Efficacy of ecologically-based treatment with substance-abusing homeless mothers: Substance use and housing outcomes

Abstract

This randomized pilot study tested the efficacy of an integrative treatment targeting homeless substance abusing mothers with young children in their care. Sixty mothers with 2–6 year old children were recruited from a local family shelter. The mothers were randomly assigned to Ecologically-Based Treatment (n = 30) or treatment as usual (n = 30). The intervention group received 3 months of rental and utility assistance up to $600 per month, case management services, and substance abuse counseling (referred to as supportive services). The treatment as usual group received housing and services through the family shelter and community housing programs. All participants completed follow-up assessments at 3, 6, and 9 months post-baseline. Mothers receiving Ecologically-Based Treatment showed a quicker decline in alcohol frequency and a quicker increase in housing stability. Furthermore, with supportive services, two-thirds of women were successful in maintaining their apartments 6 months after rental assistance ended.

Effect of Case Management Interventions for Patients with Substance Use Disorders: A Systematic Review

“…Seven publications showed better global functioning, which was described as more employment days (25, 31, 35). This was further differentiated in Morgenstern et al’s study of 2008 (29), which showed that women were more likely than men to find employment when assisted by CM, to have fewer legal (21, 35) and family problems (21), and to have better housing stability (32). Lindahl et al measured very high patient satisfaction with the treatment and 100% treatment retention compared to TAU (23).…”

“…Substance use decreased in only five papers (20, 22, 23, 27, 32), but treatment adherence and linkage between health-care providers seemed to improve in most surveys, which is an important issue for this population and one of the main aims of CM. Overall functioning improved in more than half of the studies, which is in general linked to higher life satisfaction.…”

“…In some studies, the population had SUD and no further differentiation was made, whereas other studies considered specific subgroups such as patients in methadone programs (27), women with SUD (22, 31, 32), and participants with court judgments who were either incarcerated or in court-ordered treatments (23, 28, 30). Most studies were done in the United States, except for the one by Prendergast et al (28) in Canada and Lindhal et al (23) in Sweden.…”

“…Surprisingly, the importance of comorbid mental health disorders or high service use was not defined as an inclusion criterion in most studies. Slesnick and Erdam’s study (32) included only homeless mothers, and Morgenstern et al’s studies (22, 29, 31) analyzed patients receiving welfare [in one study (22), only women were included]. Only Essock et al’s study (20) used high service use, severe comorbid mental health disorder, unstable housing, and poor living skills as inclusion criteria.…”

“…Five studies showed that substance use decreased (20, 22, 23, 27, 32), two papers (22, 26) showed that the likelihood of initiating SUD treatment increased, and four publications (22, 23, 27, 33) showed greater treatment retention when a case manager was involved in treatment. Four studies (23, 24, 33, 34) showed improved access to health care and/or linkage between health-care providers.…”