Intensive Case Management Improves Abstinence and Employment among Substance Dependent Women Receiving Temporary Assistance for Needy Families

Women with substance use disorders (SUDs) receiving Temporary Assistance for Needy Families (TANF) have high rates of co-occurring mental health and social problems and experience severe and persistent barriers to employment. Researchers examined 2-year differences in abstinence and employment outcomes among 302 women with substance dependence receiving TANF. Participants were randomized into 2 groups: usual care (screening and referral to treatment with limited outreach if patients failed to attend the first treatment session), and intensive case management (ICM) (a manual-guided intervention involving identification of barriers to treatment, assistance getting into and during treatment, coordination of needed services, weekly meetings with a case manager, and incentive vouchers for attending treatment).

• Although the usual care group had higher rates of employment than the ICM group during the first year, this relationship reversed in year 2, with the rate of improvement significantly higher over time in the ICM group.
• The mean abstinence rate across 24 months was also significantly higher in the ICM group (47%) than in the usual care group (24%).
• At 24 months, abstinence was higher among ICM participants who were working (3 of 5) compared with participants in the usual care group (1 of 3).

Comments by Norma Finkelstein, PhD, LICSW
This study provides support for those who advocate that ongoing treatment is critical to successful employment outcomes for women with SUDs. In addition, ICM appears to yield significantly better outcomes in both abstinence and employment for this population. Most government agencies providing financial assistance offer limited screening and treatment referral for clients with SUDs, usually with limited success. These results demonstrate that more intensive interventions can significantly improve employment outcomes in this group.