What is PCAP?

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 and randomly assigned to home visitation intervention (n=30) or the community standard of care control group (n=31).

Referrals meeting the same eligibility criteria were also accepted from community service providers and assigned to the intervention group (n = 35). 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 to assess status at 36 months. Each of these composite variables incorporates five domains theorized a priori to be most affected by the intervention:

1. Utilization of alcohol/drug treatment
2. Abstinence from alcohol and drugs
3. Family planning (use of birth control, subsequent pregnancies)
4. Health and well-being of target child (health care, custody)
5. 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).

Grant, T., Ernst, C.C., Pagalilauan G. & Streissguth, A.P. (2003). Post-program follow-up effects of paraprofessional intervention with 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).

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 5th edition 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%)

Grant, T., Huggins, J., Graham, C., Ernst, C., Whitney, N., and Wilson, D. (2011). Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not. Children and Youth Services Review, 33(11): 2176-2185.

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers’ needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent–Child Assistance Program (PCAP), an evidence based case management intervention. Participants’ custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.

Grant, T.M., Graham, J.C., Ernst, C.C., Peavy, K.M., & Brown, N.N. (2014). Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births. Children and Youth Services Review, 46: 11-18.

Parental alcohol and drug abuse is a factor in approximately 15% of the cases investigated by the child welfare system and in approximately one quarter of cases with substantiated maltreatment. While substance abuse treatment is generally an essential component of child welfare family plans, a relatively low proportion of substance abusing mothers involved in the child welfare system complete treatment, which typically results in placement of their children in substitute care and the beginning of a new generation of adaptive problems. This longitudinal study explores whether loss of an index child due to substance abuse is associated with risk of a subsequent alcohol/drug-exposed birth in a sample of 795 substance-abusing mothers enrolled in the Washington State Parent–Child Assistance Program (PCAP). Results indicate that at program exit, over one-fifth of these women had a subsequent birth (SB) after the birth of their index child. Among these women, over half (i.e., 56.3% or 12.3% of the entire sample) used alcohol and/or drugs during the subsequent pregnancy. Consistent with our main hypothesis, the adjusted odds of having a SB were increased nearly two-fold for women who had the index child removed from their care. Furthermore, among mothers with subsequent births, the adjusted odds of having an exposed SB were increased three-fold if the index child had been removed from the mother’s care. We discuss implications of our findings for child welfare policy and practices.

Grant, T.M., Graham, J.C., Carlini, B.H., Ernst, C.C., & Brown, N.N. (2018). Use of marijuana and other substances among pregnant and parenting women with substance use disorders: Changes in Washington State after marijuana legalization. Journal of Studies on Alcohol and Drugs, 79(1), 88-95.

In 2012, possession of marijuana for non- medical use was legalized in Washington State. This study examined how legalization affected alcohol and drug use in a sample of pregnant and parenting women with substance use disorders and enrolled in the Parent–Child Assistance Program (PCAP). Study participants from nine counties in Washington State (N = 1,359) were questioned about their substance use after completing the 3-year PCAP intervention. The sample was divided into two cohorts based on whether participants had completed PCAP before or after legalization. Study results indicated that overall, most study participants (62%) reported complete abstinence from alcohol and nonprescription drugs at PCAP exit. Among those who were still using substances, women who completed the intervention after marijuana legalization (Cohort 2) were significantly more likely to report marijuana use at program exit compared with women who completed the intervention before marijuana legalization (Cohort 1). Among study participants who did not achieve abstinence during the intervention, across both cohorts (pre- and post-legalization), we found a positive association of exit marijuana use with alcohol, illegal methadone, other opioids, amphetamines, and cocaine use; exit marijuana use was associated primarily with alcohol use. We conclude that marijuana use at PCAP exit increased significantly after marijuana legalization in the state. Women who were not abstinent from marijuana at program exit were likely to report use of other substances as well. Our study design demonstrates an association but does not allow us to conclude that marijuana use leads to other substance use among this sample of women with a history of polysubstance use.

Hildebrandt, H.D., Graham, J.C. & Grant, T.M. (2020). Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program. Infant Mental Health, 41: 677-696.

Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother–child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent–Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant–parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with
relatively less adversity.

