Contingency Management for Problematic Behavior Reduction in the Community

This study aims to determine the feasibility and effectiveness of implementing a contingency management program in a small group of mentally ill, unhoused individuals with schizophrenia or bipolar disorder and anosognosia (a lack of insight into their mental health) in the City of Tulsa. The primary objective of the study is to decrease disruptive or problematic behaviors (e.g. interactions with police, emergency services, hospitals, shelter staff, 911 calls) by unhoused individuals in the community through monetary incentives. Up to 15 participants will meet weekly for 30 minutes with their case manager to discuss progress on life goals ($10) and for having seven days with no disruptive behaviors (or "trouble-free days") per week at each visit, they will receive an additional baseline payment of $20, increasing with continued success in subsequent weeks by $1 per week.

Study Overview

• Status: Completed
• Conditions: Schizophrenia; Bipolar Disorder; Anosognosia
• Intervention / Treatment: Behavioral: Contingency Management

Detailed Description

This study aims to determine the feasibility and effectiveness of implementing a contingency management program in a small group of mentally ill, unhoused individuals with schizophrenia or bipolar disorder and anosognosia (a lack of insight into their mental health) in the City of Tulsa. Tulsa's unhoused population grew nearly 7% last year to the highest numbers since the beginning of the COVID-19 pandemic according to Housing Solutions data, an organization that oversees many of the city's efforts to address homelessness. The primary objective of the study is to decrease disruptive or problematic behaviors by unhoused individuals in the community through monetary incentives.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oklahoma
    • Tulsa, Oklahoma, United States, 74136
      • Laureate Institute for Brain Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age 18-65 years old
2. Diagnosis of Schizophrenia Spectrum, Bipolar, or Related Disorders
3. Presence of Anosognosia (SUMD: Minimum combined score of 4 on questions 1) and 2); Recent (at least <6 months) history of disruptive behaviors (at least 1 disruptive behavior per week in >50% of weeks in the 6-month period prior to enrollment)
4. Receive case management services through TDC
5. Ability to comply with study procedures
6. Willingness to participate in contingency management intervention

Exclusion Criteria:

1. Inability to provide informed consent
2. Unstable medical conditions that would interfere with participation
3. Cognitive impairment that would interfere with participation in the study
4. History of severe aggression or violent behavior posing a risk to study staff or other participants
5. Active suicidal ideation or a history of suicide attempts within the past 12 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Contingency Management; Meet weekly for 30 minutes with their case manager to discuss progress on life goals ($10) and for having seven days with no disruptive behaviors (or "trouble-free days") per week at each visit, they will receive an additional baseline payment of $20, increasing with continued success in subsequent weeks by $1 per week.	Behavioral: Contingency Management; Contingency management payment for no disruptive behaviors each week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in disruptive behaviors	Participants will decrease the frequency of disruptive behaviors in comparison with the 6-month period immediately prior to recruitment	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in disruptive behaviors	Participants will decrease the frequency of disruptive behaviors in comparison with the 6-month period immediately prior to recruitment	18 months

Collaborators and Investigators

• Sponsor: Laureate Institute for Brain Research, Inc.
• Collaborators: Tulsa Day Center
• Investigators: Principal Investigator: Martin Paulus, MD, Laureate Institute for Brain Research

Study record dates

Study Major Dates

• Study Start (Actual): June 20, 2023
• Primary Completion (Actual): December 15, 2023
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: June 27, 2024
• First Submitted That Met QC Criteria: June 27, 2024
• First Posted (Actual): July 3, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 3, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Bipolar and Related Disorders; Neurologic Manifestations; Nervous System Diseases; Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Neurobehavioral Manifestations; Mood Disorders; Perceptual Disorders; Schizophrenia; Bipolar Disorder; Agnosia
• Other Study ID Numbers: 2023-005

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No