Study Details | Pathways to Work

28567.03-Study of Project Hou

Study quality: Low

Low

Reason for the rating: This study received a low study quality rating because the implementation of the randomized controlled trial was compromised and it does not adjust estimated impacts for potentially important differences between the program and comparison groups.

Program: Project Housing and Alcohol Research Team (Project H&ART)—Case Management, Substance Use Counseling, Plus Housing with Peer Support (as compared with Referrals to Substance Use Treatment and Transportation Assistance)

Characteristics of study participants:

Homelessness, Substance use disorder

Services provided:

Case management, Housing supports and subsidies, Job search assistance, Mental health services, Peer mentoring, Soft skills training, Treatment or recovery services for substance use disorder

Setting: Urban only

Methods and Standards Protocol version used for review: Version 1.0

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Study design

Design:

Randomized controlled trial

Study group formation:

Once potential participants completed drug and alcohol detoxification, they received a baseline assessment by research staff to determine their eligibility for the study. Participants (known to be experiencing homelessness and to have substance use disorders at intake) were deemed eligible if they had lived in or near Albuquerque, NM, for three months or more, did not have serious disabilities, and had no dependent children. Once they were determined eligible, participants were randomly assigned to one of three study groups. The program condition reviewed here was provided throughout the study duration. Due to implementation challenges with the initial comparison condition that provided housing assistance without peer support, however, the no-housing comparison group condition was not introduced until eight months after the first participant was randomly assigned. At this point, research staff made the decision to only assign females (approximately 13 percent of the study sample) to one of two study conditions (the program condition reviewed here or another study condition) to ensure they received housing. The analyses do not further adjust for differing probabilities of random assignment to the study conditions over time and by gender.

Time period of study:

April 1991 to December 1993

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

Sample characteristics

Age

Mean age

37 years

Sex

Female	13%
Male	87%

Race and ethnicity

White, not Hispanic	41%
Hispanic or Latino of any race	31%
American Indian or Alaska Native	18%
Unknown, not reported, or other	10%

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.

Employment and public benefit status

Were employed	50%
Were unemployed	50%

Specific employment barriers

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

Program implementation

Implementing organization:

The Lovelace Medical Foundation in collaboration with Albuquerque's Health Care for the Homeless (HCH) Clinic in partnership with St. Martin's Hospitality Center (SMC)

Program services:

The treatment condition of case management, substance use counseling, plus housing with peer support provided high-intensity services to adults who were experiencing homelessness and had alcohol use disorders. Participants must have lived in or near Albuquerque, NM, for three months or more. Participants in the program condition could not have serious disabilities or dependent children. All program group participants successfully completed a detoxification from alcohol at a residential treatment facility between 2 and 10 days before beginning services. Services were subsequently provided in two phases, each lasting two months. In the first phase, participants housed in Project H&ART residences received group- and individual-level therapy (one to two sessions per week), art therapy, psychodrama, and group education classes in a nearby office building. The program also provided recreational events weekly. These intensive activities were scheduled from 9 a.m. to 3 p.m., five days per week. Program participants were also required to attend Alcoholics Anonymous or Narcotics Anonymous meetings once a day. In the second two-month phase, program group participants primarily received case management designed to encourage them to search for employment and to develop other soft skills, including those used in social and domestic settings. During this phase, individual counseling was continued, and participants met with case managers as often as needed. Program group participants received free housing along with peer support from residence managers who were also recently recovering from alcohol dependence.

Mandatory services:

None

Comparison services:

The comparison condition of referrals to substance use treatment and transportation assistance provided low-intensity services to adults who were experiencing homelessness and had alcohol use disorders. Participants must have lived in or near Albuquerque, NM, for three months or more. Participants could not have serious disabilities or dependent children. Comparison group participants were referred to local and statewide alcohol treatment services, were paid bus fare to these facilities, and were paid to provide data on their use of health services at biweekly check-ins with program staff. The comparison condition began operating in December 1991, about eight months after the first study participant was randomized. This replaced a housed comparison condition that was terminated due to implementation issues and limitations in the unsupervised service delivery model.

Study publications

Lapham, Sandra, Marge Hall, and Betty Skipper (1996). Homelessness and substance use among alcohol abusers following participation in Project H&ART, Journal of Addictive Diseases (14): 41-55. Available at https://www.tandfonline.com/doi/abs/10.1300/J069v14n04_03.

Lapham, Sandra, Marge Hall, Marsha McMurray-Avila, and Harry Beaman (1993). Albuquerque's community-based housing and support services demonstration program for homeless alcohol abusers, Alcoholism Treatment Quarterly (10): 139-154. Available at https://www.tandfonline.com/doi/abs/10.1300/J020V10N03_12.

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

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Study of Project Housing and Alcohol Research Team (Project H&ART)—Case Management, Substance Use Counseling, Plus Housing with Peer Support versus Referrals to Substance Use Treatment and Transportation Assistance