Debra J. Rog, PhD Vanderbilt University July 31, 2006

1. 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

2. 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

3. SAMHSA Homeless Families Program Initiative

4. 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

5. Structure of the Initiative • Began in October 1999 Phase II (3 years) Phase I (2 years) 8 sites • Conduct Cross-Site Outcome Study • Conduct Site-Specific Studies • Conduct Program Ingredients Study 14 sites • Conduct Site Process Evaluation • Design Cross-Site Study

6. 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?

7. 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?

8. Nature of the Interventions Basic Intervention Approach Comparison Intervention Approaches • 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

9. Homeless Families Interventions *Target Primarily SA

10. 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

11. 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

12. 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

13. Demographic Background & Substance Abuse Service Needs

14. Demographics MOTHER CROSS-SITE(n=1572) 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

15. 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

16. Drug Alcohol & Drug Alcohol Substance Abuse History% reporting ever treated for substance abuse

17. Illegal Drug Use Alcohol Use to Intoxication AND Illegal Drug Use Alcohol Use to Intoxication % Reporting Current Substance Abuse

18. Effectiveness of the Target InterventionsKey Outcome Results

19. Outcome SummaryTreatment vs. Comparison Intervention Results

20. Outcome SummaryProgram Emphasis Results

21. Examining Patterns of Change in OutcomesKey Outcome Results

22. Patterns of Change Over Time

23. Patterns of Change Over Time

24. 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

25. 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

26. 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