PCAP is based on the tenet that effective intervention programs for high‐risk mothers take into account the complex nature of the women’s problems, and provide services that are multidisciplinary, comprehensive, coordinated, and include the children. PCAP evaluation therefore examines multidimensional outcomes, improved overall social functioning, and reduction of risk to the mother and target child.
PCAP has been evaluated using blended evaluation designs; outcomes have been published in three peer‐reviewed papers.
Study 1. Original Demonstration Cohort (1991 – 1995)
Ernst, C.C., Grant, T.M., Streissguth, A.P., & Sampson, P.D. (1999). Intervention with high‐risk alcohol and drug‐abusing mothers: II. 3‐year findings from the Seattle model of paraprofessional advocacy. Journal of Community Psychology, 27(1): 19–38
Hospitalized postpartum women were screened for eligibility. A controlled trial, non‐equivalent groups design was used: patients who met eligibility criteria were initially assigned at random to either the intervention or control group (every third eligible woman assigned to the control group) to obtain a two‐to‐one ratio of clients to controls. Referrals meeting eligibility criteria were later accepted from community service providers and assigned to the intervention group. Due to the particular demographics of community referrals, the assignment of hospital recruits was adjusted sequentially in order to approximately balance the control group (n=31) and the composite client group (n=30 hospital‐recruited and n=35 community‐referred). Data from community- referred clients was analyzed separately. Participants were interviewed pre and post‐intervention using a structured interview adapted from instruments used by the authors in prior studies (Grant et al., 1994; Streissguth et al., 1981, 1993).
To measure overall effectiveness of the program, two composite variables were created: a baseline (intake) score, and an endpoint score assessing status at 36 months. Each composite variable incorporates five domains theorized a priori to be most affected by the intervention:
- Utilization of alcohol/drug treatment
- Abstinence from alcohol and drugs
- Family planning (use of birth control, subsequent pregnancies)
- Health and well‐being of target child (health care, custody)
- Appropriate connection with community services at 36 months
Each domain is comprised of items on which a subject was scored on a 5‐point scale. Item scores were summed to compute domain scores and domain scores summed to compute the total summary score. Cronbach’s alpha (computed from the five component domain scores) was .91 for the baseline score and .82 for the endpoint score.
Data from the 36‐month post‐intervention interview indicated that hospital‐recruited clients (n=28) scored significantly higher than hospital‐recruited controls (n=25) on the endpoint score (endpoint mean: clients = 17.1 vs. control = 10.1, t = ‐2.11, p.04). Adjusting for the baseline scores (baseline mean: clients = ‐21.8; controls = ‐18.5) we found a stronger intervention effect (p.02). Three‐group analysis of covariance (hospital‐recruited clients, community referred clients, and hospital‐recruited controls) indicated positive intervention effects among both client groups compared to controls (p.05).
Study 2. Post‐Program Follow‐Up Cohort (1997 – 1998)
Grant, T., Ernst, C.C., Pagalilauan G., & Streissguth, A.P. (2003). Post‐program follow‐up effects of paraprofessional intervention high‐risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology, 31(3): 211–222
Study 2 was a post‐program follow‐up of Study 1 intervention group subjects who were located for interview 1.6 to 3.6 years after exit from the 3‐year PCAP intervention. A total of 48 intervention group subjects were located. Among the 45 mothers on whom we had interview data at the three measurement points (PCAP enrollment, PCAP exit, and follow‐up), we found statistically significant improvements as follows.
Between PCAP exit and post‐program follow‐up:
- Increase in abstinence from alcohol and drugs for at least 6 months at the time of interview (31% at exit vs. 51% at follow‐up, p.05)
- Decrease in mothers with a subsequent pregnancy (51% during program vs. 29% during follow‐up, p.05) and with a subsequent birth ( 27% during program vs. 9% during follow‐up, p.05)
- Increase in stable, permanent housing (58% at exit vs. 80% at follow‐up, p.01)
- Decrease in mothers incarcerated during the interval (67% during program vs. 39% during follow‐up, p.01).
Study 3. Seattle and Tacoma Replication Cohorts (1996 – 2003)
Grant, T., Ernst, C., Streissguth, A., & Stark, K (2005). Preventing alcohol and drug exposed births in Washington State: Intervention findings from three Parent‐Child Assistance Program sites. American Journal of Drug and Alcohol Abuse, 31(3): 471‐490.
In 1996 PCAP obtained state funding to replicate the intervention in Seattle and Tacoma, the two largest cities in Washington State. Funds were not made available to enroll a control group. Study 3 is a cohort study, pretest–posttest comparison examining 36‐month outcomes from: the original demonstration (OD) (described in Study 1 above), the Seattle replication site (SR) (1996–2003), and the Tacoma replication site (TR) (1996–2003). Subjects enrolled after 1996 (n=84) were interviewed using the Addiction Severity Index (ASI), a widely‐used standardized instrument demonstrating good reliability and validity.
Comparing data across the OD (n=60), SR (n=76), and TR (n=80), slopes for the regression of endpoint score on baseline score were similar across the groups. Each of the replication samples performed significantly better than the OD (p.02), adjusting for baseline score.
Compared to the OD, at exit from the intervention a higher proportion of SR and TR subjects:
- Completed inpatient or outpatient treatment (OD= 52%; SR= 76%; TR= 73%)
- Were abstinent from alcohol and drugs at exit for > 6 months (OD= 28%; SR=43%; TR=39%)
- Were abstinent from alcohol and drugs at exit for > 1 year (OD=17%; SR=34%; TR=33%)
- Were abstinent from alcohol and drugs for any > 1 year period while in the program (OD=37%; SR=59%; TR=46%)
- Were employed as the primary source of income (OD=12%; SR=29%; TR=29%)
Compared to the OD, at exit from the intervention a lower proportion of SR and TR subjects:
- Had public assistance as the primary source of income (OD= 50%; SR = 26%; TR = 26%)
- Index children were in the state foster care system (OR=26%; SR=17%; TR=9%)