanctions to rewards
  • Individualization of care particularly the
    matching of patient treatment needs to
    motivations

23
  • Ongoing process of review, revision and
    improvement
  • Integration of contingency management into
    overall structure of treatment approach
  • Staff training initiatives
  • Networking and collaborating with NIDA CTN
    affiliated researchers

24
Research on Contingency Management Approaches in
Substance Abuse Settings
25
Contingency Management
  • An approach that has been in use since the late
    1970s
  • Developed by Dr. Maxine Stitzer at Johns Hopkins
    University
  • Further developed by Dr. Stephen Higgins at the
    University of Vermont, by Dr. Nancy Petry at the
    University of Connecticut, and by Dr. Ken
    Silverman at Johns Hopkins University
  • Based on the work of B. F. Skinner
  • Behavior is determined by its consequences
  • Reinforcement -- Increases the likelihood of a
    behavior occurring
  • Punishment -- Decreases the likelihood of a
    behavior occurring

26
THE FANTASY Patients Recognize that they have
a Problem They Know they Need Help with that
Problem They come to treatment ready for change
27
REALITY CHECK.
What REALLY makes patients come to treatment?
28
Negative Consequences of Drug Use
Treatment
29
External Negative Consequences
Family Members Employers Parole/Probation Child
Protective Services
30
Personal Negative Consequences Many Patients
Come to Treatment Because BAD Things are
Happening, Others are Angry with Them, They are
Tired and Depressed, They have run out of money,
They Want Life to Change BUT...
31
Drugs are Positive Reinforcers
They Make People Feel Good.
32
Abstinence
Continued Use
Drug Abusers Straddle the Fence
33
Behavioral Results of Ambivalence
Some patients stop using
Some patients continue to use drugs
during treatment
Some patients drop out of treatment early
34
Methods are needed to
Continued Drug Use
Drug Abstinence
- counteract ambivalence- increase motivation
for change
35
What are Motivational Incentives and How Can They
Help
36
Motivational Incentives In Everyday Life
  • Child rearing
  • Praise and discipline
  • Education
  • Grades/honors and detention/suspension
  • Business organizations
  • Bonuses promotions and sanctions/demotions
  • Criminal justice
  • Arrest/incarceration and early release

37
Examples of Rewards
Vouchers and Gift Certificates
Attention, Pat on the Back
Prizes and Gifts
Privileges
Services
38
Examples of Punishers
  • Fines
  • Tickets
  • Restrictions
  • Sanctions
  • Displeasure

39
It is the CONTINGENCY that matters.
BEHAVIOR
REWARD
  • Giving things away for free
  • does NOT change behavior
  • The closer in time, the more
  • powerful the reinforcement

40
Punishments
  • Do not teach what to do only what not to do
  • Promote harsh and demeaning atmosphere
  • May also do harm (e.g. promote aggression)
  • Are necessary under limited circumstances

41
Rewards
  • Teach new behaviors and promote growth
  • Promote positive atmosphere communication
  • Promote self-esteem and self-confidence
  • Sustainable over time

42
Rewards versus Punishments
  • Which is used
  • more frequently?

43
Punishments!
44
Application to Drug AbuseIntervention Targets
  • Improved Therapy Attendance
  • Decreased Drug Use
  • Treatment Plan Goal Attainment

45
Common Naturally Occurring Rewards and Punishers
In Drug Abuse Treatment
  • Positive Negative
  • - take-homes - time restriction
  • - award ceremonies - missed services
  • - certificates key chains - probation
  • - status/recognition - dismissal

46
Motivational Incentives Research
  • Clients earn vouchers for drug-free urines
  • usually cocaine-free urines
  • Vouchers are worth money
  • Vouchers are exchanged for
  • retail items (e.g. clothing, sports equipment)
  • services (e.g. rent bill payments)

47
Research on Motivational Incentives
Cocaine abusers in drug-free treatment
Cocaine abusers in methadone treatment
48
Treatment of Cocaine Dependence in a Drug-Free
ClinicHiggins et al., 1994
Control Treatment Community Reinforcement
Approach Therapy Urine testing 2x/week No vouchers
Incentive Treatment Community Reinforcement
Approach Therapy Urine testing 2x/week Vouchers
10
Can earn over 1000 Actual earnings 600
49
Treatment of Cocaine Dependence
Retained Through 6 month Study
Higgins et al., 1994
50
One-year Follow-up Results
  • 60 of incentive group were cocaine abstinent
  • While 45 of the control group were abstinent
  • During-treatment abstinence predicts long-term
    abstinence