Hildebrandt, U., Graham, J.C., & Grant, T.M. (2020). Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program.  Infant Mental Health Journal, 41(5), 677-696. Available at:  https://doi.org/10.1002/imhj.21872

Grant, T., Ernst, C., & Stoner, S. A. (2020). Parent-Child Assistance Program (PCAP): Prevention & intervention with high risk mothers and their children. University of Washington Alcohol and Drug Abuse Institute. Available here.

Grant, T.M., Graham, J.C., Ernst, C.C., Novick Brown, N., & Carlini, B.H. (2018). Use of marijuana and other substances among pregnant and parenting women with substance use disorders: Changes in Washington State after marijuana legalization. Journal of Studies on Alcohol and Drugs, 79(1), 88-95. Available at: http://www.jsad.com/doi/10.15288/jsad.2018.79.88. Epub 2017 Dec 13.

Grant, T.M. (2015). Supporting mothers to prevent subsequent prenatal substance use. National Abandoned Infant Assistance (AIA) Resource Center, Research-to-Practice Brief (May, 2015). Available at: http://depts.washington.edu/pcapuw/inhouse/AIA_ResearchtoPracticeBrief_2015.pdf

Grant, T.M., Graham, J.C., Ernst, C.C., Peavy, K.M., & Brown, N.N. (2014). Improving pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with subsequent exposed births. Children and Youth Services Review, 46: 11-18. Available at: http://dx.doi.org/10.1016/j.childyouth.2014.07.014

Grant, T., & Casey Family Programs (2013). Parent-Child Assistance Program Outcomes Suggest Sources of Cost Savings for Washington State. Available here.

Grant, T.M., and Huggins, J.E. (2013). Intervention with mothers who abuse alcohol and drugs: How relationship and motivation affect the process of change in an evidence-based model. In: Parenting and Substance Abuse: Developmental Approaches to Intervention. N.E. Suchman, M. Pajulo, & L.C. Mayes (Eds). Oxford University Press, pp. 365-385.

Grant, T., Huggins, J., Graham, C., Ernst, C., Whitney, N., and Wilson, D. (2011). Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not. Children and Youth Services Review, 33(11): 2176-2185. Available at: http://dx.doi.org/10.1016/j.childyouth.2011.07.001

Grant, T.M. (2011). Maternal alcohol and drug abuse: Effective case management with high-risk mothers and their children. In: Programs and Interventions for Maltreated Children and Families at Risk. The Clinician’s Guide to Evidence-Based Practice Series. A. Rubin (Ed). Wiley Blackwell Publishers, pp. 207-221.

Grant, T.M., Jack, D.C., Fitzpatrick, A.L., & Ernst, C.C. (2011). Carrying the burdens of poverty, parenting, and addiction: Depression symptoms and self-silencing among ethnically diverse women. Community Mental Health Journal, 47(1): 90-98.  Available at: http://dx.doi.org/10.1007/s10597-009-9255-y

Rasmussen, C., Kully-Martens, K., Denys, K., Badry, D., Henneveld, D., Wyper, K., & Grant, T. (2010). The effectiveness of a community-based intervention program for women at risk for giving birth to a child with Fetal Alcohol Spectrum Disorder (FASD). Community Mental Health Journal, 48(1): 12-21. Available at: http://dx.doi.org/10.1007/s10597-010-9342-0

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. Available here.

Grant, T. (2004). PCAP receives national exemplary prevention award. Washington State Department of Social and Health Services ‐ Division of Alcohol and Substance Abuse. Focus Newsletter, 14(3): 1,3. Available here.

Grant, T., Ernst, C.C., Pagalilauan G., & Streissguth, A.P. (2003). Post‐program follow‐up effects of paraprofessional intervention with high‐risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology, 31(3): 211‐222. Available here.

Umlah, C. & Grant, T. (2003). Intervening to prevent prenatal alcohol and drug exposure: The Manitoba experience in replicating a paraprofessional model. Manitoba Journal of Child Welfare, 2(1): 1‐12. Available here.

Grant, T., Streissguth, A., & Ernst, C. (2002). Benefits and challenges of paraprofessional advocacy with mothers who abuse alcohol and drugs and their children. Zero to Three, 23(2): 14‐20.

Grant, T.M., Streissguth, A.P., & Ernst, C.C. (2002). Intervention with alcohol & drug abusing mothers and their children: The role of the paraprofessional. The Source: Newsletter of the National Abandoned Infants Assistance Resource Center, 11(3): 5‐26. Available here.

