debra j. rog, phd vanderbilt university july 31, 2006
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Examining the Impact of Multifaceted, Short-term Interventions for Homeless Families: Substance Abuse Findings from the CMHS/CSAT Homeless Families Program. Debra J. Rog, PhD Vanderbilt University July 31, 2006. Presentation Overview. Describe the SAMHSA Homeless Families Program - PowerPoint PPT PresentationTRANSCRIPT
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Examining the Impact of Multifaceted, Short-term Interventions for Homeless
Families:
Substance Abuse Findings from the CMHS/CSAT
Homeless Families ProgramDebra J. Rog, PhD
Vanderbilt University
July 31, 2006
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Presentation Overview
Describe the SAMHSA Homeless Families
Program
Highlight the substance abuse needs of the
participating mothers and the outcomes of
their participation in the interventions
Discuss the policy implications of the results
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SAMHSA Homeless Families Program Initiative
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Impetus for the Initiative
Families comprise a significant segment of the homeless population
Research indicates a portion of the population has mental health, trauma, and/or substance abuse disorders
Virtual absence of descriptive or empirical research on interventions for homeless families
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Structure of the Initiative
14 sites
Conduct Site Process Evaluation
Design Cross-Site Study
8 sites
Conduct Cross-Site Outcome Study
Conduct Site-Specific Studies Conduct Program Ingredients Study
Began in October 1999
Phase I (2 years) Phase II (3 years)
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Cross-site Research Questions
Are comprehensive, intensive, time-limited, multi-site interventions more effective than other treatment alternatives in:
Decreasing psychological distress?
Improving trauma recovery?
Decreasing substance use/abuse?
Improving residential stability?
Improving the general well-being of children?
Improving other outcomes, including health, resources, and parenting?
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Are there consistent key dimensions of the interventions that appear to be positively associated with the outcomes?
-----------------------------------------------
What individual-level factors are associated with change?
Are there different identifiable patterns of change among the families on the outcomes?
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Time limited (up to 9 mos)
Multi-faceted intervention
Mental health treatment
Substance abuse treatment
Trauma recovery
Securing and maintaining housing
Parenting skills
Household and money management
Goal setting
“Treatment as
Usual”
Alternative
treatment
approach
Basic Intervention
Approach
Comparison Intervention Approaches
Nature of the Interventions
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Homeless Families Interventions
Site Target Intervention Comparison
Phoenix, AZ (Randomized)
Enhanced Intensive Case Management, Motivational Interviewing
Shelter Treatment as Usual
Wake County, NC Intensive Case Management with Wrap-around Services
Traditional Case Mgmnt with link to services
Connecticut* Intensive Care Coordination Treatment as Usual
Westchester, NY (Randomized)
Family Critical Time Intervention and Housing Apt Program
Shelter as Usual
Capital District, NY Modified Critical Time Intervention
Services as Usual
St. Louis, MO (Randomized)
Multi-dimensional Family Assistance
Outreach Intensive Case Management
Worcester, MA Comprehensive Family Health Practice
Treatment as Usual
Philadelphia, PA* Enhanced Family Therapeutic Community & Aftercare
Standard Family Therapeutic Community & Aftercare
*Target Primarily SA
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Substance Abuse Service Program Emphasis
Measured whether there was:
SA training for staff designated SA staff a limited or full array of SA services on site
A 4-level ordinal measure was developed for each:
0 – None - no services or staff on site 1 – Low - two or less of the ingredients at
limited/low 2 – Med - having designated staff, training, some
level of on -site services
3 – High - staff, training, full array of services
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Study Approaches Designs
Mix of randomized and non-randomized studies
Family Recruitment/Intervention Site
Shelters were most common site
Other settings include transitional and permanent housing, family health center, residential treatment center
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Participant Eligibility Criteria
Families who:
Currently are homeless
Have at least 1 child 1.5 - 16 years old
Have mothers screened to have MH and/or SA issues
1573 families in cross-site baseline sample
1467 (93%) with baseline and at least 1 follow-up
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Demographic Background & Substance Abuse Service
Needs
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Demographics
Average Age 31 years (range 18 - 61)
Marital Status Varies by site: 6% - 26% currently married
Ethnicity Varies by site Range: 2 - 47% Hispanic/Latina
Disproportionately African American (49% - 85% in 6 sites)
Education 44% lack HS diploma/GED
Employment 96% have a work history 14% working
Pregnant 14% currently pregnant
MOTHER CROSS-SITE (n=1572)
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Family Composition
Average of 2-3 total children in families
Currently 1-2 children (under age 18) living with them
31% of children are under age 5
9% of mothers are currently living with a partner
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310
7
3
42
26
5
61
33
4
22
10
3
24
19
3
16
15
112
10
012
3
0
20
40
60
80
100
%
CDNY(n=239)
CT(n=203)
PA(n=227)
AZ(n=219)
MO(n=147)
NC(n=176)
WNY(n=188)
MA(n=157)
Substance Abuse History% reporting ever treated for substance abuse
Alcohol Drug Alcohol & Drug
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6
13
4
3
35
14
3
47
46
6
33
9
12
25
12
2
17
11
5
14
1
112
2
0
20
40
60
80
100
%
CDNY(n=239)
CT(n=203)
PA(n=227)
AZ(n=219)
MO(n=147)
NC(n=176)
WNY(n=188)
MA(n=157)
% Reporting Current Substance Abuse
Alcohol Use to Intoxication Illegal Drug Use Alcohol Use to Intoxication AND Illegal Drug Use
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Effectiveness of the Target Interventions
Key Outcome Results
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Alcohol Use Drug Use
Overall Significant ImprovementOver Time (B, 3, 9, 15) √ √
Differential ChangeTx vs. Control N N
Significant Individual Level Predictors of Change (HLM results) Positive
Drug historyRace
Employment Employment
Staff Support
Negative Recurring trauma
SA services receipt
Recurring trauma
Conflict
1 or more children away
SA Services receipt
Outcome SummaryTreatment vs. Comparison Intervention Results
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Alcohol Use Drug Use
Overall Significant ImprovementOver Time (B, 3, 9, 15) √ √
Change Related to Emphasis on Substance Abuse Treatment N Y
Significant Individual Level Predictors of Change (HLM results) Positive
Alcohol history
Employment Employment
Negative Recurring trauma
1 or more children away
SA services receipt
Recurring trauma
Conflict
1 or more children away
SA Services receipt
Outcome SummaryProgram Emphasis Results
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Examining Patterns of Change in Outcomes
Key Outcome Results
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Patterns of Change Over Time
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Patterns of Change Over Time
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Summary of Findings No target intervention effect on the substance
abuse outcomes (or other treatment outcomes)
Lack of intervention differences may be due to:
Low contrast between treatment and control interventions
Benefits of even low threshold treatment
Variation of service receipt within groups and confounding of problems and service receipt
Ability to obtain services outside the program
Too short a period of intervention to be effective
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Summary of Findings Encouraging, though tentative evidence for on-site substance
abuse services
Poorer outcomes associated with:
Ongoing conflict and trauma
Having children away [trauma and SA outcomes]
Self-report on service receipt (most likely a proxy for
severity of the problem)
Having a job is related to more positive outcomes
Trajectory analyses typically one core group is accounting for
most of the change on an outcome
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Implications of the Findings Findings suggest that shelter providers and other
homeless service providers should:
Screen for substance abuse conditions, among others
Provide on-site or easy access to services in these areas
Actively work with women who are continuing to experience violence to change their life circumstances
Incorporate conflict resolution strategies and interventions to strengthen a women’s ability to avoid relationships that continue to victimize her