51
Treatment of Cocaine Abuse in Methadone
PatientsSilverman et al., 1996
  • Contingent Incentives
  • 3x weekly urine testing
  • received vouchers only if urine samples were
    cocaine negative
  • Up to 1155 available
  • Average earnings of 426
  • Non-Contingent Incentives
  • 3x weekly urine testing
  • received vouchers regardless of urine test
    results

52
Treatment of Cocaine Use in Methadone Patients
Retained Through Study
Silverman et al., 1996
53
Patient Ratings of Helpfulness
Overall helpfulness of treatment
Silverman et al., 1996
54
Adaptation into Standard Clinic Settings
  • Intermittent reward for good behavior
  • reduces cost

55
Intermittent Incentive Study with
Alcoholic-Dependent Outpatients
  • Subjects alcohol-dependent outpatients
  • Standard treatment
  • Intensive outpatient day program
  • 5 hrs/day, 5 days/week, weeks 1-4
  • Aftercare
  • 1-3 groups/week, weeks 4-8
  • Treatment consisted of group sessions 12 step,
  • relapse prevention, vocational rehab, AIDS,
    coping skills

56
Intermittent Reward
  • Instead of getting reinforced every time they are
    drug-free,
  • The drug-free patient draws from the fishbowl
  • 50 of the draws are verbal reinforcements that
    say good job
  • And 50 of draws are winners

57
Control Group
  • Received standard group treatment and
  • Breath Alcohol (BAC) monitoring
  • (daily during intensive, weekly during
    aftercare).
  • Additional 15 min of
  • education on
  • alcohol abuse weekly

Just say no
58
Incentives Group
  • Standard group treatment and BAC monitoring
  • Incentives for alcohol abstinence
  • One draw for each negative BAC.
  • Five bonus draws for a week of consecutive
    abstinence.

59
Half the cards are winning
42 of the cards are worth a small prize (i.e.
toiletries, food) 7 are worth a medium prize
(i.e., cordless phone, CD) And less than 1 are
worth a jumbo prize (i.e., TV, video)
60
Retention
Retained
Petry et al., 2000
61
Time Until First Drinking Episode
Abstinent
Weeks
Petry et al., 2000
62
Percent Positive for Any Illicit Drug
Petry et al., 2000
63
Summary of Research
  • This intermittent schedule of incentives
    significantly increased retention and reduced
    alcohol, as well as other drug, use.
  • On average, subjects earned 200 worth of prizes.
  • Local retailers and stores were willing to donate
    prizes.

64
The Original Plan
  • When I first became a part of this project, each
    HHC clinic was expected to create a plan for
    distributing reinforcements in an appropriate and
    systematic way to their patients
  • The idea was that when patients reached various
    benchmarks, they would receive a prize or reward
    (i.e., a gift certificate)

65
Potential Shortcomings
  • After our dialogue about CM, it became clear that
    there might be a shortcoming to this plan
  • My thought was that they were creating a reward
    program rather than a reinforcement program

66
Reward Vs. Reinforcement
  • The reward program can be seen as one that is
    set up to acknowledge major accomplishments
    maintaining abstinence for 1 month holding a job
    for 3 or 6 months or completing a one-year
    program in a sense, it is a program to reward
    virtue
  • The greatest concern was that it would result in
    the distribution of prizes to the best or most
    successful patients
  • While having little or no impact on those who
    were having serious problems attaining or
    maintaining abstinence and sobriety

67
Reinforcement ProgramsContingency management
programs have the ability to
  • Reinforce each of the steps and each of the
    components that are involved in reaching the
    goal, not just the attainment of the goal
  • Be more gradualistic, and, while not value-free,
    they are not as overtly value-oriented
  • Focus more on initiating and maintaining behavior
    change
  • Allow us to go from You
  • have done a good job to
  • You have taken a step in the
  • right direction
  • Help not only the most
  • motivated patients, but also
  • those who are more troubled
  • and/or more severely
  • addicted have the opportunity
  • to benefit (Petry et al., 2001)

