Intensive Case Management Improves 24 Month Abstinence and Employment Outcomes for Substance Dependent Women Receiving Temporary Assistance for Needy Families (TANF)

A major goal of welfare reform was to encourage states to provide work activities that would enhance welfare recipients' human capital, ultimately facilitating their ability to gain employment and self sufficiency. Although research has demonstrated some success in getting recipients off welfare into employment, substance abusers are a high risk group of individuals identified as those who continue to cycle on and off welfare and are less likely to leave welfare for work than their non-substance using counterparts. Some states have implemented specialized services to address the unique needs of this population. This study examined the efficacy of intensive case management (ICM) in helping substance dependent mothers on welfare to achieve abstinence and obtain employment as compared to usual care (UC).

METHOD: Substance dependent women on TANF (N=302) were recruited from local welfare offices in Essex County, NJ; assessed after screening; and randomly assigned to ICM or UC. Participants were re-assessed at 3, 9, 15, and 24 months. UC consisted of a health assessment at the local welfare office and referral to substance abuse treatment and TANF services. Clients in the experimental condition received ICM, a manual guided intervention that combined extensive outreach, assessment, and provision of services, in addition to the UC services. Appropriate to the longitudinal, repeated measures nature of the data, Generalized Estimating Equations (GEE) modeling was used to assess the predictive value of ICM in facilitating abstinence and employment. The data were modeled using Negative Binomial regression models with log link function, which provided the best model fit.

FINDINGS: Abstinence rates for ICM were higher than UC through 24 months of follow-up (OR = 2.11, 95% CI = 1.36-3.29). A statistically significant interaction between time and condition on number of days employed indicated that the rate of improvement over time in employment is greater for ICM than for UC (Incidence Rate Ratio, IRR = 1.03, 1.02-1.04). Additionally, the ICM condition exhibited greater odds of being employed full-time (OR = 1.68, 1.12-2.51).

CONCLUSION: Findings presented here suggest that ICM is a promising intervention for managing the chronic nature of substance dependence for TANF women and for improving employment rates among this vulnerable population.