CRA AND ENHANCED JOB TRAINING FOR HOMELESS WOMEN

妇女和家庭现在约占无家可归人口的30%，她们被视为增长最快的亚群体。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，但女性进入并停留在这些项目中的比率远远低于男性。一些人认为，只有当女性的问题得到解决，或者当她们有以男性为主的项目以外的其他选择时，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，因此将实施一项全女性方案，利用一种经过修改的治疗方案，以考虑到妇女问题。99名酗酒或酗酒的无家可归妇女将被随机分配到三种情况之一：病例管理(CM)、社区强化方法(CRA)或名为Create(社区强化、就业和培训加强)的增强型CRA计划。调查一个CM项目被认为是必要的，这既是因为它受到广泛的欢迎，也是因为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，并在最新的荟萃分析综述中被列为最具成本效益的治疗方法。在最近对无家可归人口的成功应用中，为一小部分女性参与者检测到了有希望的初步结果。然而，有两个明显的限制。首先，相当多的妇女在她们的治疗和在禁欲条件下的免费住房的逗留结束后复发。因此，目前的提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(例如性侵害)。第二个问题是治疗后的高失业率。作为回应，该项目将通过一个以经验为基础的应急管理(代金券)方案向Create小组提供基本的计算机技能培训，该方案被证明能够提高工作培训的出勤率。创造条件还将接受被称为系统鼓励的激励性CRA程序，以提高工作培训出勤率，并使工作环境成为一个加强的社区。据预测，与CM相比，两种CRA条件都将导致酒精使用、就业和住房稳定性的显著改善，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.