68
Definitions and Constructs
  • Technically, reward and reinforcement, as
    used here, are the same thing the issue is the
    criteria for reinforcement (Kazdin, 1994 Wolpe,
    1982)
  • However, clinically, the social constructs of
    reward and reinforcement were quite meaningful
    to the staff and the leadership

69
Definitions and Constructs (2)
  • Giving things to people on the way to
    accomplishing a goal seemed fundamentally
    different from giving to them only when they
    achieved it
  • It was this difference that played a crucial role
    in reorienting the HHC clinics and making this
    project a success

70
Reinforcement StrategiesA number of guidelines
about the use of contingencies were emphasized
(see also Kirby et al., 1999)
  • Reinforcements should be given very frequently
  • 2. It should be very easy to earn reinforcements
    at the start the bar should be kept low
  • 3. An example of this is that when the trainers
    at Sea World begin to teach the whales to jump
    over the hoops, they start with the hoop being
    under the water the whales are reinforced for
    simply swimming over it (Coonradt, 1996)

71
Reinforcement Strategies (2)
4. To be as effective as possible, the
reinforcements should include material goods and
services and these need to be of use and value to
the patients 5. Social reinforcement alone is
not likely to be sufficient -- especially for
patients who are disconnected or socially
phobic 6. Reinforcements will be most effective
if their distribution is connected to specific
and observable behaviors and they receive them
immediately after exhibiting the behavior (i.e.,
attending the group) 7. The greater the delay in
receiving the reinforcement, the weaker its
effect is likely to be
72
Clinical Considerations
  • Emphasize the positive
  • Focus on the good things the patients did -- not
    their failings
  • Any steps in the right direction is a cause for
    celebration
  • In the face of setbacks, patients should be
    encouraged, not criticized
  • Reinforcement criteria should be clear to both
    the patients and the staff if they meet the
    criteria, they must receive the reinforcement --
    regardless of their drug use status

73
Social Aspects
  • There are powerful social reinforcement processes
    at work when the counselor gives the
    reinforcement to the patient
  • Counselors who are not enthusiastic might
    inadvertently have a damaging impact on its
    efficacy
  • A congratulatory approach is seen as the most
    appropriate one

74
Implications for Counseling
  • It was emphasized that CM is not a substitute for
    counseling
  • Reinforcements do not directly teach people how
    to abstain nor do they provide skills -- they
    simply strengthen behaviors that lead to that
    outcome
  • Counselors have a valuable therapeutic
    opportunity to explore with their patients what
    actions they took to avoid using drugs this can
    be used to develop future coping strategies
    (Morral, Iguchi, Belding, 1999)

75
The HHC ExperienceImplementation and Outcomes
76
Implementation
  • 7 out of 9 clinics implemented programs
  • Contingency management programs varied some
    used points/tickets, others the fishbowl
  • Many plans changed along the way
  • Group attendance as well as goal attainment were
    reinforced - material and social reinforcements
    were used

77
Implementation - continued
  • Reinforcements were distributed in both group and
    individual settings.
  • Programs expanded upon existing award ceremonies.

78
Benchmarks Reinforcements
  • Benchmarks included
  • Group attendance
  • Goal attainment
  • Negative toxicologies
  • Completion of medical and psychosocial history
  • Higher levels of reinforcement were used for
    groups that involved exploring careers, education
    and other work related issues.

79
Reinforcements
  • Range of prizes some matched with program
    issues e.g. job interview
  • McDonalds coupons, movie passes,
    transportation vouchers (metro cards),
    calendars, gift certificates from major
    department stores and music outlets, date books,
    tools, clothes, books, tee-shirts, microwaves,
    water bottles, sunglasses, things for children,
    toiletries, food, and candy

80
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Implementation Process
  • At first, there was a fair amount of staff
    resistance
  • This was a long and hard process and there
    were lots of fights. Staff saw it as a negative
    at first,. As the director, I allowed the staff
    to ventilate. The Vocational staff started the
    whole process because their orientation is far
    more receptive to this kind of thing. (Program
    Director)

88
Patients Reactions
  • Some patients needed tangible evidence of such
    prizes
  • Eventually patients were very enthusiastic
  • Their self esteem seemed to increase as seen in
    their improved appearance and their attendance to
    and interest in groups.
  • They also began to become more empowered as seen
    in their development of goals

89
Patients Reactions - Continued
  • Clients were sayingIn Russia, we were forced
    into treatment -- Now (crying), my God, Im
    getting treatment and 25.00!
  • Clients are proud and are having fun. Early in
    treatment, when their name is called out, they
    are feeling good that they are being
    acknowledged. For once in their life, they are
    being rewarded for something.
  • When the client signs onto the computer, they
    see Dust-off Your Dreams Treatment Works. We
    know that clients dreams were lost to drug
    addiction. Now, clients are able to go to Macys
    and J.C. Penney. This is big time for them
    theyre able to shop at prestigious stores.

