Gabriel

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

University of Washington, Evergreen Recovery Centers, Triumph Treatment Services, New Horizon Care Centers, Family Health Center, Brigid Collins Family Support Center, First Step Family Support Center, Agape Unlimited, Community

Services Northwest, Connections ~ A Center for Healthy Families, Family Education and Support Services, Pacific Treatment Alternatives, Elijah Family Homes, and

Pathways to Enlightened Parenting

http://depts.washington.edu/pcapuw/

Washington State Parent Child Assistance Program (PCAP)

King, Pierce, Yakima, Spokane, Cowlitz, Skagit, Clallam, Kitsap, Clark, Grays Harbor/Pacific, Thurston/Mason, Whatcom, Snohomish,

Benton/Franklin and Chelan Counties

The 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 preventable

Maternal alcohol and drug use puts children at risk because of

An intensive, 3-year home visitation and

case management program

for high risk women who abuse

alcohol/drugs during pregnancy

Serving nearly 1,300 families in eighteen WA State counties

Over 40 PCAP sites located in other states and Canada

Parent-Child Assistance Program (PCAP) 1991- present

To help mothers…

Complete substance abuse treatment, stay in recovery

Build healthy family lives

Prevent future alcohol/drug exposed births

Parent-Child Assistance Program

Primary Aims:

History of PCAP

1991-95 Federally funded research: University of Washington

1996-97 Philanthropist provides interim funding

1996-97 Governor funds replication site in Tacoma

Since 1997 State funding, now in eighteen WA counties

Since 1998 Replications in U.S.: MN, NC, AK, TX, NV, LA, PA, MI, CA. International: 40 sites in Canada

PCAP COUNTY SITES

2012: Best Practice by federal Association of Maternal & Child Health Programs (AMCHP)

2010 , 2013, 2014: California Evidence-Based Clearinghouse for Child Welfare (CEBC)

2005, 2010: Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Model Programs Guide

August 2004: Substance Abuse and Mental Health Services Administration (SAMHSA) Exemplary Substance Abuse Prevention Award

1997 and 1998: Drug Strategies, Washington D.C. Policy Research Institute

PCAP National Recognition

What do we know about mothers who abuse alcohol and drugs?

An Intergenerational CyclePCAP mothers are repeating the patterns they grew up with

N=773

One/both parents abused alcohol/drugs 90%

Sexually abused as a child 56%Child welfare involved 31%Ran away as a child 63%Didn’t finish high school 37%

History of domestic violence 71%

The PCAP Model

Offers long-term outreach and engagement to clients

Is based on relational theory, motivational interviewing, harm reduction concepts

Provides structured goal setting, family support, and consistent coaching

The PCAP Model

Case Managers B.A. degrees, highly trained, closely supervised Have caseloads of 16 families Conduct home visits 2x /month for 3 years Connect families with comprehensive community

services, coordinate services, transport as necessary

Are role models who inspire hope

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Washington State PCAP

PCAP Annual Work Session

PCAP Conceptual Framework

Relational Theory: Positive, nonjudgmental interpersonal relationships within the intervention and recovery settings are critical. “Having a person to talk to who really cares.”

Stages of Change/ Motivational Interviewing: Clients will be at different stages of readiness for change. Helping clients motivate for change is a process that occurs within the context of interpersonal relationships.

Harm Reduction: Any steps toward decreased risk are steps in the right direction. Clients are not asked to leave the program because of relapse or setbacks.

Stages of Change

From Prochaska, J. O., Norcross, J. C., & DiClemente, C. C., (1994). Changing for good. New York: William Morrow Company

Maintenance

Relapse

ContemplationDetermination

/ Planning

Action

Permanent Exit

Pre-contemplation

Self-Efficacy

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An individual’s belief in her/his ability to accomplish the behaviors required to produce

desired outcomes.

A client’s expectations about self-efficacy are influenced most powerfully

by her own history of accomplishment.

Functions of PCAP Case Management

Assess: Determine client’s strengths, needsPlan: Help client develop goals and incremental

steps to meet goalsRole Model: Teach, demonstrate, practice, give

feedbackLink: Connect client/family to servicesAdvocacy: Coordinate with other service providers,

intercede on behalf of client and childrenMonitor: Regularly evaluate progress

When Case Management Isn’t Enough: PCAP Two-Pronged Approach

Case Manager

Community Service ProvidersClients & Families

Family Planning

Community Providers

Job Training

Schools

CPS

Alc/Drug Tx

Juvenile Justice

Probation

Mental Health Tx

Health Care

Characteristics of Effective Case Management

Client

Children

Partner

Friends

ExtendedFamily

NeighborsRoom-mates

Care-takers

Siblings

Bio Dad

PCAP Enrollment Criteria

1) Currently pregnant, or up to twelve months postpartum; and

2) Used alcohol/drugs heavily during pregnancy; and

3) Not effectively engaged with community resources

Client Characteristics

At Enrollment WA PCAP SitesN=806

Age (mean yrs) 26.8

Unmarried 91%

# of children (mean) (including target child)

2.5

# of children living w/client (mean) 0.4

Client Characteristics

At Enrollment WA PCAP SitesN=806

Years of education (mean) 11.3

History of domestic violence 71%

Ever jailed 74%

Client Characteristics

Substance Abuse During Target Pregnancy

WA PCAP SitesN=806

Any Alcohol 42%

Binge Alcohol 22%

Methamphetamine 66%

Cocaine 12%

Heroin 35%

Marijuana 55%

Cigarettes 81%

Client Characteristics

At Enrollment WA PCAP SitesN=806

Has had psychiatric evaluation 58%

Of those evaluated, were diagnosed 51%

Of those with known diagnoses

Mood disorder 82%Stress/anxiety/panic disorder 70%Personality disorder 12%Psychotic disorder 3%