Kartin, D., Grant, T.M., Streissguth, A.P., Sampson, P.D., & Ernst, C.C. (2002). Three‐year developmental outcomes in children with prenatal alcohol and drug exposure. Pediatric Physical Therapy, 14: 145‐153. Available here.

Grant, T.M., Ernst, C.C., & Streissguth, A.P. (1999). Intervention with high‐risk alcohol and drug‐abusing mothers: I. administrative strategies of the Seattle model of paraprofessional advocacy. Journal of Community Psychology, 27(1): 1‐18. Available here.

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. Available here.

Grant, T.M., Ernst, C.C., McAuliff, S., & Streissguth, A.P. (1997). The Difference Game: An assessment tool and intervention strategy for facilitating change in high‐risk clients. Families in Society, 78(4): 429‐432. Available here.

Grant, T.M., Ernst, C.C., Streissguth, A.P., Phipps, P., & Gendler, B. (1996). When case management isn’t enough: A model of paraprofessional advocacy for drug‐ and alcohol‐abusing mothers. Journal of Case Management, 5(1): 3‐11. Available here.

Grant, T.M., Ernst, C.C., & Streissguth, A.P. (1996). An intervention with high risk mothers who abuse alcohol and drugs: The Seattle Advocacy Model. American Journal of Public Health, 86(12): 1816‐1817.

Grant, T.M., Brown, N.N., & Dubovsky, D. (2015). Screening for Fetal Alcohol Spectrum Disorders: A critical step toward improving treatment success. In: Suchtgefährdete Erwachsene mit Fetalen Alkoholspektrumstörung. De Gruyter. Berlin, Germany.

Brown, N., Burd, L., Grant, T., Edwards, W., Adler, R., & Streissguth, A. (2015). Prenatal alcohol exposure: An assessment strategy for the legal context. International Journal of Law and Psychiatry, 42-43, 144-148. Available at: http://doi.org/ 10.1016/j.ijlp.2015.08.019

Brown, N.N., Grant, T., & Clarren, S. (2014). Fetal alcohol spectrum disorders (FASD): What judges and other legal professionals need to know. The Judges’ Page. Available at:  http://www.casaforchildren.org/site/c.mtJSJ7MPIsE/b.8968329/k.2A9C/Winter_2014.htm

Grant, T.M., Brown, N.N., Graham, J.C., & Ernst, C.C. (2014). Substance abuse treatment outcomes in women with fetal alcohol spectrum disorders. The International Journal of Alcohol and Drug Research, 3(1), 43-49. Available at: http://dx.doi.org/10.7895/ijadr.v3i1.112

Grant, T.M., Brown, N.N., Graham, J.C., Whitney, N., Dubovsky, D. & Nelson, L. (2013). Screening in treatment for fetal alcohol spectrum disorders that could affect therapeutic progress. The International Journal of Alcohol and Drug Research, 2(3), 37-49. Available at: http://dx.doi.org/10.7895/ijadr.v2i3.116

Sparrow, J., Grant, T.M., Connor, P., & Whitney, N. (2013). The value of the neuropsychological assessment for adults with fetal alcohol spectrum disorders: A case study. The International Journal of Alcohol and Drug Research, 2(3), 79-86. Available at: http://dx.doi.org/10.7895/ijadr.v2i3.107

Grant, T.M., Novick Brown, N., Dubovsky, D., Sparrow, J., & Ries, R. (2013). The impact of prenatal alcohol exposure on addiction treatment. Journal of Addiction Medicine, 7(2):87-95. Available at: http://dx.doi.org/10.1097/ADM.0b013e31828b47a8

Huggins, J.E., Grant, T., O’Malley, K., & Streissguth, A.P. (2008). Suicide attempts among adults with fetal alcohol spectrum disorders: Clinical considerations. Mental Health Aspects of Developmental Disabilities, 11(2): 33‐41. Available at: http://www.thefreelibrary.com/Suicide+attempts+among+adults+with+fetal+alcohol+spectrum+disorders%3A…-a0179133647

Grant, T.M., Youngblood Pedersen, J., Whitney, N., & Ernst, E. (2007). The role of therapeutic intervention with substance abusing mothers: Preventing FASD in the next generation. In: Attention Deficit Hyperactivity Disorder and Fetal Alcohol Spectrum Disorders: The Diagnostic, Natural History and Therapeutic Issues Through the Lifespan. K. O’Malley (Ed.). Hauppage, NY: Nova Science Publishers, Inc.