90
Patients Reactions - continued
  • A core issue here was the profound emotional and
    economic deprivation that these patients had
    experienced and continued to experience.
  • The reinforcements and awards were so powerful
    because some patients believed that the staff did
    not care about them, and others, in their 30s
    and 40s, had never received a certificate for
    anything.
  • Because of their high levels of economic
    deprivation, the gift certificates frequently
    made a significant difference in their lives.

91
Patients Reactions - continued
  • The basic process was that the reinforcements got
    them to the groups and motivated them to stay,
    and then the power of the group began to have its
    impact.
  • As has been noted elsewhere (Petry et al., 2001),
    patients first came for external reasons and then
    chose to stay because of their internal
    motivations.

92
Patients Reactions - continued
  • Patients who participated in the program often
    began to become more socially integrated and
    began to socialize with each other
  • They would use their coupons and go to movies
    together in groups
  • There were also reports that they were taking
    care of each other and giving each other gifts

93
Patients Reactions - continued
  • Their sense of connection to the program grew and
    they participated more freely in its events
  • The staff heard clients say that they came to
    realize that there are rewards just in being with
    each other in group. There are so many
    traumatized and sexually abused patients who are
    only told negative things. So, when they hear
    something good that helps to build their
    self-esteem and ego. As one patient put it, I
    used to think the drug dealer cared for me but
    this is really caring. (Counselor)
  • In many cases, the prizes became a vehicle for
    family healing

94
Patient Reactions - Internalization
  • They developed increased sense of ownership
    and responsibility for their program and their
    recovery.
  • You are forcing me to I choose.
  • In one striking example, patients who felt that
    methadone initially made them drowsy, delayed the
    taking of their medication until after their
    group so they could be more alert and alive..
  • Clients also began to speak privately to their
    counselors about individuals who were dealing
    drugs or otherwise engaging in anti-therapeutic
    behavior.

95
Counselor Experiences
  • Morale improved
  • Identification with evidence-based practice
  • It gives me a great deal of pleasure to know
    Im part of a state-of-the-art methadone
    treatment program.
  • Public gratitude -
  • In the last two award ceremonies, clients said,
    I want to thank the staff. That sounded real
    good we feel appreciated.

96
Counselor Experiences - continued
  • Communication Improved
  • Staff designed, evaluated and changed CM programs
  • Staff spoke more of patient changes and made more
    team decisions regarding treatment
  • Staff Attitude Improved
  • I love coming to work now.

97
Counselor Experiences - continued
  • Relationships among the different staff services
    improved
  • Last year, the staff were not positive. They
    were very territorial, and somebody was always
    waiting to attack this idea. Perhaps they were
    feeling very threatened Now, the staff are
    more cohesive.
  • (Program Director)

98
Counselor Experiences - continued
  • There has been a major acceptance now for
    vocational counseling and activities, and we now
    have a Wall of Fame. A bulletin board with
    pictures of employed patients. Before, the
    rehabiliation counselors were the brunt of
    sarcasm, now clients are asking that their
    pictures could be added to the board.

99
Counselor Experiences - continued
  • Perception of the use of reinforcements began to
    change.
  • We came to see that we need to reward people
    where rewards in their lives were few and far
    between. We use the rewards as a clinical tool
    not as bribery, but for recognition. The really
    profound rewards will come later.
  • Even small steps were recognized and celebrated.
  • I felt resistant at first. But, as it caught
    on, I began to like giving points to clients. I
    saw that my client wasnt using dope, only coke,
    and Id say give him a point! So, now Im very
    involved.

100
Kings County HospitalVocational Outcome Data
  • Kings County did a comparison between a group of
    patients who were enrolled in a series of
    vocational groups and received incentives and
    another group of patients that were involved with
    the vocational groups before the incentives were
    introduced.
  • 25 of the non-incentive group (n 20) completed
    the series while 61 of the incentive group (n
    18) completed the series of groups.

