The present application focuses exclusively on evaluating the effectiveness of a culturally-relevant, community-based CRA (Community Reinforcement Approach) enhancement to an existing residential treatment program for homeless, crack-using women with children. The proposed study builds on the research team's prior work and experience in developing and evaluating community-based interventions for the homeless and behavioral treatments for cocaine abusers. The proposed research would be the first randomized clinical trial to assess the effectiveness of CRA without vouchers, and the first to implement CRA through the natural helping network of the African-American church community which will provide mentors and culturally-relevant and spiritually-based group activities. One hundred and seventy two cocaine-abusing African-American women who enter Hutchinson Place, a community-based residential treatment facility for homeless women with children, will be randomly assigned to one of two conditions: 1) standard treatment (Control Group); or 2) standard treatment plus the CRA adjunct (Experimental Group). The standard treatment involves providing six months of comprehensive on-site treatment services activities tailored to homeless substance abusing women with preschool age children who reside together in the program. The groups will be assessed at baseline, and at 3, 6, 9, and 12 months post-entry on treatment retention, urinalysis-verified abstinence, HIV risk behaviors, treatment engagement, mood, self-esteem, motivation, social network, family and social relations, residential stability, economic status, social ties to the community, religious behavior, satisfaction with treatment, and parent functioning. In addition, children's behavior and developmental status will be evaluated at these assessment points. Based on our pilot study and other prior work, we believe that this CRA adjunct represents a unique, replicable, culturally-relevant, and potent intervention for this difficult to treat and understudied population. By using the church--a powerful, culturally relevant institution in the African-American community--as a vehicle for implementing CRA, we are taking a first step in the long-term goal of adapting this highly effective behavioral treatment for use in the community.
| Stahler, Gerald J; Kirby, Kimberly C; Kerwin, MaryLouise E (2007) A faith-based intervention for cocaine-dependent Black women. J Psychoactive Drugs 39:183-90 |
| Kerwin, Marylouise E; Walker-Smith, Katherine; Kirby, Kimberly C (2006) Comparative analysis of state requirements for the training of substance abuse and mental health counselors. J Subst Abuse Treat 30:173-81 |
| Stahler, Gerald J; Shipley Jr, Thomas E; Kirby, Kimberly C et al. (2005) Development and initial demonstration of a community-based intervention for homeless, cocaine-using, African-American Women. J Subst Abuse Treat 28:171-9 |
