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 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.
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.
PCAP Program Coordinator
University of Washington Health Science Administration
Alcohol and Drug Abuse Institute, Fetal Alcohol and Drug Unit
180 Nickerson Street, Suite 309
Seattle, WA 98109