Many of the families remaining on welfare caseloads face significant barriers to employability. Among the most significant of these is substance abuse. States are struggling to develop innovative strategies to effectively address substance abuse in the context of welfare reform. Some states have attempted to integrate substance abuse treatment into their welfare employment programs, but there are almost no data to guide states about what program features are most effective. One central problem any system will need to address is the difficulties most substance abusers have in entering and remaining in treatment. Studies have consistently demonstrated that those receiving substance abuse treatment have better employment outcomes (Nakashian & Moore, 2000), but it is necessary for clients to remain in treatment in order to achieve these effects (Wickizer et al, in press).
The purpose of this report is to present preliminary findings of a study conducted in New Jersey comparing the rates of entry and retention in substance abuse treatment for two contrasting intervention approaches: Care Coordination and Intensive Case Management. Preliminary findings clearly indicate the benefits of providing intensive case management services over a more limited triage and referral system. Clients referred to substance abuse treatment programs using the Intensive Case Management approach were much more likely to enter substance abuse treatment and were especially more likely to continue attending outpatient treatment sessions.
Care Coordination used a set of strategies similar to those of innovative programs currently being implemented in several states, including New Jersey. Welfare recipients were screened for substance abuse problems by caseworkers in welfare offices. Women screening positive were interviewed in welfare offices by specially trained addiction counselors to determine the need for substance abuse treatment and to coordinate treatment, if needed. Treatment coordination included arranging an initial appointment with a treatment program and subsequent utilization review. The alternative approach, Intensive Case Management, combined several strategies thought to be effective in enhancing substance abuse treatment retention and improving outcomes. In Intensive Case Management, welfare recipients screening positive and needing treatment were assigned to a case management team. In the initial phase of the intervention, case managers identified and attempted to resolve barriers to entering and remaining in treatment. Typically, these involved tangible barriers such as childcare or transportation and psychological barriers such as a client's denial that they needed treatment. In addition, clients in ICM received small incentives in the form of vouchers for attending treatment.