Gabriel

WA State DSHS Division of Behavioral Recovery and Health (DBHR)in conjunction with

UW School of Medicine, Triumph Treatment Services, Grant County PARC, New Horizon Care Centers, Spokane Reservation, Drug and Alcohol Prevention Center, Skagit Recovery Center, First Step Family Support Center, and Agape Unlimited.

Therese M. Grant, Ph.D.Washington State PCAP Director

The Washington State Parent Child Assistance Program (PCAP)

King, Pierce, Yakima, Spokane, Grant, Cowlitz, Skagit, Kitsap and Clallam Counties

The ProblemThe Problem

·

Possible effects of prenatal exposure on the child’s health

·

Likelihood of a compromised home environment

·

Likelihood that these mothers will have more exposed, affected children

These problems are costly to society and are completely preventable

Maternal alcohol and drug use puts children at risk because of

ParentParent--Child Assistance ProgramChild Assistance Program

An intensive, 3An intensive, 3--year paraprofessional year paraprofessional home visitation program for the highest home visitation program for the highest

risk alcohol and/or drug abusing mothers risk alcohol and/or drug abusing mothers

To prevent future births of alcohol and drug exposed

children

Primary Goal:

ParentParent--Child Assistance ProgramChild Assistance Program

History of PCAP

1991-95

Federally funded research: Seattle

1996-98

Philanthropist provides interim funding

1996-97

Governor funds replication in Tacoma

1997-98

Follow-up study, original cohort: Seattle

1997-11

State funding in nine WA counties

Since 1998 Replications/adaptations: MN, NC, AK, TX, NV, LA, PA, MI, CA, Canada , NZ

Yakima

Grant

Skagit

Pierce

Cowlitz

Spokane

Clallam

KingKitsap

PPAARREENNTT--CCHHIILLDD AASSSSIISSTTAANNCCEE PPRROOGGRRAAMM ((PPCCAAPP)) University of Washington School of Medicine

Therese Grant, Principal Investigator Cara Ernst, Program Evaluator

Washington State Department of Social and Health Services

Division of Behavioral Health and Recovery (DBHR) Funded through June, 2011 WA State Institutional Review Board

PIERCE COUNTY

KING COUNTY

UNIVERSITY OF WASHINGTON

FETAL ALCOHOL AND DRUG UNIT

TRIUMPH TREATMENT SERVICES

YAKIMA COUNTY

COWLITZ COUNTY

DRUG AND ALCOHOL PREVENTION CENTER

GRANT INTEGRATED SERVICES

PREVENTION AND RECOVERY CENTER

GRANT COUNTY

SPOKANE COUNTY

NEW HORIZONS CARE CENTERS AND

SPOKANE RESERVATION

Contractual Partnerships

Housing: - CPC/Willows Housing - Plymouth Housing

Housing: -Inter-Community Housing

SKAGIT COUNTY

SKAGIT RECOVERY CENTER

HHIISSTTOORRYY OOFF PPCCAAPP

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KITSAP COUNTY

CLALLAM COUNTY

AGAPE UNLIMITED

FIRST STEP FAMILY SUPPORT

CENTER

Housing:

- Phoenix House Longview Housing Authority, Building Changes

Contractual Partnership

1997 and 1998: Drug Strategies, Washington D.C. Policy Research Institute, cites PCAP as an award-winning intervention.

January 2004: National Healthy Mothers, Healthy Babies Coalition awards State and Community Impact Honorable Mention to PCAP for work with alcohol and drug-dependent mothers.

August 2004: Substance Abuse and Mental Health Services Administration (SAMHSA) presents PCAP a 2003 Exemplary Substance Abuse Prevention Award.

PCAP National Recognition

Theoretical Framework of the Intervention

Relational TheoryA woman’s sense of connectedness to

others is central to her growth, development, definition of self.

InterventionLong term, positive interpersonal relationship with advocate

Relational Theory

•

have experienced some of the same adverse life circumstances as clients, but seldom to same degree

•

have subsequently achieved success in important ways

•

are positive role models and offer clients hope and motivation from a realistic perspective

• 2-4 yrs. social services experience and minimum AA degree required

PCAP Advocates

“I've lived through the things they've been through, so I'm not afraid or

intimidated. I've lived with domestic violence. For someone to tell a client in a domestic violence situation to just up and go, it’s not that easy.

There are lots of plans to think about. I understand when someone says, 'I can't just leave

right now.' But I can help plan a strategy, because I've lived it.”

— PCAP Advocate

Theoretical Framework

Stages of ChangeClients will be at different stages of readiness for change. Motivation is a process for change that occurs within the context of interpersonal relationships.

