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Objective. We tested the effectiveness of a long-term coordinated care strategy-intensive case management (ICM)-compared with usual care (UC) among a group of substance-dependent women receiving Temporary Assistance for Needy Families (TANF).
Methods. Substance-dependent women on TANF (N = 302) were recruited from welfare offices. They were assessed and randomly assigned to ICM or UC; follow-up was at 3, 9, and 15 months. UC consisted of a health assessment at the welfare office and a referral to substance abuse treatment and TANF services. ICM clients received ICM services in addition to UC services.
Results. ICM clients had significantly higher levels of substance abuse treatment initiation, engagement, and retention compared with UC clients. In some cases, ICM treatment attendance rates were double those of UC rates. Additionally, almost twice as many ICM clients were abstinent at the 15 month follow-up compared with UC clients (P<.0025).
Conclusions. ICM is a promising intervention for managing the chronic nature of substance dependence among women receiving TANF. Future research should refine long-term care strategies-such as ICM-that address the chronic nature of substance dependence among low-income populations. (Am J Public Health. 2006;96:2016-2023. doi:10.2105/AJPH.2005.076380)
Substance abuse is a national health problem that creates serious personal impairment and major social and economic burdens. Addressing substance abuse among low-income mothers may be especially important because of its impact on children, who face a much greater risk for becoming substance abusers themselves.1-3 Additionally, the combination of substance abuse and poverty fuels an intergenerational pattern of severe personal and social dysfunction that creates barriers to resolving substance use disorders.4
Substance abuse is a highly stigmatized behavior. Stigma and concealment issues are especially pronounced among low-income mothers, who may fear loss of welfare benefits or involvement with child protective services if they provide accurate reports about their substance use.5 Thus, accurate data on prevalence rates of substance abuse among low-income women are lacking; however, studies have consistently found that low-income women have significantly higher rates of illicit drug use and substance abuse compared with the rates of other women.6-8 Additionally, recent studies that used self-reports of women on Temporary Assistance for Needy Families (TANF) have yielded rates of substance dependence (alcohol and illicit drugs) that range from 5% to 11%, with an additional 5% to 8% engaged...