Citation
Morgenstern, J., Neighbors, C., Kuerbis, A., Riordan, A., Blanchard, K., McVeigh, K., Morgan, T., & McCrady, B. (2009). Improving 24-month abstinence and employment outcomes for substance-dependent women receiving Temporary Assistance for Needy Families with intensive case management. American Journal of Public Health, 99(2), 328-333.
Highlights
- The study’s objective was to examine the impact on employment of an intensive case management (ICM) program for substance-dependent women receiving Temporary Assistance for Needy Families (TANF).
- Women identified as substance-dependent were randomly assigned to either the ICM or usual care treatment programs. The primary data sources were daily self-reports and follow-up interviews conducted 3, 9, 15, and 24 months after random assignment.
- The study found that women in the ICM group were generally significantly more likely than women in the usual care group to be employed full-time, particularly at the 24-month follow-up period. In addition, the study found a significantly higher rate of improvement in employment outcomes for the ICM group compared with the usual care group.
- The quality of causal evidence presented in this report is low because it was based on a randomized controlled trial with high attrition and the authors did not account for differences between the two groups in their analysis. This means we are not confident that the estimated effects are attributable to the ICM or usual care program; other factors are likely to have contributed.
Intervention Examined
Intensive Case Management (ICM) and Usual Care Programs
Features of the Intervention
The study included two treatment conditions for substance-dependent women receiving TANF: usual care and ICM. For both treatment conditions, women received the service throughout the 24-month study period. The usual care group received the standard substance use disorders treatment program, which included a meeting with a clinical care coordinator for care referral. The ICM treatment program supplemented the standard substance use disorders treatment program with intensive case management and vouchers for attending treatment meetings. The ICM component included weekly meetings with case managers who tailored services to the women’s needs and treatment phase.
Features of the Study
Women were eligible to participate in either the ICM or usual care program if they (1) were eligible for TANF, (2) were enrolled in New Jersey’s welfare-to-work program and had no medical deferrals, (3) spoke English, and (4) were diagnosed as substance-dependent as determined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The authors recruited 302 women meeting these criteria from welfare offices in Essex County, New Jersey. In total, 161 women were randomly assigned to the ICM treatment and 141 women were randomly assigned to the usual care treatment.
The authors measured employment using self-reports. The self-report consisted of daily data collection from baseline throughout the 24-month follow-up period. Follow-up interviews were conducted in months 3, 9, 15, and 24 after baseline. The authors used a regression model to compare the employment outcomes of the women in the ICM and usual care groups.
Findings
- Overall, members of the ICM group were 1.68 times more likely to be employed full-time than were members of the usual care group, a statistically significant difference. This difference in employment was most pronounced at the 24-month follow-up period, when members of the ICM group were 3.24 times more likely to hold full-time positions than were members of the usual care group.
- The rate of improvement in employment outcomes was 1.03 times higher for the ICM group than the usual care group with an incidence rate ratio equal to 1.03.
- When examining comparisons that also accounted for the prior month’s employment, the ICM group worked 1.43 times more days in the following month compared with the usual care group.
Considerations for Interpreting the Findings
The study was a randomized controlled trial with unknown attrition from the sample. Because attrition affected the treatment and control groups’ comparability on background characteristics that could have affected the outcomes of interest, CLEAR reviews the study as a quasi-experimental design. The authors noted that in the analytic sample the members of the control group were significantly younger than the members of the treatment group but did not account for this difference. As a result, the estimated program effects reflected differences related to age as well as any impact of the program.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because it was based on a randomized controlled trial with high attrition and the authors did not include sufficient controls in their analysis. This means we are not confident that the estimated effects are attributable to ICM or usual care; other factors are likely to have contributed.
Additional Sources
Morgenstern, J., Blanchard, K., McCrady, B., McVeigh, K.H., Morgan, T., & Randina, R. (2006). Effectiveness of intensive case management for substance-dependent women receiving Temporary Assistance for Needy Families. American Journal of Public Health, 96(11), 2016-2023.