Cara C. Ernst

INTERVENTION WITH HIGH-RISK ALCOHOL AND DRUG-ABUSING MOTHERS: II. THREE-YEAR FINDINGS FROM THE SEATTLE MODEL OF PARAPROFESSIONAL ADVOCACY

!We examine the efficacy of a paraprofessional advocacy program for improving health and social outcomes of high-risk substance-abusing mothers and their children. This intervention included 3 years of home visitation, advocacy, and connection with appropriate community services. To assess the overall effectiveness of the model, clients were compared to concurrently enrolled controls on a composite variable comprised of indicators of alcohol/drug treatment, abstinence, family planning, child well-being, and connection to services. Clients obtained higher scores, on average, than controls on the composite variable—as well as on every indicator. Clients who spent more time with advocates had more positive outcomes. Results suggest that this paraprofessional advocacy model can help protect the safety of the children of substance-abusing mothers, while helping mothers take the steps they need to take in order to make fundamental changes in their lives.

Intervention with high‐risk alcohol and drug‐abusing mothers: I. Administrative strategies of the Seattle model of paraprofessional advocacy

Administrative components of an effective home visitation program for high-risk alcohol and drug-abusing mothers are described. In this program, the home visitors are paraprofessional advocates who have an historical and cultural background in common with clients, excellent problem-solving skills, and a strong belief in the promise of a difficult clientele. Paraprofessionals can be dynamic members of the community provider system when they build long-term relationships with families, firmly link clients with professionals in the community, and establish strong communication networks among service providers around individual clients. Components of the program important to job satisfaction and retention of paraprofessionals include comprehensive and ongoing training, individualized supervision and consistent feedback from evaluation and administrative staff, group support, encouragement of creativity, and community recognition.

Preventing Alcohol and Drug Exposed Births in Washington State: Intervention Findings from Three Parent-Child Assistance Program Sites

Home visitation interventions show promise for helping at-risk mothers, yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women. This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program, a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy. Pretest-posttest comparison was made across three sites: the original demonstration (1991–1995), and the Seattle and Tacoma replications (1996–2003). In the original demonstration, the client group performed significantly better than controls. Compared to the original demonstration, outcomes at replication sites were maintained (for regular use of contraception and use of reliable method; and number of subsequent deliveries), or improved (for alcohol/drug treatment completed; alcohol/drug abstinence; subsequent delivery unexposed to alcohol/drugs). Improved outcomes at replication sites are not attributable to enrolling lower-risk women. Public policies and programs initiated over the study period may have had a positive effect on outcomes. Study findings suggest that this community-based intervention model is effective over time and across venues.

Alcohol use before and during pregnancy in western Washington, 1989-2004: implications for the prevention of fetal alcohol spectrum disorders

OBJECTIVE We examined trends in rates of self-reported pregnancy alcohol use among women in western Washington. STUDY DESIGN Between 1989 and 2004, we conducted 3 studies in western Washington State on problems that are associated with maternal prenatal alcohol or drug abuse (n = 12,526). To determine study eligibility, we screened hospitalized postpartum women for alcohol and drug use in the month before and during pregnancy. We examined trends in alcohol use rates and identified characteristics that were associated with any drinking and binge drinking (> or = 5 drinks on any occasion). RESULTS We found a substantial decrease in pregnancy alcohol use between 1989 and 2004 (from 30-12%) across almost all demographic categories. Binge drinking in the month before pregnancy increased significantly among all race categories, except Native American. CONCLUSION Increased prepregnancy binge drinking rates may estimate alcohol use during very early gestation and warrant clinical attention because of the potential for fetal alcohol spectrum disorders.

