# Behavioral Economics and Financial Incentive-Based Strategies to Optimize Post-CSC Outcomes

> **NIH NIH K23** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $194,940

## Abstract

This K23 application requests funds to develop and test a set of behavioral economics and financial incentive-
based strategies to improve patients' treatment engagement, medication adherence, and substance avoidance
as they transition from Coordinated Specialty Care (CSC) for first-episode psychosis (FEP) to post-CSC care.
While CSC was conceived as a means to improve short-term and long-term outcomes, evidence suggests that
its short-term gains are lost after discharge. Improving treatment engagement, medication adherence, and
substance avoidance during post-CSC care promises to mitigate this loss of gains. Behavioral economic and
financial incentive-based behavior change strategies improve treatment plan adherence for people with other
health conditions, including general psychosis.
 But these interventions have not been tested in the post-CSC period, where they face two obstacles: (1)
frequent loss of contact in care transition and (2) concerns about the ethical acceptability of these interventions.
Yet, preliminary research suggests that text messaging and emerging mHealth apps like mindLAMP will increase
continued contact and that behavioral economic and financial incentive-based interventions will be acceptable
when designed in participatory, ethically-informed ways.
 I will pursue 3 research aims to develop ethically-informed behavioral economics and financial incentive-
based strategies to improve treatment plan adherence for people transitioning from CSC to post-CSC care.
Guided by principles of community-based participatory research, a Steering Committee involving stakeholders,
including CSC researchers, patients, family members, and clinicians, will oversee all aims. In Aim 1, I will assess
facilitators of and barriers to using behavioral economic and financial incentive-based strategies in the post-CSC
period. Using data from Aim 1, in Aim 2, I will adapt and sequentially improve these strategies while leveraging
text messaging and mindLAMP to monitor and reinforce patients' adherence. In Aim 3, I will conduct a pilot RCT
to examine preliminary effectiveness, utility of the measurement battery, success of recruitment and retention
strategies, and feasibility and acceptability of the intervention developed in Aim 2. I will also pursue training goals
in (1) decision science, (2) mHealth, (3) mixed methods analysis, and (4) field trials in order to become an
independent clinician-scientist and
psychosis
 a leader in the use of behavioral economics and financial incentives in
treatment and an expert in the ethical application of these strategies.
 Successful completion of these aims will lead to an R01 application to conduct an RCT testing effectiveness,
cost implications, and implementation issues. Related future research will apply similar methods to enhance
engagement and monitoring in other domains of psychosis care. Ultimately, the research and training plans in
this K23 will launch my career as an independent clinician-scientist an...

## Key facts

- **NIH application ID:** 10984232
- **Project number:** 1K23MH135187-01A1
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** William Rudolph Smith
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $194,940
- **Award type:** 1
- **Project period:** 2024-09-07 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10984232

## Citation

> US National Institutes of Health, RePORTER application 10984232, Behavioral Economics and Financial Incentive-Based Strategies to Optimize Post-CSC Outcomes (1K23MH135187-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10984232. Licensed CC0.

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