Comprehensive services for women and children may improve treatment outcomes.
Evaluations conducted before and after PRWORA find that substance abuse treatment is associated with improved work outcomes among welfare recipients. These improvements reflect both increased employment and increased earnings among clients who find employment. Studies have recognized time spent in treatment as the most important predictor of improved work and welfare outcomes. More recent studies have recognized treatment completion as being another important predicto (Metsch et al., 2003), (Wickizer et al., 2000).
Women with substance use disorders often experience multiple barriers to employment and job retention and therefore require multi-faceted interventions. These multiple and complex challenges fit uneasily into a vision of time-limited public aid. Most welfare-to-work programs emphasize acquisition of job search skills and rapid employment.
CASAWORKS for Families provides one example of a multi-faceted intervention for substance-using TANF recipients. The program combines substance abuse treatment, work-related services (including work readiness and vocational training), mental health, parenting services, and case management to integrate services. Additional services available through case management include medical care, childcare, transportation, shelter, and clothing assistance. This and similar programs are designed to address multiple barriers and problems by integrating the efforts of many social service agencies to deliver comprehensive, concurrent services. Pilot demonstration data from 10 CASAWORKS sites suggest that 12 months of comprehensive, concurrent services, with treatment as core, would reduce substance abuse and improve work, family, and social functioning (Turner et al., 2006), (Morgenstern et al., 2003), (McLellan et al., 2003).
Current TANF rules and authorizing legislation constrain the length of time substance abuse treatment can count towards state work participation rates. As a component of job search and job readiness assistance, such services are limited to six weeks per fiscal year (with a 12-week overall time limit applying to designated "needy states"), of which no more than four weeks can be consecutively provided. How effective treatment is best provided within these constraints remains a challenge for both clinicians and policymakers (Dohan et al., 2005).