Does coordinated care management improve employment for substance-using welfare recipients?

This study tested whether coordinated care management, a continuity of care intervention for substance-use disorders, improved employment among men and women on public assistance compared with usual welfare management.

Participants were 421 welfare applicants identified via substance-use-disorder screening and assigned via a computerized allocation program to coordinated care management (CCM; n = 232) or referral and monitoring practices in usual care (UC; n = 189). Substance use, treatment attendance, job training and search activities, and employment outcomes were assessed for 1 year after baseline.

Men were more likely to be working than women overall. Among women, CCM clients increased their employment over time, whereas UC clients remained stable at very low employment levels. There were no treatment effects on employment for men. Also among women only, greater substance-use-disorder treatment attendance and abstinence in the first 6 months of CCM predicted higher rates of later employment. Job training activities were low and did not differ by condition between either gender.

Findings are consistent with previous research supporting the effectiveness of case management for improving abstinence, which leads to employment gains, among substance-using women on public assistance. In contrast, various mandated elements of welfare-to-work programs for substance users-treatment attendance, case management, job training-did not improve employment rates for men. Implications of study results for designing effective welfare-to-work interventions in a post-welfare-reform era are discussed.