The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.
The University of Washington’s (UW) Fetal Alcohol and Drug Unit developed the Parent-Child Assistance Program (PCAP) in 1991 as a demonstration project.1 Washington State subsequently funded replications of PCAP throughout the state. The UW Fetal Alcohol and Drug Unit administers PCAP and provides trainings, technical assistance, and tools to agencies interested in replicating the program.
1 The model was formerly known as the Seattle Birth to 3 Project.
PCAP is built on the idea that preventing prenatal substance exposure requires either motivating women to stop using substances during pregnancy or helping women who struggle to abstain from substances avoid subsequent pregnancies. The model incorporates concepts from three theories:
- Relational theory, which holds that a woman’s sense of connectedness to others is central to her growth, development, and self-concept.
- The stages of change approach, which accepts that ambivalence toward changing addictive behavior is normal and that clients may be at different stages of readiness.
- Harm reduction theory, which maintains there is a continuum of substance addiction and the goal is to help a client move from excess to moderation and eventually to abstinence.
PCAP targets women who self-report heavy alcohol or drug abuse during pregnancy and are ineffectively engaged with community service providers. Women are enrolled during pregnancy or up to six months postpartum. PCAP is also available to the birth mothers of children diagnosed with fetal alcohol spectrum disorder, who continue to abuse substances, and are capable of bearing children. For the purposes of the HomVEE review, this profile is based on developer recommendations and studies of programs that enroll women prenatally or within six months postpartum.
The model’s primary goal is to prevent future births of children exposed to alcohol and drugs. To achieve this goal, PCAP aims to help clients complete substance abuse treatment, maintain abstinence from substances, engage in family planning, enhance the health and well-being of their child, connect with community services, and increase their economic stability.
Program Model Components
PCAP is a social work-based case management–focused home visiting program that incorporates the Case Management Society of America’s case management principles and standards. Paraprofessional case managers provide individually tailored, multidisciplinary, community-based advocacy designed to promote client competency and timely coordination of health and social services to address a family’s specific needs.
Through home visits, case managers assess and monitor a family’s needs and well-being; connect the family with community services to address those needs; monitor service receipt; facilitate communication among the client, family members, and community service providers; and address service barriers. The case managers also teach, role model, and guide the development of clients’ interpersonal, parenting, household management, and community living skills; and provide practical assistance such as transportation to appointments.
The case managers strive to move the client along a continuum from dependence on the case manager’s support to the development of confidence in her ability to independently care for herself and her family. PCAP recognizes that setbacks are common and continues to offer services even if relapse occurs. Clients who experience setbacks are not asked to leave the program.
During the first few visits, the case manager conducts an initial assessment of the mother’s physical and mental health needs and connects her with services such as substance abuse treatment. Using a PCAP-developed assessment tool, the case manager then helps the client identify additional needs, define personal goals such as reducing substance use and obtaining further education, identify the incremental steps necessary to meet those goals, and supports the client’s work toward those goals. Every four months, the case manager and the client jointly assess progress, and update the goals and action steps.
Case managers develop and maintain professional relationships with community service providers in order to link clients to services such as family planning, safe housing, domestic violence services, parenting programs, and health and mental health services. To foster support for the client’s recovery, the case manager also seeks to develop relationships with her family and friends, and may also advocate for them as needed by providing referrals for services.
Program Model Intensity and Length
Program services are available for three years following the client’s enrollment. PCAP recommends at least two home visits per month. Case managers spend an average of one hour of face-to-face time with each client per week over the three-year intervention, and an additional 40 minutes weekly working with the client's family or service providers.
The program is currently implemented in 12 of the 39 counties in Washington State. PCAP has been replicated in Alaska, California, Louisiana, Michigan, Minnesota, Nevada, North Carolina, Pennsylvania, and Texas, and at 40 sites in several provinces of Canada.
Adaptations and Enhancements
The model can be adapted as long as the theoretical foundations and the core components of PCAP are replicated. PCAP replication sites are responsive to the unique strengths, resources, needs, and challenges of their communities. No other information on acceptable adaptations is available.
The information contained on this page was last updated in May 2016. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Therese Grant, Ph.D., University of Washington, on May 6, 2016. HomVEE reserves the right to edit the profile for clarity and consistency.