The Parent-Child Assistance Program (PCAP) helps mothers who have used alcohol, opioids,
or other drugs during pregnancy and their children through the work of highly trained,
closely supervised case managers. Case managers work closely with mothers over the course
of three years, meeting the mothers in their own homes when possible, to help them to set
goals and take advantage of available resources. The primary aims of PCAP include: (1)
assisting mothers in obtaining substance use disorder (SUD) treatment and staying in
recovery, (2) linking mothers to community resources that will help them build and
maintain healthy, independent family lives for themselves and their children, and (3)
preventing future drug and alcohol use during pregnancy.
This study brings PCAP to Oklahoma (the state with the highest incarceration rate for
women, where most enter the criminal justice system for drug charges) for the first time.
In Washington state, where PCAP was first developed and implemented by researchers at the
University of Washington in 1991 with federal funding, PCAP has expanded to 15 sites,
covering 19 counties and a large majority of the state's population. The population the
Washington program serves is highly vulnerable with significant childhood trauma.
Eighty-nine percent of the mothers themselves had parents who abused alcohol and drugs.
Nearly two-thirds were physically or sexually abused as children. Approximately one
quarter had spent time in foster care. Thirty-five percent did not have a high school
degree. Among 36% of mothers, Temporary Assistance for Needy Families (TANF) was their
main source of income. The investigators anticipate that PCAP participants in Oklahoma
will share similar characteristics with those in Washington.
PCAP in Washington conducts evaluations focused on tracking outcomes for all
participants. Despite the complex needs and vulnerability of this population and the
tenuous situation of substance abuse while pregnant, PCAP outcomes are impressive. Among
1,561 graduates of the 3-year program between 2014-2020, at their exit from the program:
90% had completed SUD treatment or were in progress
82% were abstinent from alcohol and drugs for 6 months or more during the program
and/or regularly using reliable contraception
54% had attended or completed classes (GED, college, or work training)
70% of the mothers had retained or regained legal custody of their child
93% had obtained well child visits and were up to date on child immunizations
Graduates of Washington PCAP were also less likely to use illicit drugs and receive TANF
and more likely to be employed, use reliable contraceptives, and reside in permanent or
stable housing. Furthermore, the Washington State legislature, prior to expanding the
program, requested a cost savings analysis. This analysis, based on robust evaluation
results, shows that the program likely realizes multiple sources of cost savings from
reduced dependence on child welfare, fewer subsequent alcohol- and drug-exposed children,
and reduced dependence on public assistance, among other benefits. The investigators
expect similar outcomes for PCAP in Oklahoma.
This five-year project includes 200 women who will enroll in the study and be randomly
assigned to the treatment (100 women) or control group (100 women). The intervention
(i.e., PCAP services) will take place over a three-year period at two sites: Oklahoma
City, Oklahoma and Tulsa, Oklahoma. The control group will be provided with a service
resource list and receive services as usual but will not be enrolled in PCAP. The
intervention will conclude with sufficient time for a six-month follow-up survey for
women who are among the first to enroll in PCAP.
The evaluation of Oklahoma PCAP includes multiple surveys to measure participants'
substance use, substance use disorder (SUD) treatment outcomes, and a host of other
well-being outcomes, including but not limited to subsequent substance-exposed births,
use of public assistance, education, use of family planning methods, and employment.
Among these, the investigators have identified four key outcomes: (1) the mother is on a
reliable method of birth control, (2) abstinence for six months, (3) child custody (i.e.,
placement of children in foster care and/or with kinship providers), and (4) criminal
justice involvement.