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Temporary Assistance for Needy Families and Safety Net recipients whose application questionnaires indicated possible substance abuse were referred via an electronic scheduling system to New York City’s Human Resources Administration (HRA) for more detailed assessments. When the SACM program had available slots, the automated scheduling system referred applicants to the program. Otherwise, applicants were referred to services as usual.
The referral process compromised randomization because new SACM slots always became available in the morning. Thus, in instances of systematic differences between applicants who applied for appointments in the morning and those who applied in the afternoon, the assignment mechanism would not generate equivalent groups. For example, those eager to engage in treatment and return to work could be more likely to show up for scheduling early in the morning. In addition, staff might have known that the probability of assignment to the SACM group was higher in the morning and thus encouraged participants who, in their opinion, needed extra help to show up earlier rather than later. The study authors argue that such probabilities are remote but later present evidence of differences between the groups and acknowledge that the assignment process was not entirely random. Consequently, the integrity of the random assignment process was compromised, and the study was evaluated as a quasi-experimental comparison group design.
Individuals were referred for a substance abuse assessment from June 2003 through June 2005 and followed for 1.5 years.
University Behavioral Associates
The flow of services available to intervention and comparison group members was broadly similar but was more intensive for the intervention group. Clinically oriented program staff, such as psychologists or social workers, conducted a two- to three-hour-long substance abuse assessment to determine the type of substance abuse treatment needed and whether the client was ready to participate in employment-related services. The evaluator then assigned a case manager to the client and referred clients to appropriate substance abuse treatment and other services that addressed clients’ barriers to employment.
Participation in the in-depth assessment and substance abuse treatment was mandatory; failure to attend could result in benefits cancellation. Clients who did not require intensive treatment, and who were therefore nonexempt, were referred to HRA vendors for employment services. Case managers had frequent contact with clients and monitored their participation in treatment and employment services. Case managers remained engaged with clients for the first 30 days after employment, focusing on the clinical status of the client; a retention coordinator oversaw a program that rewarded clients for reaching employment milestones by, for example, giving them an alarm clock or gift certificate.
Clients received the usual services available through HRA’s Substance Abuse Service Center, a preexisting program. Credentialed alcoholism and substance abuse counselors conducted a 45-minute substance abuse assessment and made referrals to treatment. When clients no longer required intensive treatment, they were assigned a caseworker to address eligibility issues and were referred to HRA vendors for employment services. Case management was minimal.
None.