Kentucky Incentives for Improving Outpatient Engagement Project

Individuals with chronic illnesses typically require continuity of care to achieve and maintain desired outcomes. Discontinuity of outpatient care following discharge from institutional settings places individuals at increased risk for poor clinical outcomes and contributes to inappropriate and costly use of hospitals, emergency departments, and jails or prisons. Improving outpatient treatment adherence following discharge from a state psychiatric hospital is a critical component of Kentucky’s continuity of care efforts and its larger Recovery-Oriented System of Care transformation efforts. Individuals with serious mental illness (SMI) are at particularly high risk for poor adherence to recommended treatments and mental health clinic appointments. A variety of mechanisms are in place to support these efforts, including contractual language requiring that individuals be seen within 14 days of discharge, the use of community liaisons to conduct hospital in-reach, and the deployment of engagement teams that support community transition. Despite these efforts, data on 30-day hospital readmission rates and outpatient appointment no-show rates indicate room for improvement. Contingency management (CM), also referred to as motivational incentives, is a type of behavioral therapy rooted in the principles of operant conditioning in which individuals are ‘reinforced’ or rewarded for evidence of positive behavioral change. The reinforcers typically consist of vouchers exchangeable for retail goods and services including items to make treatment more accessible such as transportation and communication expenses. While CM has been shown to be a highly effective treatment for substance use and related disorders, it is rarely used in mental health practice. Through funds from a Transformation Transfer Initiative grant, the Commonwealth will design, install, and implement a CM intervention for individuals with SMI discharged from Western State Hospital and evaluate the impact of the intervention on outpatient treatment engagement. The Kentucky Incentives for Improving Outpatient Engagement Project (hereafter referred to as the Kentucky Incentives Project, KIP) offers a unique opportunity to expand upon existing continuity of care efforts for individuals with SMI through the addition of CM and evaluate the impact of this intervention on engagement and retention in outpatient treatment following hospital discharge. University of Kentucky Research Foundation (UKRF), University of Kentucky College of Medicine, Family and Community Medicine shall provide a program evaluation services for KIP, a Transformation Transfer Initiative grant project.