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Building FASD State Systems Fetal Alcohol Spectrum Disorders Center for Excellence 

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@u.washington.edu University of Washington School of Medicine

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Building FASD State Systems Fetal Alcohol Spectrum Disorders Center for Excellence 

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  1. Building FASD State SystemsFetal Alcohol Spectrum Disorders Center for Excellence  Promising Practices for FASD Prevention and Intervention May 6, 2004 Therese Grant, Ph.D. granttm@u.washington.edu University of Washington School of Medicine Director, Washington State Parent-Child Assistance Program

  2. Parent-Child Assistance Program (PCAP) WHEN CASE MANAGEMENT ISN’T ENOUGH A 3-year home visitation intervention program for high risk mothers who abuse alcohol and/or drugs during pregnancy

  3. Client Picture

  4. Parent-Child Assistance Program Primary Goal To prevent future births of alcohol and drug exposed children.

  5. The Formulafor Preventing Alcohol/Drug Exposed Births Motivate women to stop drinking or using drugs before and during pregnancy. - OR - Help women who can’t stop drinking or using drugs avoid becoming pregnant.

  6. Parent-Child Assistance Program History of the 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

  7. PCAP Theoretical Framework Relational Theory A woman’s sense of connectedness to others is central to her growth, development, definition of self Intervention Long term, positive interpersonal relationship with advocate

  8. 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

  9. “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, it’s 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 Advocate Quote #1

  10. 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 client’s perception of situation • encourage her to explore + and – aspects

  11. 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.

  12. PCAP: A Two-Pronged Approach Paraprofessional Advocate Clients & Families Community Service Providers

  13. The Scope of Advocacy Community Providers Juvenile Justice Bio Mom Schools Bio Dad Care- takers Job Training Siblings Probation Extended Family Friends Family Planning Alcohol/Drug Tx Neighbors Partners Children Mental Health Tx Health Care

  14. 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?

  15. SystemsWorking Together Good things happen when the State implements strong policy, and communities implement effective programs

  16. Parent-Child Assistance ProgramTreatment & Abstinence Outcomes

  17. SystemsWorking Together WA State Policy •DASA increased treatment beds for women (55 in 1991; 149 in 2004) •FAS Diagnostic and Prevention Network (1995 – 2004)

  18. Parent-Child Assistance ProgramFamily Planning Outcomes * Tubal ligation, consistent DepoProvera, IUD, Norplant

  19. SystemsWorking Together WA State Policy •DSHS First Steps improved family planning education and access to services and supplies (1989 – 2004)

  20. SystemsWorking 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

  21. 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."

  22. Risk for Subsequent Alcohol/Drug Exposed Pregnancy (N = 174) *Adjusted for age, race, education, parity, and mental health diagnosis What are the policy implications?

  23. 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

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