InterventionMotivational Interviewing

•

acknowledge client’s perception of situation•

encourage her to explore + and –

aspects

Theoretical Framework

Harm ReductionAddiction and associated risks are on a continuum. The goal is to reduce harmful consequences of the habit for mother and her child.

InterventionAny steps toward decreased risk are steps in the right direction.

PCAP Enrollment Criteria

1)

Used alcohol/drugs heavily during pregnancy

2)

Not effectively engaged with community resources

3)

Are currently pregnant, up to six months postpartum

-or-Have delivered a child with a diagnosis of FAS/E

Client Characteristics

At Enrollment WA PCAP SitesN=817

Mean age (yrs) 26.5

Unmarried 91%

Mean # of children(including target child)

2.7

Mean # of children living w/client .35

Client Characteristics

At Enrollment WA PCAP SitesN=817

Years of education 11.00

History of domestic violence

76%

Ever jailed 75%

Client CharacteristicsSubstance Abuse During Target

PregnancyWA PCAP Sites

N=817

Any Alcohol 51%

Binge Alcohol 32%

Methamphetamine 54%

Cocaine 34%

Opiates (including Oxycodone) 15%

Marijuana 55%

Cigarettes 82%

Client Characteristics

At Enrollment WA PCAP SitesN=817

Has had psychiatric evaluation 54%

Of those evaluated, were diagnosed 46%

Of those with known diagnoses

Mood disorder 81%Stress/anxiety/panic disorder 50%Personality disorder 13%

Psychotic disorder 3%

Most of our clients were themselvesabused or neglected as children

At Enrollment WA PCAP SitesN=817

One/both parents used alc/drugs 92%

Client’s mom used alcohol during pregnancy w/client 19%

Experienced physical abuse as a child 47%

Experienced sexual abuse as a child 60%

CPS involvement as a child 26%

Advocate

Community Service Providers

Clients & Families

PCAP: A Two-Pronged Approach

Five Functions of PCAP Advocacy

Assessment: determine client’s strengths, weaknesses, needs

Planning: develop specific service plans

Linking: connect client/family to services

Monitoring:

continuous evaluation of progress

Advocacy: intercede on behalf of client and children

PCAP Incorporates These Characteristics

Community Providers

Juvenile Justice

Probation

Alc/DrugTx

Mental HealthTx

Health Care

FamilyPlanning

Job Training

Schools

Bio Dad

Room-mates

Friends

Partners

Neighbors

ExtendedFamily

Caretakers

Children

CPS

Siblings

PCAP Administrative Strategies

•

Individual weekly supervision

•

Weekly group staffing

• Training: pre-service, in-service, and continuing education

• Biannual evaluation feedback

Core Components of the Intervention (DBHR-contracted)

PCAP is a three year home visitation model, implemented by well trained and closely

supervised advocate/case managers.

Caseload recommendation is 15 to 16

active client families per advocate.

Core Components of the Intervention

• Clients are not asked to leave the program because of relapse or setbacks.

• To facilitate an effective service plan, advocates develop and coordinate a network of contacts with family, friends, and providers involved in a client’s life.

• Clients define and evaluate personal goals every four months, which advocates coordinate with program goals.

Core Components of the Intervention

• Advocates link clients with appropriate and available community services.

• Advocates work with both mother and target child regardless of custody issues, and provide advocacy for other family members as needed.

• A minimum of twice monthly individual supervisions and group staffing meetings are recommended.

• Advocates are required to submit completed evaluation instruments according to PCAP protocol.

IT WOULD MAKE A DIFFERENCE IN MY

LIFE IF I HAD:

MORE EDUCATION

IT WOULD MAKE A DIFFERENCE IN MY

LIFE IF I HAD:

MORE EDUCATION

IT WOULD MAKE A DIFFERENCE IN MY

LIFE IF I HAD:

MORE EDUCATION

IT WOULD MAKE A DIFFERENCE IN MY

LIFE IF I HAD:

HELP WITH CHILDCARE

IT WOULD MAKE A

DIFFERENCE IN MY

LIFE IF I HAD:

BIRTH CONTROL

IT WOULD MAKE A

DIFFERENCE IN MY

LIFE IF I HAD:

DRUG AND ALCOHOL

TREATMENT

The Difference Game

• Identify the “baby”

steps it will take to reach each goal

• Make sure at least some of these baby steps are attainable in the 4-month period.

• The client MUST observe herself succeeding in order for her to move along to new Stages of Change.

The Difference Game

The Formula for Preventing Alcohol/Drug Exposed Births

•

Motivate women to stop drinking or using drugs before and during pregnancy

-OR –

• Help women who can’t stop drinking

or using drugs to avoid becoming pregnant

PCAP is Evidence-Based

Published Outcomes

1999:

Intervention with high-risk alcohol and drug-abusing mothers: II. 3-year findings from the Seattle model of paraprofessional advocacy.