101
Before C.M. After C.M.
N 20 N 18
  • The two groups were compared at a six-month
    follow-up.
  • 40 of the non-incentive group were
    vocationally engaged while
  • 89 of the incentive group were vocationally
    engaged.

102
Harlem Hospital Vocational Outcome Data

Before C.M. After C.M.
(Census stable at 350)
as of 12/02 as of 4/03

103
Clinic Changes - Mood and Culture
  • Marked decrease in conflicts and disruptive
    behavior in some of the clinics
  • The mood has changed in the last 6 months
    there has been less disciplinary action in
    fact, no fights at all. There has been no need
    for escorting people out of the building as has
    been the case in the past.
  • Before, the clients would yell and curse, and
    now things are calm. Amazing. Clients are
    more pleasant its an easier place to exist
    in.

104
Clinic Changes - Mood and Culture
  • I think it does strengthen the alliance with the
    team, not just one counselor. The program has
    become nurturing.
  • Communication Improved
  • Staff spoke more of patient changes and made more
    team decisions regarding treatment.
  • Staff designed, evaluated and changed CM
    programs.
  • Staff Attitude Improved
  • I love coming to work now.

105
Staff, Patient, and Clinic Overall Impressions
  • One year later, the contingency management
    programs were a reported success and valued by
    both staff and patients.
  • The patients loved it, and some reported that it
    had saved their lives. They felt that their drug
    use had been getting worse and worse, and it was
    the contingencies that encouraged their choosing
    a different life direction.

106
Staff, Patient, and Clinic Overall Impressions -
continued
  • The staff and leadership were very excited about
    and proud of their reinforcement programs. As
    one counselor put it,
  • I dont know who invented it, but it was a
    stroke of genius.

107
Acknowledgements
108
  • Collaborators of this project were
  • Marylee Burns, MEd, MA, CRC, Assistant Director,
    HHC Office of Behavioral Health
  • Peter Coleman, MS, CASAC, Senior Director, HHC,
    Office of Behavioral Health
  • Scott Kellogg, Ph.D., Clinical Psychologist,
    Laboratory of the Biology of the Addictive
    Diseases, The Rockefeller University

109
  • Development, implementation and support of this
    project is due to the efforts of the leadership,
    staff, and patients of the New York City HHC
    Chemical Dependency Programs.
  • Wed like to thank specifically
  • HHCs Office of Behavioral Health
  • Joyce B. Wale, Senior Assistant Vice President
  • Michael Norman Haynes, Sr. Management Consultant,
    and
  • Antonio Webb, Sr. Management Consultant

110
  • Ludwig Hauser, CSW and the staff of Bellevue
    Hospitals Methadone Treatment Program,Jaime
    Rosario, CSW and the staff of Coney Island
    Hospitals Outpatient Chemical Dependency
    Treatment Program, Martin Gaffney, CSW and the
    staff of Elmhurst Hospitals Methadone Treatment
    Program,Aisha Muhammad, CSW and Curtis Saunders
    and the staff Harlem Hospitals Methadone
    Treatment Program,Janet Aiyeku, CASAC and Dayo
    Alalade, Ph.D and the staff of Kings County
    Hospitals Methadone Treatment Program
  • All the patients at HHC programs who have
    supported the development of contingency
    management and have evolved into some of the
    strongest advocates.

111
  • And a special thanks to the researchers
    associated with the NIDA CTN Project
  • John Rotrosen, MD, NYU School of Medicine
  • Maxine Stitzer, Ph.D., John Hopkins University
  • Dr. Mary Jeanne Kreek at the Rockefeller
    University
  • NIH-NIDA Grants P60-DA05130 (Kreek),
  • DA13046-04 (Rotrosen)

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CONTACT INFORMATION
  • Marylee Burns, MEd, MA,, CRC
  • Assistant Director,
  • NYC Health and Hospitals Corp.
  • 212-788-3458 burnsm_at_nychhc.org
  • Peter Coleman, MS, CASAC
  • Senior Director,
  • NYC Health and Hospitals Corp.
  • 212-442-3993 colemanp_at_nychhc.org
  • Scott Kellogg, Ph.D.,
  • Clinical Psychologist,
  • The Rockefeller University
  • 212-327-8282 kellogs_at_rockefeller.edu
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