Program

Aug 26, 2007
OVERVIEW

The Parent-Child Assistance Program (P-CAP) is a paraprofessional visiting, case management, and advocacy program designed to improve the health and social outcomes of high-risk substance-abusing mothers and their children. In a three-year, random assignment evaluation of the program’s effectiveness, mothers assigned to a paraprofessional advocate were compared with mothers not assigned to an advocate on measures of drug/alcohol use, utilization of drug/alcohol treatment, family planning, connection with community services, and health and well-being of children.

Treatment mothers scored higher than control mothers on every measure, but these differences did not reach statistical significance. Treatment mothers were substantially more likely than control mothers to receive a higher overall score and to score in the positive range on at least four of the measures; however, the impact was of borderline statistical significance.

Children of treatment mothers were not any more likely than children of control mothers to have received regular medical care or appropriate immunizations and they scored no higher on a measure of mental and motor skills. Children of treatment mothers were more likely than children of control mothers to be in an appropriate custody situation, however. That is to say, they were more likely to have been removed from the custody of a substance-abusing mother or to be in the custody of a mother who had been in recovery for at least six months.

DESCRIPTION OF PROGRAM

Target population: This program provides long-term paraprofessional advocacy for extremely high-risk mothers who abuse alcohol or drugs heavily during pregnancy and are estranged from community service providers. Advocacy is also provided for these women’s children.

In the Parent-Child Assistance Program, high-risk mothers are matched with paraprofessional advocates who meet with them regularly from the time their children are born until children turn three years old. Serving as advocates are people who have had many of the same types of adverse life experiences their clients have had and who can act as positive role models with an experienced and realistic perspective.

Advocates work with 12-15 clients each. They establish trusting relationships with their clients, motivate clients to make changes in their lives, assist clients in identifying personal goals, and assure that clients follow up on referrals to treatment programs and community services. Advocates do not provide treatment or clinical services to their clients, but instead put them in touch with service providers and transport them to appointments.

The program provides advocacy services for children, regardless of whether or not they are in the custody of their birth mothers. In addition to assisting mothers recover from problems associated with substance abuse, advocates are charged with the responsibility of guaranteeing that children are in a safe environment and receiving appropriate health care.

Cost of the P-CAP program was approximately $3,800 per woman in 1997 dollars.

EVALUATION(S) OF PROGRAM

Ernst, C.C., Grant, T.M., Streissguth, A.P., & Sampson, P.D. (1999). Intervention With High-Risk Alcohol and Drug-Abusing Mothers: II. Three-Year Findings From the Seattle Model of Paraprofessional Advocacy. Journal of Community Psychology, 27(1), 19-38.

Evaluated population: Subjects in the random assignment study were recruited at hospitals in Seattle during the early 1990s. Subjects had used alcohol or drugs heavily during their pregnancy, had little or no involvement with social or health services while pregnant, and had given birth to a single child. After screening out women who did not meet eligibility criteria, 103 women were asked to participate in this study, and 94 accepted the offer. At baseline, mothers were, on average, 27 years old and had completed 11 years of school. 48% of the mothers were African American, 29% were white, 15% were Native American, and 8% were of another ethnic background. 77% of the mothers were single; 83% had public assistance as their source of income; 55% did not have permanent housing; and 80% had been in jail before.

Approach: All women recruited via community referral (n = 35) were assigned to the treatment group and women recruited from hospitals were randomly assigned to either the treatment group or the control group. Results are presented for the random assignment analyses.

Immediately after giving birth, women in the treatment group were assigned to an advocate and were contacted within the week to commence the advocacy program. Advocates met with mothers once a week for six weeks and then bi-weekly (or more frequently) for the next three years, depending on client needs.

All women took part in a 50-minute structured postpartum interview. Follow-up interviews took place at 4, 12, 24, and 36 months after birth. Both parents and children were assessed at each time point. At 36 months, 28 of 30 mothers in the treatment group and 25 of 30 living mothers in the control group provided follow-up data.

Results: Mothers were given a composite score at baseline and at 36 months. This score reflected evaluations on five domains: the mother’s utilization of alcohol/drug treatment, the mother’s abstinence from alcohol and drugs, the mother’s family planning, the mother’s connection with community services, and the health and well-being of the target child.

At 36 months, among hospital-recruited clients in the experimental portion of the study, mothers in the treatment group had substantially higher composite scores than did mothers in the control group; however, differences were of borderline statistical significance. Treatment group mothers scored higher than control mothers on each of the five domains, but none of these differences reached statistical significance.

Non-experimental analyses found that, to a great extent, treatment mothers who were the most involved with their advocates reaped the greatest benefits from the program. Highly-involved mothers were more likely to complete inpatient drug/alcohol treatment, more likely to have abstained from alcohol/drug use for a large portion of the intervention period, and more likely to be using a reliable method of birth control.

Analyses of child outcomes were conducted for children in the project and are not experimental. With that caveat, comparisons indicate that children differed very little with regard to having a regular doctor, being seen for well-child visits, and receiving appropriate immunizations. Children whose mothers were assigned an advocate were more likely than children whose mothers were not assigned an advocate to be in an appropriate custody situation, however. The researchers defined “appropriate custody” as a child being in the custody of a mother who had been in recovery for at least six months or a child not being in the custody of a mother who was unable to maintain abstinence from drugs and alcohol. Only 29% of children whose mothers were not assigned an advocate were in appropriate custody situations, whereas 69% of children whose mothers were assigned an advocate were.

SOURCES FOR MORE INFORMATION

Program information can be found at: http://depts.washington.edu/fadu/FADU.projects.html#B23P

References:

Ernst, C.C., Grant, T.M., Streissguth, A.P., & Sampson, P.D. (1999). Intervention With High-Risk Alcohol and Drug-Abusing Mothers: II. Three-Year Findings From the Seattle Model of Paraprofessional Advocacy. Journal of Community Psychology, 27(1), 19-38.

Program categorized in this guide according to the following:

Evaluated participant ages: 0-3

Program age ranges in the guide: early childhood

Program components: home visiting, parent or family component

Measured outcomes: physical health

KEYWORDS: High-Risk, Substance Abuse, Alcohol Use, Illicit Drug Use, Physical Health, Social/Emotional Health, Mental Health, Child Development, Parenting, Counseling/Therapy, Gender Specific (Female-Only), African American or Black, Native American or American Indian, White or Caucasian,Home Visiting, Parent or Family Component, Early Childhood (0-5), Healthcare.

Program information last updated on 8/26/07