One-year outcomes from the CASAWORKS for Families intervention for substance-abusing women on welfare
Drug and alcohol addictions continue to pose serious public problems for the nation, particularly in the areas of crime, overutilization of expensive health services, lost productivity, and welfare costs. The percentage of individuals receiving welfare with diagnosable substance-abuse disorders has ranged from 2% to 37% in various studies. There is general consensus that these individuals will be among the last to exit the welfare rolls.
The purpose of this study was to evaluate the CASAWORKS for Families (CWF) intervention, developed by the National Center for Substance Abuse and Addiction (CASA) at Columbia University and implemented in 11 sites across the country. The CASAWORKS demonstration project was designed to reduce alcohol and drug use among substance-abusing women receiving welfare and increase independence through employment.
Using a recruitment process, 11 sites were selected from a pool of more than 30 applicants. Three sites were located in California, and one each in the states of Maryland, Missouri, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, and Tennessee. Five sites were located within urban cities, two were located in suburbs, and the others were in small towns.
The study sample consisted of 962 women referred to one of the 11 demonstration sites, of whom 673 were determined to be eligible for services. The mean age was 32 years, 38% were white, 48% African-American, and 12% Hispanic.
Repeated measures included the Addiction Severity Scale, a structured interview related to problem areas (health, transportation, finances, etc.), and six- and 12-month follow-up interviews regarding employment status. Data analysis used mixed-effects models to describe in-treatment change. These models comprise fixed effects, describing the average change over time, and random effects, describing the components of variation about that average pattern of change. For continuously distributed linear mixed-effects models were used, and for binary responses generalized linear mixed-effects models.
The CWF model is a multifaceted integrative intervention strategy designed to assist recipients of TANF achieve stable employment and self-sufficiency by overcoming substance abuse and other major barriers to work. The core services of the intervention were focused on substance abuse, employment (work readiness, vocational training, and basic education), domestic violence, and parenting training. Additional as-needed services were physical health, mental health, and assistance with basic needs such as child care, transportation, shelter, and clothing.
There was no control or comparison condition. The study used a pre/during/post intervention design.
Because of time limits on the evaluation, only the first 529 clients from 10 sites had an opportunity to be followed at least 12 months. Retention was relatively high in comparison to similar programs; 81%of those enrolled were still in the intervention at the 1-month point, 61% were enrolled at 3 months, 51% were enrolled at 6 months, and 38% were enrolled at 9 months. Significant improvements in drug and alcohol use were seen at the 6- and 12-month follow-ups. There were significant improvements in employment and earnings from baseline to 6-month follow-up and from 6-month to 12-month.
Although the authors note that it cannot be certain that the generally favorable results seen in this formative evaluation were actually caused by the intervention, the findings are quite consistent with the underlying CWF model under which the interventions were conceived, delivered, and evaluated. In addition, there is evidence that the intervention was appropriate for and attractive to the target population. These initial findings offer a compelling rationale for continued development and evaluation of the CWF model.
