Parent-Child Assistance Program (PCAP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Parent-Child Assistance Program (PCAP) has been rated by the CEBC in the area of: Substance Abuse Treatment (Adult).

Target Population: Women who are using alcohol or drugs heavily during pregnancy, or who did and had their baby in the past 6 months, and are not effectively connected with community service providers; and their children

For parents/caregivers of children ages: 0 – 3

Brief Description

Maternal alcohol/drug abuse puts children at risk because of possible effects of prenatal exposure on the child’s health and because these mothers are likely to provide a compromised home environment. These problems are preventable by helping the mothers build healthy and independent lives. Since 1991, PCAP has served high-risk mothers who abuse alcohol/drugs during pregnancy and their families using a theory-based model (relational theory, stages of change, and harm reduction). PCAP intervention activities are conducted by trained and supervised case managers who each work with 16 families for 3 years, beginning during pregnancy or postpartum. PCAP case managers have experienced similar adverse life circumstances as clients, have subsequently achieved success in important ways, are positive role models, and offer hope from a realistic perspective. They provide regular home visitation, and help clients obtain treatment and stay in recovery. They connect families with comprehensive services including health, housing, parenting, and vocational services.

Program Goals:

The goals of the Parent-Child Assistance Program (PCAP) are:

  • Assist mothers in obtaining alcohol and drug treatment and staying in recovery
  • Link mothers and their families to community resources that will help them build and maintain healthy and independent family lives
  • Help mothers prevent the births of future alcohol- and drug-affected children

Essential Components

The essential components of the Parent-Child Assistance Program (PCAP) include:

  • Being a three-year home visitation model, implemented by trained and closely supervised case managers (CMs)
  • Not providing direct alcohol or drug treatment or clinical services, and instead linking women and their families with a comprehensive array of appropriate and available community resources and services
  • Facilitating an effective service plan by having the CMs coordinate with the network of client’s service providers and organize regular team case consultations
  • Having the CMs develop a network of contacts and relationships with client’s family and friends, and provide advocacy for other family members as needed
  • Not asking the clients to leave the program because of relapse or setbacks
  • Beginning case management at enrollment therefore during the mother’s pregnancy or up to 6 months postpartum
  • Having the CMs conduct an initial needs assessment using The Difference Game, (a card sort assessment developed by PCAP in 1997 and being used in U.S. and Canada); this assessment helps clients define individualized goals and incremental (‘baby’) steps required to meet those goals.
  • Adding or modifying goals and steps as client makes progress and evaluating goals every four months
  • Having one full-time clinical supervisor and six case managers to comprise a full PCAP site
  • Recommending a caseload recommendation of 16 active client families per CM
  • Having the CMs receive a minimum of twice monthly individual supervision and attend twice monthly group staffing meetings
  • Having program evaluation as an integrated part of PCAP since ongoing program evaluation allows for generation of outcomes on both current and exiting clients
  • Requiring CMs to complete evaluation instruments according to PCAP protocol

Parent/Caregiver Services

Parent-Child Assistance Program (PCAP) directly provides services to parents/caregivers and addresses the following:

  • Co-occurring substance abuse and mental health disorders, and problems associated with these disorders including health, domestic violence, housing, child welfare, and legal issues
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Being a home visiting intervention, the case managers observe interactions with the children and teach the parents and caregivers necessary skills for providing the best care to their child and how to eliminate health risks and make the house safer.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Residential Care Facility

Homework

This program does not include a homework component.

Languages

Parent-Child Assistance Program (PCAP) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Office space and desks for 6 case managers and a supervisor
  • At least 3 computers with high-speed internet for web-based data entry
  • Cell phones for field communication
  • Recommended: vehicles for transport of mothers and children to important appointments

Minimum Provider Qualifications

Case managers need a Bachelor’s degree and at least two years of prior community-based experience. From this pool of people, the program values staff who have experienced some of the same types of adverse life circumstances as clients (but usually not to the same degree), and who have subsequently achieved success in important ways. If staff are in recovery, at the time of hire they must be clean and sober for at least 5 years and be maintaining a recovery-oriented lifestyle.

