Bout CM: “We were purchased by a major holding organization, and I get the perception they’re money-driven, although loads of employees listed below are not. We PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/21081558 endeavor to obtain balance amongst fantastic care for sufferers and satisfying the bottom line at the very same time, but expense might be an obstacle for CM right here.” “It appears like a patient could abuse the [CM] technique if they figured out how you can… and a few in the counselors may be concerned that it would create competitors amongst the patients.” Clinic Executive as Laggard At one clinic, no implementation or pending adoption choices was reported. The clinic primarily served immigrants of a particular ethnic group, with sturdy executive commitment to giving culturally-competent care to this population. A byproduct of this concentrate seemed to become limited familiarity of therapy Monocrotaline practices like CM for which broader patient populations are generally involved in empirical validation. Upon recognizing that following federal and state regulations concerning access to take-home medicines represent a de facto CM application, staff voiced assistance for familiar practices but reticence toward extra novel uses of CM: “It’s like that saying…`give a man a fish he’s only gonna consume after. But when you teach him to fish he can eat for a lifetime.’ The monetary incentives seem like `I’m just gonna provide you with a fish.’ But receiving take-home doses is like `I’m gonna teach you the best way to fish’.” “I consider that would be one of the worst items an individual could ever do, mixing economic incentives in with drug addiction. Personally, I’d stick with the classic way we do issues due to the fact if I’m just giving you material stuff for clean UAs, it really is like I am rewarding you as an alternative to you rewarding yourself.” At a last clinic, no CM implementation or imminent adoption decisions were reported. The executive was fairly integrated into its daily practices, but normally highlighted fiscal concerns more than issues regarding quality of care. Consequently, empirically-validated practices like CM appeared under-valued. Staff saw little utility in the use of CM, even as applied to state and federal recommendations governing access to take-home medication doses. A rather strong reluctance toward optimistic reinforcement of customers of any type was a consistent theme: “I do not believe it’s a motivator of any sort with our clientele, to provide a voucher is just not a motivator at all. And [take-home doses] are of pretty minimal value also…I mean, the drug dealer will provide you with those.” “Any sort of economic incentive, they’re gonna obtain a method to sell that. So I think any rewards are probably just enabling. As opposed to all that, I’d push to determine what they value…you know, push for individual responsibility and just how much do they value that.”NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptDiscussionAs signifies of investigating influences of executive innovativeness on CM implementation by neighborhood OTPs, sixteen geographically-diverse U.S. clinics have been visited. At each visit, an ethnographic interviewing method was employed with its executive director from whichInt J Drug Policy. Author manuscript; readily available in PMC 2014 July 01.Hartzler and RabunPageimpressions have been later made use of for classification into one of five adopter categories noted in Rogers’ (2003) diffusion theory. The executive, too as a clinical supervisor and two clinicians, also participated in person semi-structured interviews wherein they described training/exposure to CM and commented on clinic att.