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CHAPTER 13
NEED FOR ADDITIONAL SERVICES AND CO-OCCURRING BARRIERS ACROSS PROBLEM DOMAINS
This chapter examines the need for services in addition to substance abuse treatment and barriers to employment across problem domains reported in earlier chapters. Figure 13.A reports on need for services in the five areas: medical, mental health, family, employment, and legal problems. Women were categorized as needing service in these areas if interviewers rated them as such on the need for service rating scale. Over half (52%) of non-affected women were rated as not requiring additional services, 42% were reported as requiring services in one problem area (typically employment), and 6% were rated as requiring services in two problem areas. By contrast, only 10% of substance abusing women were rated as needing no additional services beyond addiction treatment. About 26% were rated as needing two additional services and 35% were rated as needing three or more services.
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| [D] |
Danziger and colleagues (2000) have developed an approach to assess barriers to employment across problem domains. Their approach identifies barriers to employability in a variety of domains and then sums those barriers to create a barriers index. In their study, a greater number of barriers was strongly associated with women not being employed. We developed a similar set of barriers across different areas using the Danziger approach. Table 13.A reports the percent of women with barriers in 12 areas. Barriers included: education (less than a high school education); low work experience (unemployed past 3 years and no job skills); housing (homeless in past 90 days); transportation (severe transportation problems); childcare (severe childcare problems); physical health (fair or poor health and scoring in the lowest quartile compared to US adult population); child's physical health (child become seriously ill in past year); legal (ever arrested); mental health-depression (current depression diagnosis); mental health-PTSD (current post traumatic stress disorder diagnosis); domestic violence (severe physical domestic violence); and child welfare (current child welfare investigation).
| Substance abusers |
Non-affected Sample |
|
|---|---|---|
| Education | 56 | 43 |
| Low work experience | 50 | 26 |
| Housing | 25 | 13 |
| Transportation | 40 | 10 |
| Childcare | 16 | 14 |
| Physical health | 14 | 16 |
| Child's physical health | 12 | 15 |
| Legal | 56 | 15 |
| Mental Health - depression | 45 | 9 |
| Mental Health - PTSD | 20 | 3 |
| Domestic Violence | 38 | 13 |
| Child welfare | 34 | 13 |
Next we summed the number of barriers to create an index from 0-12. Figure 13.B reports the percent of women experiencing different numbers of employment barriers. Non-affected women experienced significantly fewer barriers than substance abusers: 51% experience none or one barrier, 31% experienced two or three barriers, 15% experienced four or five barriers, and 3% experienced six or more barriers. About 12% of substance abusers experienced none or one barrier, 30% experienced two or three barriers, 32% experienced four or five barriers, and 26% experienced six or more barriers.
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| [D] |
Overall, substance abusers experienced the need for additional services in multiple domains beyond just substance abuse treatment. The majority required services in at least two additional domains and about one in three required services in three or more domains. In addition, both groups reported barriers to employability. For non-affected women, the most prevalent barriers were in the areas of education and work experience. The majority of non-affected women reported having up to three barriers to employment. Substance abusers reported significantly more barriers. The most prevalent barriers for substance abusers were in the areas of legal, educational, work experience, mental health, and transportation. The majority of substance abusers experienced four or more employment barriers not counting their substance abuse problems.
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