Supervisors need at least a Bachelor’s degree, with Master's level training preferred in the mental health, substance abuse, or social work fields, and extensive clinical supervisory experience.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • Therese M. Grant, PhD, Director
    Washington State Parent-Child Assistance Program

    phone: (206) 543-7155
Training is obtained:

Training provided onsite or in Seattle; field observation and practice provided in Seattle

Number of days/hours:
  • Training on model: 5-day training and follow-up consultation
  • Field observation and practice: 5-day
  • Training on evaluation (recommended): 4-day training
Additional Resources:

There currently are additional qualified resources for training:

Additional University of Washington qualified trainers:

For evaluation:

  • Cara Ernst, MA
    email: ccernst@u.washington.edu
  • Ron Jackson, MSW
    email: ronjack@u.washington.edu
  • Michelle Peavy, Ph.D.
    email: Peavy@evergreentx.org

Website with protocols and evaluation materials: depts.washington.edu/pcapuw/

Implementation Information

Since Parent-Child Assistance Program (PCAP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Parent-Child Assistance Program (PCAP) as listed below:

In Washington State, the University of Washington Fetal Alcohol and Drug Unit oversees and provides technical assistance for implementation and conducts evaluation. Outside of Washington State, the Washington State Parent-Child Assistance Program (see contact information below) provides consultation on the model as requested and provides ongoing technical assistance as contracted.

The following training resources are also available on the PCAP website (http://depts.washington.edu/pcapuw/):

  • Administrative forms and protocols
  • Evaluation forms and protocols
  • Training videos and demonstrations of PCAP methods (including the Difference Game and Client Goal Setting; PCAP intake interview)
  • Complete list of PCAP peer-reviewed publications and book chapters

Formal Support for Implementation

There is formal support available for implementation of Parent-Child Assistance Program (PCAP) as listed below:

The following tools and materials are available on PCAP website (http://depts.washington.edu/pcapuw/):

  • Pre-implementation checklist: In implementing PCAP in a new community, it is essential that core components of the model be maintained if PCAP demonstrated outcomes are to be achieved. The pre-implementation checklist helps providers assesses readiness to adopt the model. It first asks questions regarding the community setting and the hosting agency setting. Next, the checklist asks questions regarding eight core components of the model. Each component has an “anchor” statement that describes what the ideal implementation of the PCAP model would look like relevant to that characteristic.
  • PCAP manual including chapter describing what is required to implement PCAP
  • PowerPoint presentation to introduce PCAP to potential providers

Fidelity Measures

There are fidelity measures for Parent-Child Assistance Program (PCAP) as listed below:

The PCAP fidelity measure is a quality assurance tool that helps assess a provider’s degree of adherence to the model. The assessment is organized into ten core components of the model. Each characteristic has one “anchor” statement that describes what the ideal replication of the PCAP model would look like relevant to that characteristic. The fidelity measure can be used to help agencies or communities determine how well they meet criteria for implementing the evidence-based model; determine whether changes need to be made in implementation; and track improvements over time. The measure can also be used to help outside evaluators understand the PCAP model elements. The Fidelity measure is available on PCAP website at http://depts.washington.edu/pcapuw/

Implementation Guides or Manuals

There are implementation guides or manuals for Parent-Child Assistance Program (PCAP) as listed below:

The PCAP manual is a 108-page PDF document organized into six sections:

  • Introduction
  • Getting Started: Operations
  • Getting Started: Clinical
  • Delivering the Intervention
  • Managing Client Status Changes
  • Evaluation and Sustainability

Research on How to Implement the Program

Research has been conducted on how to implement Parent-Child Assistance Program (PCAP) as listed below:

There are two published articles on Canadian PCAP implementation:

Rasmussen, C., Kully-Martens, K., Denys, K., Badry, D., Henneveld, D., Wyper, K., & Grant, T. (2012). The effectiveness of a community-based intervention program for women at-risk for giving birth to a child with Fetal Alcohol Spectrum Disorder (FASD). Community Mental Health Journal, 48(1), 12-21. doi: 10.1007/s10597-010-9342-0.

Thanh, N. X., Jonsson, E., Moffatt, J., Dennett, D., Chuck, A. W., & 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(1), 10-18. doi:10.1007/s10488-014-0537-5

Umlah, C., & Grant, T. (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.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Safety, Permanency and Child/Family Well-Being

Show relevant research...

Ernst, C. C., Grant, T. M., Streissguth, A. P., & Samson, 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.

