Parent-Child Assistance Program (PCAP) 1991-present An intensive 3-year home visitation intervention for pregnant and parenting, alcohol/drug abusing mothers “When Case Management Isn’t Enough” Nearly every woman referred to PCAP has many case managers involved in her life. 2

Parent-Child Assistance Program Primary Aims: To help mothers… Complete substance abuse treatment, stay in recovery Build healthy family lives Prevent future alcohol/drug exposed births

Theoretical Framework 1. Relational Theory A woman’s sense of connectedness to others is central to her growth, development, definition of self 4

Relational Theory: Research Findings For women with SUD, positive relationships in the intervention, treatment, and recovery settings are critical. Findings: The quality of interpersonal relationships: May determine whether or not a woman remains in an intervention; May be more important to improvement than concrete services received. “Someone to talk to who really cares.” 5

Theoretical Framework 2. Stages of Change Clients will be at different stages of readiness for change. Motivation is a process for change that occurs within the context of interpersonal relationships. Intervention Motivational Interviewing Acknowledge client’s perception of situation Encourage her to explore + and – aspects 6

Your expectations about self-efficacy are influenced most powerfully “An individual’s belief in her ability to accomplish the behaviors required to produce desired outcomes.” Your expectations about self-efficacy are influenced most powerfully by your own history of accomplishment 7

“For me to overcome my addictions and traumatic childhood, I needed every piece of the puzzle from all the services I was involved with.  However, it was my relationship with my PCAP advocate that helped me translate everything that people were telling me to do.  She truly cares about me and I know it. My advocate has taught me how to advocate for myself and my children.  She is my support system, my family and my friend.  She doesn’t just tell me what I want to hear but she tells me what I need to know, even when I don’t want to hear it.  Overcoming alcohol and drug addiction, domestic violence, child abuse and neglect and a total lack of support takes time.  The effects don’t go away overnight.  I have been in PCAP for 2 ½ years.  I’ve come along way and have more goals to accomplish.  I know how to do that now, thanks to PCAP.” --PCAP Client

to independence and strength within her own support network. The goal is to help the client move along a continuum, from dependence on the case manager, to interdependence with the case manager, to independence and strength within her own support network. 9

Theoretical Framework of the Intervention 3. Harm Reduction Addiction and associated risks are on a continuum. The goal is to reduce harmful consequences of the habit for mother and her child. Intervention Any steps toward decreased risk are steps in the right direction. History: AIDS : eg., needle exchange, condoms Continuum: low risk to high risk. Examples? Use of family planning if a mother is continuing to use drugs PCAP HALLMARK: Women are not kicked out if they relapse or have setbacks Remember, not all community services have this same philosophy, and we have to respect that and work with it. 10

“Who’s driving this bus?” Our clients’ lives are their own. The case manager’s job is to help clients recognize this, help them to THINK about their lives, make better decisions, and take responsibility for what they do every day. 11

Example: Safety Planning = Harm Reduction Safety planning: If client is still using or is at risk for relapse, ask “Are you ready for the weekend? How do you need to plan?” Safe babysitter Food, diapers for kids Condoms or other birth control for mom Discuss how PCAP helps women mitigate consequences of relapse

PCAP Substance Abuse and Mental Health Services Outcomes 3-Year Outcomes 2016 (N =1056) 2017 (N = 1218) Follow-up rate Inpatient or outpatient substance abuse tx completed or in progress Abstinent at exit for ≥ 6 mo Abstinent at exit for ≥ 1 yr Longest abstinence in PCAP ≥ 1 yr 87% 91% 42% 34% 58% 83% 38% 31% 57% Mental health service connection 62% 60%

PCAP Family Planning Outcomes 3-Year Outcomes 2016 (N = 914) 2017 (N = 1009) Family planning at exit - More reliable method 66% 52% 67%

Preventing future substance-exposed births Among 907 clients, during PCAP: 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

PCAP Enrollment Criteria Pregnant or up to 12 months postpartum* Heavy alcohol/drug abuse during pregnancy Not successfully engaged with community service providers *Referrals up to 24 months postpartum are considered if site has openings. 16