Journal of Community

Psychology, 27(1), 19-38.

2003: Post-program follow-up effects of paraprofessional intervention with high-risk women who abused alcohol and drugs during pregnancy.

Journal of Community

Psychology, 31(3), 211-222.

2005: Preventing alcohol and drug exposed births in Washington State: Intervention findings from three Parent-Child Assistance Program sites.

American

Journal of Drug and Alcohol Abuse, 31(3): 471-90.

Other PCAP Publications

• 2009: Alcohol use before and during pregnancy in Western Washington, 1989-2004: Implications for the prevention of fetal alcohol spectrum disorders. American Journal of Obstetrics and Gynecology, 200(3):278e1-8.

• 2008: Suicide attempts among adults with fetal alcohol spectrum disorders: Clinical considerations. Mental Health Aspects of Developmental Disabilities, 11(2):33-41.

• 2006: Neonatal cranial ultrasound leads to early diagnosis and early intervention in baby of alcohol-abusing mother. Mental Health Aspects of Developmental Disabilities, 9(4), 125-127.

• 2005: Quality of Life and Psychosocial Profile Among Young Women With Fetal Alcohol Spectrum Disorders. Mental Health Aspects of Developmental Disabilities, 8(2), 33-39.

• 2004: A pilot community intervention for young women with fetal alcohol spectrum disorders. Community Mental Health Journal. 40(6), 499-511.

• 2003: Intervening to prevent prenatal alcohol and drug exposure: The Manitoba experience in replicating a paraprofessional model. Envision: The Manitoba Journal of Child Welfare 2(1), 1-12.

• 2002: Benefits and challenges of paraprofessional advocacy with mothers who abuse alcohol and drugs and their children. Zero to 3. 23(2):14-20.

Treatment & Abstinence Outcomes

3-Year Outcomes WA State PCAP

Follow up rate

Inpatient or outpatient tx complete or in progress

Abstinent at exit for ≥

6 moAbstinent at exit for ≥

1 yr

Longest abstinence in PCAP ≥

1 yr Longest abstinence in PCAP ≥

2 yrs

84%

90%

48%41%

65%36%

3-Year Outcomes WA State PCAP

Family planning at intakeFamily planning at exit

-

More reliable method

Subsequent alc/drug exposed birth

10%65%52%

13%

Family Planning Outcomes

Income & Custody Outcomes

3-Year Outcomes WA State PCAP

Main income employmentAt intakeAt exit

Main income welfareAt intakeAt exit

Custody of target child at exitBio motherOther familyFoster careAdopted

3%28%

55%33%

64%15%11%8%

Good things happen when communities implement effective programs and states implement strong

policy.

Systems Working Together

Division of Alcohol & Substance Abuse

(DASA)

Increased treatment beds for women: 55 to 149 (1991 -

2003)

Systems Working Together

The PCAP Model Maintains Project Fidelity

• Monitor quality control• Evaluate program• Demonstrate consistent positive outcomes • Build acceptance, recognition in community• Participate in community task forces

PCAP continues to …..

PCAP is cost effective and saves Washington State

taxpayer dollars.

Reduced Dependence On Child Welfare System Reduced Dependence On Child Welfare System = Reduced Costs to the Public= Reduced Costs to the Public

At PCAP exit, 58 mothers who at enrollment were not caring for/living with any of their previous children, had cared for/lived with their PCAP child throughout the 3-year program.

For every month a PCAP child is not in foster care, the state avoids at least $1,000 in costs.

State foster care costs avoided = $2,088,000.

Fewer Alcohol & Drug Affected Births = Reduced Costs to the Public

112 recent PCAP graduates were using a reliable family planning method at program exit (tubal ligation, IUD, regular Depo Provera injections or Norplant implant).

The average cost for a Medicaid mother's prenatal care, delivery, and postpartum care ($7,949) and her infant’s first year of medical care ($7,168) = $15,117.

If each of these mothers had delivered just one more child, perinatal and first year infant medical costs alone would = $1,693,104.

43

Reduced Involvement with the Criminal Justice System = Reduced Costs to the Public

$10,000$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Costs if originalsentence imposed

Actual costsbecause of PCAP

Coststo the Public

Amount Saved: $77,644

8 Months Home Electronic

Monitoring $3,625

$18,000 18 mo. Foster Care$63,269 18 mo. Medium Security Prison$81,269

Example of Cost Savings

$80,000$90,000

“Before PCAP I never thought about goals.

They showed me the right direction. They showed me that I am responsible. That no matter who I am or what I do,

I am somebody. It is never too late.”

--

PCAP Client at Graduation