Study Details | Pathways to Work

3118-Study of Intensive C

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a low-attrition randomized controlled trial with no known issues that suggest the findings cannot be attributed to the intervention.

Intervention: Intensive Case Management (ICM) for Women with Substance Dependence Receiving Temporary Assistance for Needy Families (TANF)

Population and employment barriers:

Public Benefits Recipients (Cash assistance recipients, Public benefits recipients), Specific employment barriers (Substance use disorder)

Services provided:

Case management, Performance- or behavior-based financial incentives, Treatment or recovery services for substance use disorder

Setting: Urban only

Study design

Design:

Randomized controlled trial

Study group formation:

Eligible study participants were women with substance dependence who met criteria for a substance-dependence diagnosis (using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Participants also had to be eligible for TANF and in the New Jersey welfare-to-work program without a medical deferral, able to speak English, not diagnosed as psychotic, not receiving or seeking methadone treatment, not seeking long-term residential treatment, and not consistently engaged in substance abuse treatment. Eligible study participants were randomly assigned to the intensive case management intervention group or the usual care comparison group.

Time period of study:

The study followed participants for two years after enrollment.

Primary outcome domains examined:

Increase long-term employment

Other outcome domains examined:

Substance use

Study funded by:

National Institute on Drug Abuse (Grant Number 5 R01 DA12256), ACF, the Assistant Secretary for Planning and Evaluation (Grant Number 90XP0002), and the New Jersey Department of Human Services.

Results

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Outcome domain	Measure	Timing	Study quality by finding	Impact	Units	Findings	Sample size
Increase long-term employment	Ever employed, monthly	Month 24	High	3.00	Percentage points		294

Short-term outcomes are those measured 18 months or fewer after participants are first offered services. Long-term outcomes are those measured between 18 months and 5 years after participants are first offered services. Very long-term outcomes are those measured 5 years or more after participants are first offered services.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the intervention. We do not display findings that rate low.

Findings key:

A moderate-to-large favorable finding that is unlikely to be due to chance
A moderate-to-large favorable finding that might to be due to chance
A small favorable finding that is unlikely to be due to chance
A small favorable finding that might be due to chance
A favorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
A favorable finding that might be due to chance, but we cannot determine the standardized effect size
A moderate-to-large unfavorable finding that is unlikely to be due to chance
A moderate-to-large unfavorable finding that might to be due to chance
A small unfavorable finding that is unlikely to be due to chance
A small unfavorable finding that might be due to chance
An unfavorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
An unfavorable finding that might be due to chance, but we cannot determine the standardized effect size
A finding that is unlikely to be due to chance, but we cannot determine the standardized effect size or direction
A finding of no effect that might be due to chance

Favorable findings are impacts in a direction that is socially desirable. Statistical significance indicates the likelihood that a study finding is due to the intervention, rather than due to chance. Findings are described as moderate-to-large if the intervention produced a sufficiently large change in the outcome. An impact receives this designation if the standardized effect size is equal to or greater than 0.25 or equal to or less than -0.25.

Sample characteristics

All participants were women receiving TANF who screened positively for substance-use dependence. Most (96 percent) were Black, and 3 percent were Hispanic. The average age was 36. About half (48 percent) of participants had graduated from high school, and 4 percent were married at the time of random assignment.

Age

Mean age

36 years

Sex

Female

100%

Participant race and ethnicity

Black or African American	96%
Hispanic or Latino of any race	3%
Unknown, not reported, or other	1%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Family status

Married

Participant employment and public benefit status

Public benefits recipients	100%
Cash assistance recipients	100%

Participant education

Had a high school diploma or GED	48%
Did not have a high school diploma or GED	52%

Specific employment barriers

Had a substance abuse disorder

100%

Intervention implementation

Implementing organization:

New Jersey Department of Human Services (NJDHS) Division of Family Development, which administered TANF

Program history:

The program did not exist before the start of this study.

Intervention services:

Women enrolled in TANF who had substance dependence received intensive case management and vouchers to support their participation in substance use disorder treatment. Intensive case management involved working with case managers who identified barriers to entry into substance use disorder treatment and addressed those barriers. While participants were in treatment, case managers met with participants weekly and coordinated with treatment facility staff to provide other needed services. Participants received vouchers for items such as children's toys or cosmetics as an incentive to participate in treatment.

Mandatory services:

None

Comparison services:

Women receiving TANF who had substance dependence were assigned to the comparison group (the usual care group). A clinical care coordinator screened and referred them to substance use disorder treatment. Participants who failed to attend treatment received minimal follow-up outreach.

Service receipt duration:

Participants received case management services throughout the 24-month follow-up period.

Intervention funding:

National Institute on Drug Abuse, ACF, the Assistant Secretary for Planning and Evaluation, and the New Jersey Department of Human Services.

Study publications

Morgenstern, J., C.J. Neighbors, A. Kuerbis, A. Riordan, K.A. Blanchard, K.H. McVeigh, T.J. Morgan, and B. McCrady (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. doi:10.2105/AJPH.2007.133553. Available at https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2007.133553.

Morgenstern, J., K.A. Blanchard, B. McCrady, K.H. McVeigh, T.J. Morgan, and R.J. Pandina (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. Available at https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2005.076380.

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The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Intensive Case Management (ICM) for Women with Substance Dependence Receiving Temporary Assistance for Needy Families (TANF)