Continency Management Case Study

Case Study: Contingency Management – Mark, aged 14

What were the issues at referral?

Behavioural concerns at point of referral included daily drug use (Mark had used most substances apart from heroin), daily drug dealing at school and in the community (exploitation concerns), absconding from home and school, offending behaviour – charges of assault and vandalism, carrying knifes/weapons, physical aggression towards parents and fights in the community/school with peers and verbal aggression.

Mark had been missing for 4 days before being located by police at the flat of an older male registered sex offender. At this point, his parents requested Mark be accommodated as they were at a breaking point with his behaviours. Mark was accommodated for 3 weeks, thereafter a move back home was agreed with the support of Multisystemic Therapy (MST).

What did MST do with the family and systems around the young person?

MST developed a safety plan alongside family and professionals which was implemented for Mark’s transition out of care back home. The plan incorporated daily room and bag searches to reduce the likelihood of Mark carrying drugs or weapons. The safety plan also contained retrieval steps for his family and supports to take to locate and bring Mark home if he did not return home on time or left without permission. The MST team was able to support the family to gather information on known addresses of associated peers by working closely with the social worker, school and police to reduce referral behaviours. A retrieval plan was developed with school to close-down opportunities for Mark to deal or collect drugs in the town centre and increase supervision at these risky times. This was a hugely successful intervention as class teachers would notify Reception if Mark was more than 5 minutes late to class which would then trigger the retrieval process.  Working with the school also supported Mark to be successful in his educational provision.

The MST therapist undertook the use of Contingency drug Management (CM), one of the most extensively researched and best validated treatments in the field of substance abuse, with a family goal of eliminating Mark’s drug use and drug dealing. Drug testing was used to enforce incentives for clean tests or consequences for dirty tests. A tool known as “Antecedent Behaviour Consequences (ABC) sequences” was used to identify what was causing or sustaining Mark’s drug taking behaviours. These causes, also known as drivers, allowed the MST Therapist and family to support Mark to identify triggers for drug use and develop strategies to use to reduce the likelihood of being in situations which would trigger drug use.  This allowed the whole family to work together using the Family Drug Management Plans to reduce Mark’s drug use. 

The family with the support of the MST Therapist developed a robust behaviour management plan which stated rules, rewards and consequences for all behavioural concerns. To ensure participation from Mark, he was regularly encouraged by his family to update his rewards menu (identifying a list of things that would motivate change) so as his incentives to be drug-free remained meaningful. Towards closure the family and the MST Therapist spent time developing meaningful sustainability plans to support Mark and his family to sustain gains made post-MST.  This plan covered scenarios and solutions for after the COVID 19 lockdown and when schools went back as these changes are likely to impact Mark.

What is the impact?

At discharge, there were 6 weeks of clean drug testing, no reports of drug dealing/drugs or paraphernalia, no reports of absconding, late for curfew and no reports of physical or verbal aggression.