Parent-Child Assistance Program

Brief Program Description

The Parent-Child Assistance Program (P-CAP) is a paraprofessional home visitation model for extremely high-risk substance abusing women. The program uses a casemanagement approach which is an effective complement to traditional substance abuse treatment, and focuses not simply on reducing alcohol and drug use, but on reducing other risk behaviors and addressing the health and social well-being of the mothers and their children. 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
4. Demonstrate successful strategies for working with this population in order to prevent the risk of future drug- and alcohol-affected children

Program Strategies

The program does not provide direct alcohol, drug treatment or clinical services, but instead offers consistent home visitation and links 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.

Clients are not required to obtain alcohol/drug treatment in order to participate, and are never asked to leave the program because of relapse or setbacks. Advocates trace clients who are missing, stay in contact with the client's family members, and provide advocacy services for the target child regardless of who has custody of the child.

Population Focus

Participants are high-risk substance abusing women. Criteria for inclusion in the program include chronic alcohol and/or drug use during pregnancy, and little connection with community service providers, including little or no prenatal care.

Suitable Settings

Advocates visit participants in their homes and accompany them to community service provider offices.

Required Resources

Advocates are hired with at least 4 years of prior community-based experience related to prenatal substance abuse or associated problems, or the equivalent combination of education and experience. Comprehensive supervision and training are essential to a successful paraprofessional program. Clinical supervisors meet individually with advocates on a weekly basis to review cases, and they conduct group staffing meetings weekly. Supervisors provide initial intensive training and arrange ongoing training sessions with representatives from key provider agencies (e.g., Children's Protective Services, Planned Parenthood) in order for advocates to learn the dynamics of the agencies and work more effectively with them, and for agency staff to be introduced to the role of the advocates.

Implementation Timeline

The intervention lasts 36 months. Advocates visit client homes weekly for the first 6 weeks, then biweekly or more frequently, depending on client needs.

Outcomes

Major program outcomes included:

• Clients with the highest level of involvement with their advocates (> 1.5 hours per week on average over the 36-month intervention) were more than twice as likely to have completed inpatient treatment than those least involved (< 30 minutes per week).
• Sixty-seven percent of the most involved clients, compared to only 40% of the clients least involved and 32% of the control group, had a period of abstinence from alcohol or drugs for one year or more during the 36-month intervention.
• The most involved clients were less likely to become pregnant during the 36 months compared to the least involved clients (40% vs. 67%), and were also less likely to have had a subsequent birth (20% vs. 53%).
• The full client group was more satisfactorily connected with needed service providers than the control group at 36 months.

Contact Information

For indepth information on this program, please use the contact listed below.

Program Developer

In March 2002, this program was designated as a Promising Program under SAMHSA's previous National Registry of Effective Prevention Programs system.

Resources

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A program of the U.S. Department of Health and Human Services Substance Abuse & Mental Health Services Administration