Parent-Child Assistance Program

The Parent-Child Assistance Program (PCAP), formerly known as the Seattle (Wash.) Birth to 3 Program, is a home visitation program for high-risk substance-abusing women. Case-managers address the health and social well-being of mothers and their children and help participants reduce alcohol and drug use. Advocates are paraprofessionals who have personal experience with many of the same adverse circumstances as their clients and can therefore serve as positive role models. PCAP does not provide direct alcohol treatment, drug treatment, or clinical services. Advocates visit client homes, transport clients and their children to important appointments, and link clients with appropriate service providers. The intervention lasts 36 months. Advocates visit client homes weekly for the first 6 weeks, then at least once every 2 weeks, depending on client needs, for the duration of the program.

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, and 4) demonstrate successful strategies for working with this population and thus reduce the numbers of future drug- and alcohol-affected children.

At a 36-month follow-up women in PCAP were more likely to have received alcohol/drug treatment than the control group. Cost savings were suggested by a reduction in length of out-of-home care and prevention of Fetal Alcohol Syndrome.

A comparison of the original demonstration treatment group and the control group at 36 months showed that the treatment resulted in significantly higher endpoint scores. At a 36-month follow-up women in PCAP were more likely to have received alcohol/drug treatment than the control group (85% vs. 76%). Alcohol and drug abstinence rates at 36 months were higher among the treatment group than the control group (37% vs. 32%). The treatment group was also more likely to use birth control than the control groups (73% vs. 52%) and have the appropriate custody of their child (69% vs. 29%). The program has been replicated at two other sites in Seattle and Tacoma. Compared to the original demonstration, positive outcomes at the replication site were maintained for contraception use (72%), use of reliable contraceptives (51%) and number of subsequent deliveries (27%). Outcomes improved for completed alcohol/drug treatment (74%), alcohol/drug abstinence (53%), and subsequent delivery unexposed to alcohol/drugs (36%).

A brief prepared by Casey Family Programs found that PCAP outcomes suggest sources of cost savings. Two examples include: 1) children of mothers enrolled in PCAP who were in out-of-home care and reunified at program exit had a shorter length-of-stay (3.8 months), on average, than Washington’s statewide average (20.4 months). Thus, for each successful reunification, savings of approximately $21,231 per child could be realized; 2) the estimated total lifetime cost of Fetal Alcohol Syndrome (FAS) for one individual is $2.5 million (including medical costs and lost productivity). Of 239 binge alcohol drinkers served by PCAP in seven counties, 62 had a subsequent pregnancy. If all 62 mothers continued to drink, approximately 13 mothers (21%) would have a child with FAS, resulting in total lifetime costs of $33.2 million. Instead, only 18 mothers enrolled in PCAP continued to drink during the subsequent pregnancy, resulting in four children who may have FAS. This difference represents $23.6 million in lifetime cost savings.