IT WOULD MAKE A DIFFERENCE IN MY

LIFE IF I HAD:

MORE EDUCATION

Learning the Client’s Story: The Difference Game

Journal of Contemporary Human Services, 78(4): 429–432

Talk about what you learned in the Difference Game

Identify a goal that is realistic, manageable Break the goal into small steps that are attainable

and that you both will take.

Self-efficacy is about

helping clients accomplish steps successfully.

Reinforce every step in the right direction.

Identify Goals & “Baby Steps” to reach each goal.

PCAP Administrative Strategies

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

Individual weekly or biweekly supervision

Weekly group staffing

Biannual evaluation feedback

PCAP Evidence Base

Published PCAP Outcomes2014: Improving pregnancy outcomes among high-risk mothers who

abuse alcohol and drugs: Factors associated with subsequent exposed births. Children and Youth Services Review, 46: 11-18.

2011: Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not. Children and Youth Services Review, 33, 2176-2185.

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.

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.

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.

Substance Abuse and Mental Health Services Outcomes

3-Year Outcomes WA State PCAP(N = 1056)

Follow-up rate

Inpatient or outpatient tx completed or in progress

Mental health service connection

Abstinent at exit for ≥ 6 moAbstinent at exit for ≥ 1 yr

Longest abstinence in PCAP ≥ 1 yr

87%

91%

62%

42% 34%

58%

3-Year Outcomes WA State PCAP(N = 914)

Family planning at intake

Family planning at exit- More reliable method

12%

66%52%

Family Planning Outcomes

Preventing future substance-exposed births

At 3-year program exit

• 78.1% of mothers had no subsequent birth (SB)

during PCAP

• 9.6% had a SB not exposed to alcohol or drugs

• 12.3% had a SB exposed to alcohol or drugs

Income & Custody Outcomes

3-Year Outcomes WA State PCAP(N = 914)

Main income employmentAt intakeAt exit

Main income welfareAt intakeAt exit

Custody of target child at exitBio motherOther familyFoster careAdopted

6%22%

70% 25%

67%14%9%9%

Other PCAP/FASD Publications2014: Substance abuse treatment outcomes in women with fetal alcohol spectrum

disorder. International Journal of Alcohol and Drug Research, 3(1), 43-49.

2013: Screening in treatment for fetal alcohol spectrum disorders that could affect therapeutic progress. International Journal of Alcohol and Drug Research, 2(3), 37-49.

2013: The value of the neuropsychological assessment for adults with fetal alcohol spectrum disorders: A case study. International Journal of Alcohol and Drug Research, 2(3), 79-86.

2013: The impact of prenatal alcohol exposure on addiction treatment. Journal of Addiction Medicine, 7(2):87-95.

2013: Parent-Child Assistance Program Outcomes Suggest Sources of Cost Savings for Washington State. Available at: http://depts.washington.edu/pcapuw/inhouse/PCAP_Cost_Savings_Brief_Feb_2013.pdf

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.

PCAP is Cost Effective

Casey Family Programs: PCAP outcomes suggest sources of cost savings for Washington State

PCAP children had a shorter average length-of-stay in foster care compared to WA state average (3.8 months vs. 20.4 months). Savings = $21,231 per child.

Reduced dependence on public assistance, from 70% at PCAP intake to 25% at exit.

Increased employment as main source of income, from 6% at PCAP intake to 22% at exit.

Available at: http://depts.washington.edu/pcapuw/inhouse/PCAP_Cost_Savings_Brief_Feb_2013.pdf

Canadian Economic Evaluation of PCAP

Summary: Using PCAP data from Alberta, Canada, this is the first study estimating the incremental cost effectiveness ratio and the net monetary benefit of a PCAP program. Results estimate that PCAP prevented approximately 31 (range 20–43) cases of Fetal Alcohol Spectrum Disorder among 366 clients in a 3-year period. The net monetary benefit is approximately $22 million (range $13–$31 million). Results indicate that the program is cost–effective and the net monetary benefit is significant.

Authors note that the benefit is likely underestimated as the study did not include benefits from the reduction in unemployment and welfare income dependence rates among PCAP participants.

Thanh, N.X., Jonsson, E., Moffatt, J., Dennett, L. Chuck, A., & Birchard, S. (2015). An Economic Evaluation of the Parent–Child Assistance Program for Preventing Fetal Alcohol Spectrum Disorder in Alberta, Canada. Administrative Policy and Mental Health, 42:10–18.

The PCAP Model Maintains Project Fidelity

Monitor quality control Evaluate program

Demonstrate consistent positive outcomes

Participate in the community

Build acceptance, recognition in community

PCAP continues to …..

Systems Working Together

Good things happen when

WA State implements

effective programs and

communities collaborate

to improve outcomes

for families.

“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