Study Details | Pathways to Work

28503-Cognitive behavioral

Study quality: Low

Low

Reason for the rating: This study received a low study quality rating because it did not use a method for addressing missing data that is known to limit bias.

Intervention: Cognitive Behavioral Day Treatment Plus Abstinence-Contingent Housing, Vocational Training, and Work

Population and employment barriers:

Specific employment barriers (Homelessness, Substance use disorder)

Services provided:

Case management, Financial incentives, Health services (Substance use disorder treatment and mental health services), Soft skills training, Supportive services, Training, Work readiness activities

Setting: Urban only

Study design

Design:

Randomized controlled trial

Study group formation:

All intervention participants were recruited from a federal health care center in Birmingham, AL, from November 2001 to June 2004. To qualify for program enrollment, applicants had to meet the following criteria: (1) be experiencing homelessness; (2) have a cocaine dependence (with reported cocaine use over the past 2 weeks serving as the proxy); (3) be experiencing psychological distress (as measured by the Brief Symptom Inventory); (4) participate voluntarily; and (5) plan to stay in Birmingham, AL, for the next 18 months. Two hundred and six applicants met these criteria, and 103 were subsequently assigned each to the intervention condition and the comparison condition. Individuals were randomly assigned to the two intervention conditions with equal probabilities.

Time period of study:

Researchers followed study participants for 18 months after random assignment.

Pathways only reports results from studies with a study quality rating of high or moderate.

Sample characteristics

Age

Mean age

40 years

Sex

Female	28%
Male	72%

Participant race and ethnicity

Black or African American	95%
White, not Hispanic	5%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Specific employment barriers

Had a substance abuse disorder	100%
Were experiencing homelessness	100%

Intervention implementation

Implementing organization:

University of Alabama at Birmingham, Department of Psychology; Birmingham Healthcare

Intervention services:

The intervention condition provided paid employment training up to $5.25 an hour, daily cognitive behavioral treatment, and six months of abstinence-contingent housing to people experiencing homelessness and cocaine dependence in Birmingham, AL. Participants were transported from study-provided housing to job training, job interviews, and work sites. Participants who failed a drug or alcohol test (administered three times weekly) were relocated to a shelter or other housing and lost their program stipend; they could return to abstinence-contingent housing and had a chance to re-earn their stipend after three consecutive negative urine tests. Throughout the intervention, participants received cognitive behavioral therapy focused on completing behavioral assessments, setting treatment goals, and reviewing and revising those goals throughout the intervention period. During the six-month active treatment phase, participants received an initial job-readiness assessment and computer and office training in a computer training lab, followed by training focused on job search, interviewing, and job retention skills. Participants received an additional 12 months of aftercare treatment and post-treatment follow-up after the 6-month active treatment phase.

Mandatory services:

None

Comparison services:

The comparison condition also provided 6 months of abstinence-contingent housing and paid employment training up to $5.25 an hour to people experiencing homelessness and cocaine dependence in Birmingham, AL. This was followed by up to 12 months of aftercare treatment and post-treatment follow-up. However, comparison group participants did not receive the extensive cognitive behavioral treatment received by participants in the intervention group.

Study publications

Milby, Jesse. B., Joseph. E. Schumacher, Dennis Wallace, Rudy Vuchinich, Stephen T. Mennemeyer, and Stefan. G. Kertesz (2010). Effects of sustained abstinence among treated substance abusing homeless persons on housing and employment, American Journal of Public Health 100(5): 913-918. Available at https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2008.152975.

Milby, Jesse. B., Joseph. E. Schumacher, Rudy Vuchinich, Michelle J. Freedman, Stephen G. Kertesz, and Dennis Wallace (2008). Towards cost effective initial care for substance abusing homeless, Journal of Substance Abuse Treatment 34(2): 180-191. Available at https://www.sciencedirect.com/science/article/pii/S0740547207000864.

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The Pathways Clearinghouse refers to interventions by the names used in study reports or manuscripts. Some intervention names may use language that is not consistent with our style guide, preferences, or the terminology we use to describe populations.

Study of Cognitive Behavioral Day Treatment Plus Abstinence-Contingent Housing, Vocational Training, and Work