Type of Study: Randomized controlled trial, with small amount of adjustment to balance samples
Number of Participants: Intervention: 65, Control Group: 31

Population:

  • Age — Mean=27 years
  • Race/Ethnicity — Intervention group: 48% African American, 29% White, 15% Native American, and 8% Hispanic/Asian/Other; Control group: 36% African American, 42% White, 16% Native American, and 6% Hispanic/Asian/Other
  • Gender — 100% Female
  • Status — Participants were women who abused alcohol/drugs during pregnancy, and their infants; recruited via hospital postpartum screening or from community provider referrals.

Location/Institution: Seattle, WA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Women were randomly assigned to three years of intensive home visitation/case management (intervention group) or the community standard of care (control group). Participants were interviewed pre- and post-intervention regarding substance use, risk and protective factors, and use of community services. A composite summary score was computed for overall well-being. The intervention group participants obtained significantly higher outcome summary scores; those who spent more time with case managers had more positive outcomes.

Length of postintervention follow-up: None.

Kartin, D., Grant, T. M., Streissguth, A. P., Sampson, P. D., & Ernst, C. C. (2002). Three year development outcomes in children with prenatal alcohol and drug exposure. Pediatric Physical Therapy, 14, 145-153.

Type of Study: Randomized controlled trial, with small amount of adjustment to balance samples
Number of Participants: Intervention group: 53, Control group: 25

Population:

  • Age — Not specified
  • Race/Ethnicity — Intervention group: 50.9% African American, 26.4% White, 15.1% Native American, and 7.6% Other; Control group: 25.5% African American, 50.0% White, 20.8% Native American, and 4.2% Other.
  • Gender — Not specified
  • Status — Participants were women who abused alcohol/drugs during pregnancy, and their infants; recruited via hospital post-partum screening or from community provider referrals.

Location/Institution: Seattle, WA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
(Note: This analysis uses children from the sample described in Ernst et al., 1999). Women were randomly assigned to three years of intensive home visitation/case management (intervention group) or the community standard of care (control group). At intervention exit, children were evaluated using the Mental, Motor, and Behavior Rating Scales of the Bayley Scales of Infant Development Second Edition (BSID-II). Results indicated that scores, on average, were lower than expected for age among both the intervention and control groups. Previous research suggests that the home-visiting intervention showed positive results for mothers; however it was not sufficient to address the needs of children exposed to prenatal alcohol and drugs.

Length of postintervention follow-up: None.

Grant, T., Ernst, C. C., Pagaliauan, G., & Streissguth, A. (2003). Post-program follow-up effects of a paraprofessional intervention with high-risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology, 31(3), 211-222.

Type of Study: Follow-up of intervention group from randomized controlled trial
Number of Participants: 48 clients

Population:

  • Age — Not Specified
  • Race/Ethnicity — Not Specified
  • Gender — 100% Female
  • Status — Participants were mothers at-risk for alcohol/drug abuse; former PCAP participants originally recruited via hospital postpartum screening or from community provider referrals.

Location/Institution: Seattle, WA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
(Note: This study uses the same sample as Ernst et al., 1999.) Interviews were conducted to obtain information on alcohol and drug use, use of family planning and community services. Clients were interviewed at intervention enrollment, at intervention completion 3 years later, and 2.5 years after completing the intervention. Located mothers were significantly more likely to have abstained from alcohol and drugs for 6 months or more and had fewer subsequent children. They were also more likely to be living in permanent housing and less likely to have been incarcerated. A limitation to this analysis is the lack of comparison with the control group.

Length of postintervention follow-up: 2.5 years

Grant, T. M., Ernst, C. C., Streissguth, A., & Stark, K. (2005). Preventing alcohol and drug exposed births in Washington State: Intervention findings from three Parent-Child Assistance Program sites. The American Journal of Drug and Alcohol Abuse, 31, 471-490.

Type of Study: Pretest/Posttest
Number of Participants: 216 women

Population:

  • Age — Mean=28 years
  • Race/Ethnicity — 47% White, 37% African American, 9% Native American, and 7% Other
  • Gender — 100% Female
  • Status — Participants were women who abused alcohol/drugs during pregnancy, and their infants; recruited via hospital post-partum screening or from community provider referrals.

