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Screening and Intervention Programs

Michigan Dept.of Community Health, Mental Health & Substance Abuse Admin., Bureau of Substance Abuse & Addiction Services

Intervention Type

FASD Prevention Subcontractors
(Parent-Child Assistance Program)

Project Contact Information

Michigan Dept.of Community Health, Mental Health & Substance Abuse Admin., Bureau of Substance Abuse & Addiction Services
Brenda Stoneburner, M.A., LPC, Parent-Child Assistance Program (P-CAP) Director
320 South Walnut Street
Lansing, MI 48913
Phone: 517-335-5247
Fax: 517-335-0121

Project Summary Statement

The Michigan Department of Community Health/Bureau of Substance Abuse and Addiction Services (MDCH/BSAAS) is implementing the Parent-Child Assistance Program (PCAP) in three counties in Western Michigan: Berrien, Kent and Muskegon. The goal of PCAP is to reduce future alcohol-exposed pregnancies by increasing abstinence from alcohol and drug use and/or improving regular use of reliable contraception among enrollees. The target population is pregnant or up to six-month post-partum women who have had an alcohol-exposed pregnancy and meet ASAM criteria for, or are participating in, residential or intensive outpatient treatment.

This initiative supports the mission of the MDCH to protect, preserve and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and underserved populations. The service delivery system is centered on 16 regional Coordinating Agencies (CAs) charged with planning, contracting for and administering treatment and prevention services in their geographic boundaries. The PCAP initiative will collect data from individual clients at enrollment and at the end of the program to assess the following outcomes:

  1. Use of alcohol Eliminate or reduce use of alcohol. 60% (36) of women who are eligible at enrollment. Completion of PCAP or May 31, 2012, whichever comes first?
  2. Use of alcohol during subsequent pregnancy Eliminate the use of alcohol for PCAP participants who have a subsequent pregnancy. 100% of women. End of pregnancy or completion of PCAP whichever comes first
  3. Use of contraception Consistent use of an effective contraceptive method. 50% (30) of women who are eligible at enrollment. Completion of PCAP or May 31, 2012, whichever comes first?

The target population for the PCAP initiative is women who have had an alcohol-exposed pregnancy and meet ASAM criteria for, or are participating in, residential or intensive outpatient treatment within the Network 180 and Lakeshore area of service. The counties to be used as the target geographic area are Kent, Muskegon and Berrien. The number of women eligible for PCAP, based on our FY 2006 data, is approximately 1,700.

The organization of the state system for substance abuse services is centered on the 16 regional CAs. These agencies are charged with planning, contracting for and administering the treatment and prevention services in their geographic boundaries. ODCP monitors CAs to assure compliance with state and federal regulations. The two participating CAs are located on the western side of the Michigan’s Lower Peninsula. Grand Rapids is the second largest city in Michigan and is in Kent County, which is served by network 180. Lakeshore Coordinating Council (LCC) provides services in Ottawa, Allegan, Muskegon and Berrien counties. These counties, although smaller in population, have two of the highest-need areas in the state, Benton Harbor and Muskegon. The LCC region also has a large rural population.

The complex needs of women with a substance use disorder cannot be met by the treatment system alone. Adequately addressing all their needs will require multiple systems of providers and services. Case managers face the challenge of integrating PCAP into the existing treatment system, collaborating with other human service systems and earning the respect of others in the community. Eligibility criteria are used to screen and identify women in residential substance abuse treatment programs who are eligible for participation in the program.

Women enrolled in the program are linked with case managers who work with the women in a wide range of areas as needed. Case managers are responsible for establishing relationships with clients, identifying client goals, establishing linkages with service providers, developing written agreements between clients and service providers, teaching clients basic living skills and evaluating client outcomes. Case managers work closely with their clients to help support their efforts at recovery and are active in assisting them reconnect to treatment services if the clients experience relapse.

The Project Director is responsible for facilitating group and individual staff meetings, providing opportunities for staff development training, and developing and maintaining collaboration with local service delivery organizations. The Project Director works with the project Evaluator to collect, manage and deliver data on individuals served. The Project Director also communicates frequently with the Task Force and the Grant Manager to monitor progress of the project’s activities and to develop the policy recommendations needed to sustain and enhance efforts to prevent alcohol-exposed pregnancies.

The hiring and training of staff was completed by the end of September 2008. Arrangements have been made for training as needed for staff turnover. Some glitches in financial reporting have been worked out, but the initial process was completed as planned in August. The process of implementing the enrollment of eligible women began in October 2008; women were assigned to a case manager. Recruitment strategies were developed in September 2008. Policies for retention and referral were also been completed as planned. Data collection strategies were reviewed and began in October 2008 with collection of completed intake forms and time summaries. The paper system was replaced with a internet based data system in the spring of 2009. This system allows for more data analysis at the program and state levels.

Problems in implementation have been addressed through monthly staff meetings and/or Leadership Team meetings as needed. In order to assess the project’s impact on enrolled clients, the use of alcohol, drugs and contraception was assessed at program entry and will again be measured at exit by administration of the Alcohol Severity Index as modified by PCAP. This data will determine if the outcome objectives have been achieved. PCAP requires data collection every six months during the intervention, this includes:

  1. verifying eligibility;
  2. initial client assessment;
  3. weekly case manager time summaries;
  4. review of client goals;
  5. biannual client progress reports; and
  6. final outcome measures.

Process objectives have been monitored through data regarding enrollment, retention, frequency of case manager contact, client progress toward goals and community service use. During option year two the project completed enrollment of clients. Since the intervention covers three years, clients should have all be enrolled by May 2009. Michigan did not meet that goal. Since that time, any new enrollments have been because of a client due moving out of the service area. In the state of Washington, clients are staggered so that case managers have some clients who are in each year of the intervention. By enrolling within a short period of time case managers have been overwhelmed at times with the crisis’s that come with new clients.

Client progress is seen in the data collected at six-month intervals. Current data shows increases in the number of clients who are abstinent from both alcohol and drugs as compared to their status at intake. The best outcome has been in the area of family planning. It is a fact that abstinence will prevent alcohol exposed births, but family planning can also limit the exposure of fetuses to alcohol. The use of permanent or effective birth control methods will allow clients to plan for future pregnancies and stop the use of alcohol when they decide to have a new child. The rates at intake were 28% of clients. At six months the rates increased to 39%, at twelve months 55% and at 18 months 67%.

Michigan PCAP offers a unique intervention strategy for women who are most at-risk of an alcohol-exposed pregnancy. The success of this strategy may influence replication in other parts of the state. The project has been a positive example of collaboration between substance abuse treatment centers and maternal and child health programs at the Department of Community Health.