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The Parent–Child Assistance Program (P–CAP), formerly known as the Seattle (Wash.) Birth to 3 Program, is a paraprofessional home visitation model for extremely high-risk substance–abusing women. The program uses a case-management approach and concentrates not only on reducing alcohol and drug use but also on reducing other risk behaviors and addressing the health and social well-being of the mothers and their children. Advocates are paraprofessionals who have experienced many of the same adverse circumstances as their clients and can therefore serve as positive role models.
The goals of the program are to 1) assist mothers in obtaining treatment, maintaining recovery, and resolving the complex problems associated with their substance abuse, 2) guarantee that the children are in a safe environment and receiving appropriate health care, 3) effectively link families with community resources, and 4) demonstrate successful strategies for working with this population and thus reduce the numbers of future drug- and alcohol-affected children.
P–CAP does not provide direct alcohol treatment, drug treatment, or clinical services but instead offers consistent home visitation and provides women and their families with a comprehensive array of existing community resources. Paraprofessional advocates have a maximum caseload of 15 families. They visit client homes, transport clients and their children to important appointments, link clients with appropriate service providers, and work actively within the context of the extended family. The intervention lasts 36 months. Advocates visit client homes weekly for the first 6 weeks, then at least once every 2 weeks, depending on client needs, for the duration of the program.
Clients are not required to obtain alcohol or drug treatment to participate, and they are never asked to leave the program because of relapse or setbacks. Advocates trace clients who are missing, stay in contact with clients’ family members, and provide advocacy services for target children regardless of who has custody.
The program was evaluated using an experimental design with a randomized as well as a nonequivalent control group. Hospitalized postpartum women delivering at two urban Seattle hospitals were asked to complete a confidential screening questionnaire. Participants who met the eligibility requirements were randomly assigned to either the treatment or the control group. Referrals of high-risk substance-abusing women were also accepted from local health, social, and welfare agencies. Women recruited from community agencies were considered as a second treatment group and were evaluated in comparison with the hospital-recruited clients.
A total of 2,244 postpartum women, including referrals, completed the screening. After controlling for eligibility requirements, 96 women remained (n=65 treatment and n=31 control). The sample was 48 percent African-American, 29 percent white, 15 percent Native American, and 8 percent other (Hispanic or Asian-American). The control group, which received no services from the program, was evaluated at baseline and 36 months. The two treatment groups were evaluated at 4, 12, 24, and 36 months. Data was collected using a structured interview to obtain information on substance abuse, changes in life circumstances, maternal and child health, and use of community services. The overall effectiveness of the program was assessed using a baseline assessment score and an endpoint assessment score that incorporated five domains: family planning, health and well-being of target child, use of alcohol or drug treatment, abstinence from alcohol and drugs, and appropriate connection with community services at 36 months. The follow-up rate at 36 months was 92 percent for the treatment groups and 83 percent for the control.
A comparison of the treatment group (hospital recruited) and the control group at 36 months shows that the treatment resulted in significantly higher endpoint scores, despite the fact that the control group had more positive scores at baseline. The referred clients also had higher scores than the control group, but the difference was not significant.
Alcohol and drug abstinence rates at 36 months were higher among the treatment group than the control group (28 percent versus 24 percent). A subsample of clients considered most involved with their advocates increases the difference to 53 percent versus 24 percent. The treatment group was also more likely to use birth control than the control groups (73 percent versus 52 percent) and have the appropriate custody of their child (69 percent versus 29 percent). Appropriate custody was defined as either the child being in the custody of a mother who had been in recovery for at least 6 months or the child not being in the custody of the mother who is unable to maintain abstinence. There were no differences between the two groups with regard to the health and well-being of the child. Both client groups were more adequately connected to needed services, compared with the control group. In general, the researchers found the outcomes were better among clients who spent more time with their advocates.
Grant, Therese M., Cara C. Ernst, and Ann P. Streissguth. 1999. “Intervention With High-Risk Alcohol and Drug-Abusing Mothers: 1. Administrative Strategies of the Seattle Model of Paraprofessional Advocacy.” Journal of Community Psychology 27(1):1–18.
Grant, Therese M., Cara C. Ernst, Ann P. Streissguth, Pam Phipps, and B. Gendler. 1996. “When Case Management Isn’t Enough: A Model of Paraprofessional Advocacy for Drug- and Alcohol-Abusing Mothers.” Journal of Case Management 5(1):3–11.
Grant, Therese M., Cara C. Ernst, Ann P. Streissguth, and Paul D. Sampson. 1999. “Intervention With High-Risk Alcohol- and Drug-Abusing Mothers: 3-Year Findings From the Seattle Model of Paraprofessional Advocacy.” Journal of Community Psychology 27(1):19–38.
Therese Grant, Ph.D.
Parent–Child Assistance Program
University of Washington School of Medicine, Fetal Alcohol and Drug Unit
180 Nickerson Street, Suite 309
Seattle, WA 98109
Phone: (206) 543-1631
Fax: (206) 685-2903
E-mail: granttm@u.washington.edu
Web site: http://depts.washington.edu/fadu
Therese Grant, Ph.D.
Parent–Child Assistance Program
University of Washington School of Medicine, Fetal Alcohol and Drug Unit
180 Nickerson Street, Suite 309
Seattle, WA 98109
Phone: (206) 543-7155
Fax: (206) 685-2903
E-mail: granttm@u.washington.edu
Web site: http://depts.washington.edu/fadu