Location/Institution: Washington State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
(Note: This study includes some participants from the Ernst et al. 1999 study.) Pretest-posttest comparison was made across three PCAP sites: the original demonstration (OD) (1991-1995), and two replication sites (1996-2003). Women were interviewed using the Addiction Severity Index with supplemental questions on pregnancy substance use, contraception, and use of community services. On an endpoint summary score, each of the replication samples performed significantly better than the OD, adjusting for baseline. Compared to the OD, outcomes at replication sites were maintained (for regular use of contraception and use of a reliable method of birth control; and number of subsequent deliveries [i.e., children born]), or improved (for alcohol/drug treatment completed; alcohol/drug abstinence; subsequent delivery [i.e., child born] unexposed to alcohol/drugs). Study findings suggest that this community-based intervention model is effective over time and across venues.

Length of postintervention follow-up: None.

Grant, T., Huggins, J., Graham, C., Ernst, C., Whitney, N., & Wilson, D. (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.

Type of Study: One group pretest-posttest design
Number of Participants: 458

Population:

  • Age — Mean age=27 years
  • Race/Ethnicity — 60% White, 20% Native American, 13% African American, and 7% Other
  • Gender — 100% Females
  • Status — Participants were substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP).

Location/Institution: Five counties in Washington State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study explores how maternal risk and protective characteristics and service elements are associated with reunification among a sample of women participating in PCAP. The measure utilized was the Addiction Severity Index (ASI), 5th edition, as well as self-report of service use. Results indicated that, at program exit, 60% of the mothers were caring for their child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Results also showed that among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. Limitations included lack of a control group and possible self-report biases.

Length of postintervention follow-up: None.

Grant, T. M., Graham, J. C., Ernst, C. C., Peavy, K. M., & Brown, N. N. (2014). 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.

Type of Study: One group pretest-posttest design
Number of Participants: 795

Population:

  • Age — Mean=27.2 years
  • Race/Ethnicity — 58.5% White, 18.5% Native American, 12.7% African American, and 10.3% Hispanic/Asian/Other
  • Gender — 100% Female
  • Status — Participants were women who abused alcohol/drugs during pregnancy and enrolled in the Washington State Parent-Child Assistance Program (PCAP).

Location/Institution: Nine counties in Washington State (King, Pierce, Yakima, Spokane, Grant, Cowlitz, Skagit, Clallam, and Kitsap)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study explores whether loss of an index child due to substance abuse is associated with risk of a subsequent alcohol/drug-exposed birth in a sample of women participating in Parent-Child Assistance Program (PCAP). The measure utilized was the Addiction Severity Index (ASI), 5th edition, as well as self-report of service use. Results indicate that at program exit, over one-fifth of the women had a subsequent birth (SB) after the birth of their child. Results also found that among women whose index child had been removed from their care, the adjusted odds of having a SB increased nearly two-fold and the adjusted odds of having an exposed SB increased three-fold. Additionally results found that among the women in this study, being relatively young, having no pattern of employment, and using cocaine during an index pregnancy increased risk of having a subsequent birth, while receiving both inpatient and outpatient treatments reduced those odds. Receiving outpatient treatment reduced the risk of a subsequent exposed birth. Limitations include nonrandomization of participants, reliability on self-reported measures, and attrition.

Length of postintervention follow-up: None.

References

Grant, T., Huggins, J., Graham, J. C., Ernst, C., Whitney, N., & Wilson, D. (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.

Grant, T. M., Ernst, C. C., & Streissguth, A. P. (1999). Intervention with high-risk alcohol and drug-abusing mothers: I. Administrative strategies of the Seattle model of paraprofessional advocacy. Journal of Community Psychology, 27(1): 1–18.

Grant, T. M., Youngblood Pedersen, J., Whitney, N., & Ernst, E. (2007). The role of therapeutic intervention with substance abusing mothers: Preventing FASD in the next generation. In Attention Deficit Hyperactivity Disorder and Fetal Alcohol Spectrum Disorders: The Diagnostic, Natural History and Therapeutic Issues Through the Lifespan. K. O’Malley (Ed.). Hauppauge, NY: Nova Science Publishers, Inc.

Contact Information

Name: Therese M. Grant, PhD
Title: Director, Washington State Parent-Child Assistance Program (PCAP)
Agency/Affiliation: University of Washington
Department: Health Sciences Administration, Fetal Alcohol and Drug Unit
Website: depts.washington.edu/pcapuw
Email:
Phone: (206) 543-7155
Fax: (206) 685-2903

Date Research Evidence Last Reviewed by CEBC: July 2015

Date Program Content Last Reviewed by Program Staff: April 2016

Date Program Originally Loaded onto CEBC: October 2009