Evaluation of EBT With Young, Substance Abusing Homeless Mothers
Condition: Substance Use
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      A dearth of information is available regarding how best to intervene with substance use
      disordered homeless mothers and their young children. This proposal follows from the
      promising findings of a rigorously developed ecologically based treatment that offers a
      comprehensive intervention for the multiple needs of this vulnerable population. Such
      research attention is needed in order to effectively intervene in the substance use, HIV
      risk, mental/physical health and homeless trajectory of these women and their young children.
      Further, if successful, this intervention may be transportable to communities without crisis
      shelters and to homeless mothers who do not access shelter or residential treatment services.
    

Detailed description: 
      Homeless mothers with young children in their care contend with high rates of substance use,
      HIV risk, physical and mental health problems and parenting stress. These struggles are in
      addition to homelessness and meeting the basic needs of themselves and their children.
      However, a very limited number of studies have examined mother and child outcomes associated
      with housing and supportive services. Even with increased focus on those experiencing
      homelessness, the number of homeless families continues to rise, with the demand for
      temporary shelter so high that many cities are unable to meet the needs of these families. A
      comprehensive intervention that can be offered outside the shelter setting may offer greater
      reach to those experiencing homelessness who do not make it in to the shelter system, and for
      those communities that do not have shelters available. Among the young homeless, those under
      age 25, research documents that the majority (70%) have never used shelter services. Research
      attention towards identifying efficacious interventions for this population which address the
      multiple needs of these families is thus considered an important focus. The proposed
      intervention (Ecologically-Based Treatment, EBT) includes housing and supportive services and
      utilizes an ecological systems approach as the theoretical base. It was rigorously developed
      in a Stage 1 treatment development study with substance use disordered homeless mothers who
      were engaged through a crisis shelter. EBT showed several outcomes superior to shelter
      services and is therefore considered a good fit for a population who avoids the shelter but
      is in great need of housing and support services. Two hundred forty (N = 240) substance use
      disordered homeless young women between the ages of 18 to 24 years with a biological child
      under the age of 6 years in their care will be randomly assigned to one of three conditions:

        1. housing and support services (EBT) + Treatment as Usual (TAU) (N = 80),

        2. housing only (HO) + TAU (N = 80), or

        3. TAU only (N=80).

      EBT includes 6 months of supportive services (case management, HIV prevention and the
      Community Reinforcement Approach) in addition to 3 months of rental assistance. HO includes 3
      months of rental assistance, but without supportive services. TAU is usual services offered
      by a homeless youth drop-in center. Participants will be re-assessed at 3, 6, 9 and 12 months
      post-baseline. Theoretically derived mediators of change as well as a formal economic
      evaluation will offer important policy implications. Since homeless substance use disordered
      mothers and their children are at increased risk for a variety of adverse outcomes, the
      intervention may produce substantial health-care benefits to their families and society at
      large.
    

Intervention name(s): Ecologically Based Therapy; Housing Only; Treatment as Usual
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): 6 months of community reinforcement approach and case management, 3 months of rental assistance for housing; receives 3 months of project supported rental assistance; receives services as normally offered within the community
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment