Absence of conflict of interest.
Citation
Siegal, H. A., Fisher, J. H., Rapp, R. C., & Kelliher, C. W. (1996). Enhancing substance abuse treatment with case management: Its impact on employment. Journal of Substance Abuse Treatment, 13(2), 93-98.
Highlights
- The study aimed to examine the impact of a strengths-based case management intervention on veterans’ employment and earnings.
- Even though the treatment and control groups were randomly assigned, the study used a pre/post analysis design to compare all participants before the study to all participants six months after the study began. The study collected data using the Addiction Severity Index (ASI-5) and study-created measures including levels of drug use, substance abuse treatment history, health and psychiatric status, occupational and education functioning, living situation, relationship with family and peers, and HIV risk status.
- The study found all study participants, including those in the intervention and control groups, increased earnings and days employed at the six-month follow-up.
- The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to strengths-based case management; other factors are likely to have contributed.
Intervention Examined
The strengths-based case management
Features of the Intervention
The treatment group received a case management service, which used a strengths-based model. After a strengths-based assessment to identify successes, the case manager and veteran worked together to identify goals and strategies for finding employment. Case managers sometimes went with veterans on job searches. The case managers focused on nine life areas: employment/education, living skills, financial, health, leisure, housing, internal resources, recovery, and relationships. These veterans also received the substance abuse program offered to the control group.
Features of the Study
Even though the treatment and control groups were randomly assigned, the study used a pre/post analysis design to compare all participants before the study to all participants six months after the study began. Half of the participants received strengths-based case management services. All participants received the Polysubstance Rehabilitation Program (PRP) at the Department of Veterans Affairs Medical Center in Dayton, Ohio. PRP has inpatient and outpatient components that provide substance abuse treatment programs. The inpatient component of the program consisted of three phases during 28 days. The outpatient component consisted of 10 weeks of sessions with education about substance abuse problems and group therapy focusing on abstinence. Inpatient and outpatient components referred veterans to after-care services after they completed treatment. Veterans in the treatment group and those in the control group could have been referred to vocational rehabilitation services while receiving the PRP services if they requested this referral. To be eligible for the study, veterans needed to have used heroin or cocaine in the past six months, or had regularly used other drugs in the past six months and had not been in treatment during the past three months. Enrollment from to September 1991 to December 1994 included 632 veterans. The study collected data using the Addiction Severity Index (ASI-5) and measures developed for this study at intake into the program and at six months after treatment. The measures included levels of drug use, substance abuse treatment history, health and psychiatric status, occupational and education functioning, living situation, relationship with family and peers, and HIV risk status.
Findings
Employment
- The study found all study participants, including veterans in the treatment and control groups, worked an additional 6 days compared to the 30-day periods preceding the intake and the follow-up interviews.
Earnings
- The study found all study participants, including veterans in the treatment and control groups, increased their earnings by an average of $231 during the study period.
Considerations for Interpreting the Findings
The authors compared the outcomes of participants measured before and after they participated in either the treatment or comparison group. For these types of designs, the authors must observe outcomes for multiple periods before the intervention to rule out the possibility that participants or institutions had increasing or decreasing trends in the outcomes examined before enrollment in the program. Without knowing the trends before program enrollment, we cannot rule this out. Therefore, the study receives a low causal evidence rating.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not account for trends in outcomes before the intervention. This means we are not confident that the estimated effects are attributable to strengths-based case management; other factors are likely to have contributed to the findings.