Building FASD State Systems Fetal Alcohol Spectrum Disorders Center for Excellence

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Building FASD State Systems Fetal Alcohol
Spectrum Disorders Center for Excellence 

• Promising Practices for FASD Prevention and
  Intervention
• May 6, 2004

Therese Grant, Ph.D. granttm_at_u.washington.edu Univ
ersity of Washington School of Medicine Director,
Washington State Parent-Child Assistance Program
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WHEN CASE MANAGEMENT ISNT ENOUGH
Parent-Child Assistance Program (PCAP)
A 3-year home visitation intervention
program for high risk mothers who abuse alcohol
and/or drugs during pregnancy
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Client Picture
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Primary Goal
Parent-Child Assistance Program
To prevent future births of alcohol and drug
exposed children.
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The Formula for Preventing Alcohol/Drug Exposed
Births
Motivate women to stop drinking or using drugs
before and during pregnancy. - OR - Help women
who cant stop drinking or using drugs avoid
becoming pregnant.
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History of the Program
Parent-Child Assistance Program
1991-95 Federally funded demonstration
Seattle 1996-98 Philanthropist provides
interim funding 1996-97 Governor funds
replication in Tacoma 1997-98 Follow-up
study, original cohort Seattle 1997-05 WA
State funding Seattle and Tacoma 1999-05
Expanded WA State funding Spokane, Yakima,
Grant County 1998-04 Replication sites
Minnesota, N.Carolina, Alaska, Texas, Canada
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PCAP Theoretical Framework
Relational Theory A womans sense of
connectedness to others is central to her
growth, development, definition of self
Intervention Long term, positive
interpersonal relationship with advocate
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PCAP Advocate Characteristics
Have experienced some of the same types of
adverse life circumstances as clients, but
seldom to same degree Have subsequently
achieved success in important ways Are
positive role models and offer clients hope and
motivation from a realistic perspective
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Advocate Quote 1
I've lived through the things they've been
through, so I'm not afraid or intimidated. I've
lived with domestic violence. For someone to
tell a client in a domestic violence situation to
just up and go, its not that easy. There are
lots of plans to think about. I understand when
someone says, 'I can't just leave right now.'
But I can help plan a strategy, because I've
lived it. PCAP Advocate
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PCAP Theoretical Framework
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 clients perception
of situation encourage her to explore and
aspects
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PCAP Theoretical Framework
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.
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PCAP A Two-Pronged Approach
Paraprofessional Advocate
Clients Families
Community Service Providers
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The Scope of Advocacy
Community Providers
Juvenile Justice
Bio Mom
Schools
Bio Dad
Care- takers
Job Training
Siblings
Probation
Extended Family
Friends
Alcohol/Drug Tx
Family Planning
Neighbors
Partners
Children
Mental Health Tx
Health Care
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PCAP Outcomes Over Time
PCAP has demonstrated improved FASD prevention
outcomes between original demonstration
(1991-1995) and current replication programs.
How do we account for this?
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Good things happen when the State implements
strong policy, and communities implement
effective programs
Systems Working Together

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Parent-Child Assistance Program Treatment
Abstinence Outcomes
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Systems Working Together
WA State Policy DASA increased treatment beds
for women (55 in 1991 149 in 2004) FAS
Diagnostic and Prevention Network (1995 2004)
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Parent-Child Assistance ProgramFamily Planning
Outcomes
Tubal ligation, consistent DepoProvera, IUD,
Norplant
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Systems Working Together
WA State Policy DSHS First Steps improved
family planning education and access to
services and supplies (1989 2004)
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Systems Working Together

• PCAP CONTINUES TO IMPLEMENT AN EFFECTIVE PROGRAM
• Maintains high-quality program, trained staff
• Evaluates program
• Demonstrates consistent positive outcomes to
  sustain funding
• Builds acceptance, recognition in community
• Participates in legislative task forces
• Educates community legislature to solve
  problems

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Are mothers who lose custody of their children
more likely to have a subsequent exposed
pregnancy?
"I'm going to keep having babies until they let
me keep one."
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Risk for Subsequent Alcohol/Drug Exposed
Pregnancy (N 174)
Adjusted for age, race, education, parity, and
mental health diagnosis
What are the policy implications?
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Client Quote

• 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 at Graduation