Characteristics of Individuals Screening Positive for Substance Use in a Welfare Setting: Implications for Welfare and Substance-Use Disorders Treatment Systems

Abstract

Objective-This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol-and drug-use problems.Method-A representative sample (N = 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work.Results-Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as "severe" and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing.Conclusions-Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems.During the 1990s, welfare reform and other legislation dramatically altered the availability of social safety net benefits for individuals with substance-use disorders (SUDs; Schmidt et al., 1998). One important change that occurred as part of welfare reform was the *

Does Coordinated Care Management Improve Employment for Substance-Using Welfare Recipients?

“…in this second study, we compared coordinated care management (ccM) with the referral and monitoring activities of usual care (uc) within the human Resources administration. in a first study reporting on suD treatment participation and abstinence outcomes for this sample, we found that ccM was more effective than uc, except for clients receiving methadone maintenance at baseline (Morgenstern et al, 2009a).…”

“…Days of employment were assessed using a structured interview measuring the number of days worked since the previous assessment time point. the interview, previously used in the multisite employment Retention and advancement (eRa) evaluation of innovative welfare programs for hard-to-employ populations sponsored by the Department of health and human services, is a state-of-the-art measure of employment outcomes in welfare-to-work evaluations (MDRc, 2008). at each follow-up assessment, participants were asked to recall how many days since the last interview they were paid for working on the books, off the books, in full-time jobs, or in part-time jobs.…”

“…the 421 clinical trial participants were assigned either to ccM (a continuity-of-care intervention focused on engaging clients in drug treatment, linking them directly to needed ancillary services, and fostering transition to employment) or uc (a screen-and-refer intervention focused on assessing clients for substance use and related problems and referring needy clients to community services). For a full description of study recruitment, assessment procedures, and outcomes see Morgenstern et al (2009a). of the 421 participants, 27 (6%) did not provide data at any follow-up time point (1, 3, 6, and 12 months), leaving 394 participants (221 ccM, 173 uc) included in current study analyses.…”

“…they met with clients annually for recertification or whenever a noncompliance issue arose. a full description of the two conditions is provided in Morgenstern et al (2009a).…”

“…specifically, intensive case management yielded significantly higher levels of suD treatment engagement as well as higher rates of abstinence and employment at 24 months following program entry (cf. Morgenstern et al, 2003Morgenstern et al, , 2006Morgenstern et al, , 2009b.…”