Intensive Case Management Improves Welfare Clients Rates of Entry and Retention in Substance Abuse Treatment. Methods


The following section provides a brief description of study methods. Additional details are available from the study authors.


The sample was a preliminary cohort of 146 women who were recruited into the study between September 1999 and July 2000. Selection criteria were designed to identify a sample of women receiving TANF benefits who were required to engage in employment activities and met criteria for a substance use disorder. Women on or requesting methadone maintenance treatment were excluded. A preliminary descriptive profile indicated that on average women were in their mid-thirties, were mothers to about 3 children, a little less than half had completed high school, and most were African-American. More than half reported a primary problem with either opiates or cocaine, most had been using substances regularly for several years, and about half had received prior substance abuse treatment.


Women were screened by caseworkers at local welfare offices using a brief nine item screening measure that assesses the presence of alcohol and other drug use problems, the CAGE-AID (Brown, 1992). Those whose screening results suggested a substance use disorder (screened positive) were referred to specially trained addiction counselors who completed a comprehensive assessment using a standardized battery of measures. Constructs assessed included substance use diagnoses, the American Society of Addiction Medicine (ASAM) Patient Placement Criteria, and need for services in a variety of domains. Women who met study criteria were then randomly assigned to one of two intervention conditions: CC or ICM. Very few women (less than 5%) refused study participation. Thus, it appears that the sample is representative of women on welfare who screen positive for substance abuse in a welfare setting and require, although not necessarily request, substance abuse treatment. Treatment programs provided attendance data on participants at least every other week.


Women randomized into CC met with a masters level addiction counselor who reviewed with the client the need for substance treatment and the type of treatment (e.g. inpatient) that was recommended. In addition, the counselor reviewed NJ welfare work requirement regulations and time limit statutes. According to these regulations women neither attending treatment nor engaged in a work activity were subject to benefit sanction. Initial appointments were scheduled with treatment facilities. Counselors contacted the treatment program regularly to review client's progress and authorize additional treatment. For clients failing to attend a first session, outreach was limited to several phone calls and letters. Women randomized to ICM met with a pair of case managers. In the first phase of ICM, case managers identified tangible barriers to treatment entry such as childcare, transportation, and housing problems and provided needed services. In addition, case managers addressed client's resistance to enter treatment using motivational counseling strategies. If needed, case managers engaged in extensive outreach efforts including home visits and contacting family members. Once clients entered treatment, case managers assisted treatment programs in coordinating needed services and met with clients weekly. Clients also received incentives for attending treatment in the form of vouchers that could be used to purchase certain items such as children toy's or cosmetics.