Role of the case management relationship in helping homeless mothers with addictive disorders

Date of Completion

January 2007


Women's Studies|Psychology, Clinical




Homelessness is a complex and pressing social problem, especially since a large subgroup of homeless individuals also have addictive disorders. The present study examined the effect of direct and indirect ratings of working alliance on concurrent and longer-term health outcomes, and measured the moderating impact of racial and age matching between clients and their case managers on the effect of working alliance. This study represented a secondary data analysis of a case management intervention for homeless mothers with addictive disorders. Cases were selected for this investigation if they reported having a case manager at a baseline assessment and if demographic characteristics had been collected on their primary case manager (n=90). Working alliance ratings, demographics, physical health, mental health, and substance-use outcomes were collected at baseline, as well as 3-month, 9-month, and 15-month interviews. Relationships between baseline variables and the working alliances were analyzed, as well as the effect of the working alliance on health outcomes over time. Finally, the moderating effect of racial and age matching was considered. The overall effect of working alliance by itself on subsequent physical and mental health and substance use outcomes was negligible. However, the interaction between age and racial matching with working alliance appeared to influence clients' health outcomes over time. In racially matched dyads, high direct working alliance was associated with self-reported improvements in overall physical health as well as for more specific components of physical health (i.e., role limitations and vitality). When clients and case managers were age-matched, low indirect working alliance ratings were associated with better substance abuse outcomes, and when racially matched, better social functioning. This contrast between the direct and indirect measures as well as the key importance of the interaction effects, indicate a need to examine working alliance ratings in the context of the role of race and age matching between clients and case managers for women who have physical health, mental health, or substance use concerns. These findings have important implications for programs seeking to help homeless mothers with addictive disorders to help manage and improve their physical health, mental health, and substance use. ^