英语论文网

Objective.We examined abstinence rates among substance-dependent women receiving Temporary Assistance for Needy Families (TANF) in intensive case management (ICM) over 24 months and whether ICM yielded significantly better employment outcomes compared with a screen-and-refer program (i.e., usual care). Methods. Substance-dependent (n=302) and non-substance dependent (n=150) TANF applicants in Essex County, New Jersey, were recruited. We randomly assigned substance-dependent women to ICM or usual care. We interviewed all women at 3, 9, 15, and 24 months. Results. Abstinence rates were higher for the ICM group than for the usual care group through 24 months of follow-up (odds ratio [OR]=2.11; 95% confidence interval [CI]=1.36, 3.29). A statistically significant interaction between time and group on number of days employed indicated that the rate of improvement over time in employment was greater for the ICM group than for the usual care group (incidence rate ratio=1.03; 95% CI=1.02, 1.04). Additionally, there were greater odds of being employed full time for those in the ICM group (OR=1.68; 95% CI=1.12, 2.51). Conclusions. ICM is a promising intervention for managing substance dependence among women receiving TANF and for improving employment rates among this vulnerable population. (Substance use disorders are among the most prevalent and costly national health problems. Addressing substance use disorders among lowincome mothers has special importance because of the vulnerable nature of the population and the higher prevalence rates of substance use disorders than for other women.1-4 The passage of welfare reform legislation heightened concerns about the well-being of low-income mothers with substance use disorders and opened new opportunities for system change. Under Temporary Assistance for Needy Families (TANF) regulations, women who fail to participate in mandated work activities face sanction and loss of benefits. At the same time,welfare reformgrantedmuch greater latitude to states to develop comprehensive support services, including funding substance use disorders reatment.5 Recent reviews note that women with substance use disorders represent a minority of TANF populations but experience more severe and persistent barriers to employment and are less likely to become employed than are their counterparts without substance use disorders. 6,7 There is a consensus that women with substance use disorders who receive TANF need services that are more intensive than the rapid labor force attachment approach typically found in welfare settings.8 However, there is an absence of research to guide states in evaluating policy and program options. In an earlier study, we reported on substance use outcomes comparing 2 policy-relevant options for women receiving TANF who were diagnosed with substance dependence: (1) a substance use disorders screen-and-refer program, and (2) a substance use disorders screen-and-refer program augmented by intensive case management (ICM) and vouchers.9 Substance use disorders screen-and-refer models screen applicants in welfare offices for substance use disorders with paper and pencil screeningmeasures. Applicants screening positive are assessed for substance use disorders, and if treatment is deemed necessary, clients are mandated to a substance use disorders treatment program. This screen-and-refer approach for women with substance use disorders who apply for benefits is the most common strategy that states