Three-Year Developmental Outcomes in Children with Prenatal Alcohol and Drug Exposure

Purpose: The purpose of this study was to describe the performance of children whose mothers abused alcohol and drugs heavily during pregnancy, using the Bayley Scales of Infant Development Second Edition (BSID‐II) at three years, and to examine the effects of study group, prenatal binge alcohol exposure, and prematurity on developmental outcome. Methods: Children were born to mothers recruited from two large hospitals or through community referral. Hospital recruits were randomly assigned to either a three‐year paraprofessional home visitation intervention program (n = 30) or a control group (n = 31). Community recruits were enrolled in the intervention program (n = 35). Results: Among all children the mean BSID‐II Mental Developmental Index (MDI) was 84.4 (SD = 14.4) and mean Psychomotor Developmental Index (PDI) was 84.1 (SD = 16.9). Box plots of the MDI and PDI scores by study group, maternal prenatal binge alcohol status, and a binary indicator of prematurity suggested an effect of maternal binge drinking on MDI and PDI scores: children of mothers with a history of binge alcohol consumption have, on average, slightly lower scores. We saw no evidence of a systematic effect of the maternal intervention. Conclusions: Developmental performance of preschool children exposed to alcohol and drugs prenatally was, on average, substantially lower than expected for age regardless of study group. Although this home visitation intervention has been shown to be effective in helping mothers address a wide spectrum of needs, it is unlikely sufficient to overcome complex developmental risks of children exposed to alcohol and drugs prenatally. The effect of more comprehensive, multidimensional services specifically designed for the children should be investigated within this context. (Pediatr Phys Ther 2002;14:145‐153)

The Difference Game: Facilitating Change in High-Risk Clients

Professionals who work with alcohol- and drug-dependent mothers face difficult challenges, particularly when the clients are alienated from the health and social services community. Typically, these clients have had abusive childhoods, have little reason to trust those in authority, and have even less reason to expect that positive changes might occur in their chaotic, fragmented lives. In the process of establishing a therapeutic relationship and conducting initial and follow-up assessments, it is critical for social workers or case managers to engage clients in a meaningful way so that the assessment represents the clients reality. The more individualized and accurate the assessment, the more useful it will be to the social worker and the client as they negotiate a service plan, monitor objective progress, and examine personal growth.

Alcohol Use Prior to and During Pregnancy in Western Washington, 1989–2004: Implications for Preventing Fetal Alcohol Spectrum Disorders

OBJECTIVE We examined trends in rates of self-reported pregnancy alcohol use among women in western Washington. STUDY DESIGN Between 1989 and 2004, we conducted 3 studies in western Washington State on problems that are associated with maternal prenatal alcohol or drug abuse (n = 12,526). To determine study eligibility, we screened hospitalized postpartum women for alcohol and drug use in the month before and during pregnancy. We examined trends in alcohol use rates and identified characteristics that were associated with any drinking and binge drinking (> or = 5 drinks on any occasion). RESULTS We found a substantial decrease in pregnancy alcohol use between 1989 and 2004 (from 30-12%) across almost all demographic categories. Binge drinking in the month before pregnancy increased significantly among all race categories, except Native American. CONCLUSION Increased prepregnancy binge drinking rates may estimate alcohol use during very early gestation and warrant clinical attention because of the potential for fetal alcohol spectrum disorders.

Alcohol use before and during pregnancy in western Washington, 1989-2004

OBJECTIVE We examined trends in rates of self-reported pregnancy alcohol use among women in western Washington. STUDY DESIGN Between 1989 and 2004, we conducted 3 studies in western Washington State on problems that are associated with maternal prenatal alcohol or drug abuse (n = 12,526). To determine study eligibility, we screened hospitalized postpartum women for alcohol and drug use in the month before and during pregnancy. We examined trends in alcohol use rates and identified characteristics that were associated with any drinking and binge drinking (> or = 5 drinks on any occasion). RESULTS We found a substantial decrease in pregnancy alcohol use between 1989 and 2004 (from 30-12%) across almost all demographic categories. Binge drinking in the month before pregnancy increased significantly among all race categories, except Native American. CONCLUSION Increased prepregnancy binge drinking rates may estimate alcohol use during very early gestation and warrant clinical attention because of the potential for fetal alcohol spectrum disorders.