Savannah O'Neill, Senior Consultant at Facente Consulting, brings decades of experience in harm reduction, working in SSPs, providing capacity-building support, and engaging in policy organizing at National Harm Reduction Coalition and HIV Education Prevention Project of Alameda County (HEPPAC). She holds a Masters in Social Work from University of Michigan

Background
Contingency Management (CM) is an evidence-based behavioral intervention that provides immediate, tangible rewards to reinforce positive, self-identified behavior change. It is the most effective treatment for stimulant use disorder. In 2023, in response to rising rates of stimulant overdose deaths, California became the first state in the U.S. to offer CM as a benefit through public insurance. Having already embraced CM two decades prior, San Francisco (SF) was well-positioned to expand this model. The San Francisco Department of Public Health (SFDPH) first launched a CM pilot in 2004, designed for men who have sex with men to reduce sexually transmitted infections. Today, SF has more than a dozen clinical and community-based programs serving diverse populations.
Description
SFDPH partnered with Facente Consulting to facilitate focus groups and interviews with over 50 participants from SF CM programs to assess impact and identify recommendations for expansion. Qualitative transcripts were systematically coded and analyzed, yielding clear recommendations. SFDPH and Facente Consulting co-presented these findings to a newly emerging stakeholder group of all the CM providers citywide and developed a report to guide SFDPH. These recommendations included:
1. Offer CM models that reinforce behaviors across the spectrum of harm reduction, including abstinence.
2. Provide funding to offer CM group sessions in addition to individual counseling services.
3. Create opportunities for aftercare.
4. Integrate meaningful involvement and feedback from people who are or have been participants in CM programs in an ongoing way.
Conclusions
CM has the potential to be a powerful harm reduction treatment modality, providing a positive framework for substance use treatment. Rather than the financial incentives being the primary driving force for success, participants described inclusivity and support, regardless of any return to use, as the primary reason they continued to engage, emphasizing that the non-judgmental approach was core to expansion efforts.