Improving 24-Month Abstinence and Employment Outcomes [2]
论文作者:匿名论文属性:短文 essay登出时间:2009-06-07编辑:刘宝玲点击率:11728
论文字数:5000论文编号:org200906071527188956语种:中文 Chinese地区:中国价格:免费论文
关键词:Improving24-MonthAbstinenceEmploymentOutcomes
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Although screen-and-refer programs focus on case identification and triage to substance use disorders treatment, evidence strongly supports the consideration of more-intensive interventions. Studies of women with substance use disorders who receive TANF indicate high rates of co-occurring mental health and social problems that are not likely to be addressed in substance use disorders treatment.11,12 In addition, newer conceptualizations of substance use disorders as a chronic illness suggest that interventions should provide extended monitoring over time; coordination of services may improve outcomes when added to standard substance use disorders treatment.13,14
In our earlier study, we found that substancedependent women receiving TANF in ICM had significantly higher levels of access and retention in substance use disorders treatment and were almost twice as likely to be abstinent15 months following study entry than were those assigned solely to a screen-and-refer option. In our current study, we had 2 primary aims: to examine whether early group main effects for abstinence were sustained over longer-term follow-up (16-24 months) and to test whether ICM yielded significantly better employment outcomes when compared with screen and refer.
To the best of our knowledge, no previous study has reported employment outcomes among women who formerly received TANF either in substance use disorders screen-andrefer programs or in ICM. Testing the effectiveness of policy-relevant interventions for lowincome mothers with substance use disorders is vitally connected to health issues post-welfare reform. Women who fail to achieve employment are subject to sanction and loss of social safety net benefits, including Medicaid coverage. Also, programs with demonstrated effectiveness in helping women with substance use disorders gain employment, rather than simply become abstinent, are more likely to receive additional resources from welfare agencies.15
In addition, we had 1 secondary aim. We examined whether previous abstinence predicts later employment outcomes. A guiding supposition among welfare and substance use disorders treatment professionals is that abstinence from mood-altering substances is a necessary first step toward gaining employment.16 Surprisingly, previous studies have not reported a strong relationship between abstinence and employment outcomes.17 However, no study has examined this hypo
thesis in a post-welfare reform context.
METHODS
We used routine self-report drug-use screening procedures (which were part of determining TANF benefit eligibility) to identify substance-dependent women in welfare offices. We evaluated women who screened positive for substance use disorders for study selection criteria. In addition, we recruited and followed a comparison sample of women receiving TANF who did not meet criteria for substance use disorders in the previous 5 years. Our aim in collecting these data was to provide a means of benchmarking the employment outcomes of substance-dependent women against a sample of women without substance use disorders who received TANF. Accordingly, we asked women who screened negative for substance use disorders to participate in the study as a nonaffected, comparison sample. Thus, the study examined employment outcomes for 3 groups: a usual care group, an ICM group, and a comparison sample.
Of those substance-dependent women who agreed to participate and proved to be eligible, 1 group receiv
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