Restructuring services for drug abusing TANF women

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DESCRIPTION (provided by applicant): Federal legislation in the mid 1990s related to social welfare programs, including welfare reform, was arguably the most important policy development in recent times to impact substance abuse treatment services for low-income Americans. Over the last 8 years, our work has focused on two broad issues: one policy and one scientific as well as the intersection between them. From a policy perspective, we developed a strong and ongoing partnership with the New Jersey Department of Human Services (NJDHS) and a myriad of providers to implement a statewide screening and assessment program for AOD clients located in welfare settings and conduct a two-county welfare demonstration project. From a scientific perspective, we have examined whether science-based interventions can be adapted for delivery in routine care settings and lead to improved outcomes as compared to usual care. Results of our randomized clinical trial indicated that intensive case management (ICM) delivered within a welfare setting increased access, engagement, and retention in substance abuse treatment as well as improved outcomes for drug abusing TANF mothers when compared to usual care (UC). This competitive continuation R01 proposes to take two next important steps in this line of research to provide policy-makers and scientists with crucial information needed for dissemination: 1) conducting an economic evaluation of ICM including a cost of illness study and cost benefit study; and 2) increasing adoption of evidence-based practice by examining the effectiveness of ICM as delivered in a real-world setting. Methods to accomplish these aims include analysis of cost data collected as part of the earlier trial, collection of additional administrative data on clients from the original trial, recruiting and following for 9 months a new sample of TANF women with substance use disorders, and collecting administrative data on the newly recruited sample. Results from this study should guide dissemination of this promising intervention.