Restructuring services for drug abusing TANF women

描述(申请人提供)：20世纪90年代中期与社会福利计划相关的联邦立法，包括福利改革，可以说是近年来影响低收入美国人药物滥用治疗服务的最重要的政策发展。在过去的8年里，我们的工作集中在两个广泛的问题上：一个是政策，一个是科学，以及它们之间的交集。从政策的角度来看，我们与新泽西州公共服务部(NJDHS)和众多提供商建立了强有力的持续合作伙伴关系，以实施全州范围的AOD服务对象筛选和评估计划，并开展两个县的福利示范项目。从科学的角度来看，我们研究了以科学为基础的干预措施是否可以适应常规护理环境中的提供，并导致与常规护理相比改善结果。我们的随机临床试验结果表明，与常规护理(UC)相比，在福利环境下提供的强化病例管理(ICM)增加了药物滥用治疗的可及性、参与度和保留率，并改善了药物滥用TANF母亲的结局。这一竞争性延续R01建议在这一研究领域采取下两个重要步骤，为政策制定者和科学家提供传播所需的关键信息：1)对ICM进行经济评估，包括疾病成本研究和成本效益研究；2)通过检查在现实世界环境中提供的ICM的有效性，增加对循证实践的采用。实现这些目标的方法包括分析作为早期试验的一部分收集的成本数据，从原始试验收集关于客户的额外管理数据，招募并跟踪患有药物使用障碍的TANF妇女的新样本9个月，以及收集关于新招募样本的管理数据。这项研究的结果将指导这一有希望的干预措施的传播。

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.