CRA AND ENHANCED JOB TRAINING FOR HOMELESS WOMEN

妇女和家庭目前占无家可归人口的30%左右，她们被视为增长最快的群体。酗酒是他们最普遍的健康问题。不幸的是，尽管有有效的治疗方案，但女性进入并保持在其中的比例远低于男性。一些人认为，只有当女性问题得到解决，或者当她们有其他选择而不是男性主导的项目时，女性才会寻求治疗。由于拟议的研究将试图招募大量无家可归的妇女作为样本，因此将采用一种经过修改的治疗方法进行全女性方案，以考虑到妇女问题。99名酒精依赖或酒精滥用的无家可归妇女将被随机分配到以下三种情况中的一种：案例管理（CM）、社区强化方法（CRA）或称为CREATE（社区强化、就业和培训强化）的强化CRA计划。研究CM计划被认为是必要的，这既是由于它的广泛流行，也是由于它只有不一致的经验支持。行为干预，CRA，已被证明对治疗酗酒者有效，在最近的荟萃分析综述中被列为最具成本效益的治疗方法。在最近对无家可归者的成功应用中，在女性参与者的小样本中发现了有希望的初步结果。然而，有两个限制是明显的。首先，相当多的妇女在她们的治疗和她们在禁欲条件下的免费住房的停留结束后又复发了。因此，目前的建议是试图在这一高风险时期提供善后服务。它还将从一开始就具体解决这些妇女的关键问题（例如性受害）。第二个问题是治疗后的高失业率。作为回应，该项目将通过一个基于经验的应急管理（凭证）计划，为CREATE小组提供基本的计算机技能培训，该计划已被证明可以提高就业培训的出勤率。CREATE条件还将接受称为系统鼓励的激励性CRA程序，以提高就业培训的出勤率，并使工作环境成为一个加强社区。我们预测，与CM相比，两种CRA条件都会导致酒精使用，就业和住房稳定性的显著改善，并且CREATE组将获得优于常规CRA组的就业结果。

Women and families now comprise about 30 percent of the homeless population and they are viewed as the fastest rising subgroup. Alcoholism is their most widespread health problem It is unfortunate, then, that despite the availability of efficacious treatment programs, women enter and remain in them at much lower rates than do men. Some suggest that women will only seek treatment if women's issues are addressed or when they have options other than predominantly male programs. Since the proposed study will attempt to recruit a large sample of homeless women, an all-female program will be conducted utilizing a treatment that has been modified to take women's issues into consideration. Ninety-nine alcohol-dependent or alcohol-abusive homeless women will be randomly assigned to one of three conditions: case management (CM), the Community Reinforcement Approach (CRA), or an enhanced CRA program called CREATE (Community Reinforcement, Employment, and Training Enhancement). It is considered essential to investigate a CM program, both due to its widespread popularity, and the fact that it has only inconsistent empirical backing. The behavioral intervention, CRA, has proven to be efficacious for treating alcoholics and was listed as the most cost-effective treatment in the latest meta- analytic review. In its recent successful application to a homeless population, promising preliminary outcomes were detected for the small sample of female participants. However, two limitations were apparent. First, a considerable number of women relapsed when both their treatment and their stay in the abstinence-contingent, free housing ended. Consequently, the current proposal is an attempt to provide aftercare services during this high-risk period. It also will specifically address critical issues for these women (e.g. sexual victimization) from the start. A second problem was the high rate of unemployment posttreatment. In response, this project will offer basic computer skills training to the CREATE group through an empirically-based contingency management (voucher) program proven to enhance job-training attendance. The CREATE condition also will receive motivational CRA procedures called Systematic Encouragement to bolster job-training attendance and to make the work environment a reinforcing community. It is predicted that both of the CRA conditions will result in significant improvement in alcohol use, employment, and housing stability compared to CM, and that the CREATE group will obtain employment outcomes superior to the regular CRA group.