Designing a CM Program
One important decision to make is whether to use a Prize-draw or Voucher CM model.
Designing an effective and compliant CM program is done by considering federal policies, funding requirements (e.g. SAMHSA advisory), and evidence-based protocols.
Comparing Prize-Draw and Voucher-Based CM
Pros, Cons, and Considerations
Category
Prize Model CM
Voucher Model CM
Pro (used by most current state and federally funded CM programs, including California's Recovery Incentives Program)
Widespread use
Neutral (used in many research studies and by Veteran's Administration)
Neutral
Excitement
Pro (draws increase anticipation)
Con (may not attract people seeking larger prizes)
Reach
Pro (may attract people with larger prizes)
Neutral/con (may need to use "banking" when the voucher value earned is not a round number. Example: $14 earned, $10 taken home, $4 banked. May also require "rounding up" at the end of the program)
Reward redemption experience
Pro (straight forward)
Pro (escalation pattern is clear and linear)
Use of escalation
Neutral (number of prize-draws increases, rather than the value of the total reward earned)
Pro (more time spent on discussions with client, which can include linking reward to larger recovery goals or other clinically relevant topics)
Time allocation within CM visits
Pro (more time spent drawing prizes, which is fun and engaging)
Pro (visit very straightforward)
Ease of administration
Con (more details to track relating to the prize draw itself, including auditing and managing the slips/tokens)
Pro (clear link between behavior and reward value)
Fairness perception
Con (clients may perceive rewards as inconsistent or unfair)
Pro (everyone earns rewards proportionate to their performance)
Equity concerns
Con (due to probability and chance, some will earn a higher dollar amount of rewards than others, even when the same number of prize-draws are earned)
Pro (guaranteed rewards can be more compelling early on and help with initial motivation)
Potential frustration
Con (clients may draw low-value prizes repeatedly)
Pro (reinforcement schedules are straightforward)
Requires explanation
Con (staff may need to describe the probabilistic nature of the prize-draw and ensure understanding)
Pro (the maximum possible earnings is the same for every client and thus can be designed to consistently land within the pre-determined duration of the program)
Impact on CM program duration
Con (in programs with a strict per-client, per-year cap, due to probability and chance, some clients may exceed the max allowable earning. To mitigate, the CM program must be prepared to shorten the duration of the CM program for that individual or design the maximum possible earnings to average under budget to account for some outliers)
Pro (banking or accumulating earnings can encourage return behavior)
CM retention
Neutral/con (may not naturally encourage repeat visits)