Grant, T.M., Bookstein, F.L., Whitney, N.L., & Streissguth, A.P. (2006). Neonatal cranial ultrasound leads to early diagnosis and early intervention in baby of alcohol‐abusing mother. Mental Health Aspects of Developmental Disabilities, 9(4): 125‐127. Available here.

Grant, T., Huggins, J., Connor, P., & Streissguth, A. (2005). Quality of Life and Psychosocial Profile Among Young Women With Fetal Alcohol Spectrum Disorders. Mental Health Aspects of Developmental Disabilities, 8(2): 33‐39. Available here.

Grant, T., Huggins, J., Connor, P., Pederson, J., Whitney, N., & Streissguth, A. (2004). A pilot community intervention for young women with fetal alcohol spectrum disorders. Community Mental Health Journal, 40(6): 499‐511. Available here.

Grant, T.M., Ernst, C.C., Streissguth, A.P., & Porter (1997). An advocacy program for mothers with FAS/FAE. In: Streissguth, A.P. & Kanter J. (eds.) The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities (pp. 102‐112). Seattle: University of Washington Press.

Rasmussen, C., Kully-Martens, K., Denys, K., Badry, D., Henneveld, D., Wyper, K., & Grant, T. (2012). The effectiveness of a community-based intervention program for women at risk for giving birth to a child with Fetal Alcohol Spectrum Disorder (FASD). Community Mental Health Journal, 48(1): 12-21. Available at: http://dx.doi.org/10.1007/s10597-010-9342-0

Streissguth, A.P. & Grant, T.M. (2011). Prenatal and postnatal intervention strategies for alcohol‐abusing mothers in pregnancy. In: Drugs in Pregnancy ‐‐ The Price for the Child: Exposure to Foetal Teratogens and Long Term Neurodevelopmental Outcome. D. Preece & E. Riley (Eds.) London: MacKeith Press, pp. 217-233.

Grant, T.M. (2011). Preventing FASD: The Parent‐Child Assistance Program (PCAP) intervention with high‐risk mothers. In: Fetal Alcohol Spectrum Disorder – Management and Policy Perspectives of FASD. E. Riley, S. Clarren, J. Weinberg, & E. Jonsson (Eds.). Wiley Blackwell Publishers, pp. 193‐206.

Grant T.M., Huggins J.E., Sampson P.D., Ernst C.C., Barr H.M., & Streissguth A.P. (2009). Alcohol use before and during pregnancy in Western Washington, 1989‐2004: Implications for the prevention of fetal alcohol spectrum disorders. American Journal of Obstetrics and Gynecology, 200(3): 278e1‐8. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724985/

Thanh, N.X., Jonsson, E., Moffatt, J., Dennett, L., Chuck, A.W., Birchard, S. (2015). An Economic Evaluation of the Parent–Child Assistance Program for Preventing Fetal Alcohol Spectrum Disorder in Alberta, Canada.  Administration and Policy in Mental Health and Mental Health Services Research, 42:10–18. Available at: https://doi.org/10.1007/s10488-014-0537-5

Zulliger, K., Maher, E., Myslewicz, M., Corwin, T. Wilson, D. Jones-Peguero, S. Williams, J., and Marcynyszn, L. (2015). Prioritizing Early Childhood to Safely Reduce the Need for Foster Care: A National Scan of Interventions. Casey Family Programs, Research and Practice Brief (March, 2015). Available at: http://www.casey.org/prioritizing-early-childhood/

Consensus Statement on Fetal Alcohol Spectrum Disorder (FASD) ‐ Across the Lifespan. Institute of Health Economics Consensus Statements, Volume 4 ‐ October 7‐9, 2009, Alberta, Canada. Available at: http://www.ihe.ca/download/consensus_statement_on_fetal_alcohol_spectrum_disorder_fasd_across_the_lifespan.pdf

Major Ryan, D., Bonnett, D.M., and Gass, C.B. (2006). Sobering Thoughts: Town Hall Meetings on Fetal Alcohol Spectrum Disorders. American Journal of Public Health, 6(12): 2098‐2101. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698155/

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