Parent-Child Assistance Program (PCAP)

Brief Description

The Parent-Child Assistance Program (PCAP) launched in New Brunswick in 2018 in response to the growing number of babies born with Neonatal Abstinence Syndrome and Fetal Alcohol Spectrum Disorder. Rooted in relational theory, PCAP provides trauma-informed, evidence-based, and goal-oriented support to women/birthing people who use substances. By pairing clients with an Advocate for three years, PCAP supports families to access the supports and resources needed to disrupt cycles of adversity, build assets, and gain agency of their life while preventing Adverse Childhood Experiences and supporting healthier lives for children.

Goals

The main goals of the Parent-Child Assistance Program are to:

• Help mothers/birthing people achieve and maintain recovery;
• Build healthy family lives; and
• Prevent the births of subsequent alcohol/drug exposed infants.

Clientele

The clientele for the Parent-Child Assistance Program are women and birthing people (19 years old and older) who are pregnant or up to 5-years postpartum, self-report using alcohol or drugs during the pregnancy, and who have ineffectively engaged with community service providers. PCAP is a non-mandated program. Participants are identified through engagement with other services offered by New Brunswick Social Pediatrics (e.g.,. Community Social Pediatrics Clinic) or can be referred by completing an online referral screening questionnaire.

Core Components

PCAP’s theoretical framework has three main components: relational theory, stages of change, and harm reduction. The client and target child are paired with an Advocate who facilitates client-driven goal setting, mitigation of barriers, role-modelling of positive relationships, service connection, and community-building activities. Visits occur in various settings and can include the home, appointments or scheduled chats. Advocates have a caseload of 16-20 families each and see clients at least twice monthly. Advocates become a consistent and supportive person to clients and help them to build their self-efficacy and avoid future substance- or alcohol-exposed pregnancies.

The Parent-Child Assistance Program consists of:

• Individually tailored, strengths-based case management to build rapport and deliver interventions, attends to the needs of the whole family, and utilizes existing resources in the community;
• Long-term interventions (three years) which allow for clients to form a therapeutic alliance with their case manager and undergo the developmental process of making gradual behavioural changes; and
• Mentoring as the attention, care and support that is given to clients is expected to be reflected in the way clients interact with their children, enabling clients to enhance their ability to care for their child(ren) physically, emotionally, and socially.

Implementation Information

Some of the critical elements for the implementation of this program or initiative include the following:

• Organizational requirements: This program relies on a host agency which can successfully provide long-term services to high-risk families or populations who use substances, and trained clinical supervisors and case managers.
• Partnerships: PCAP relies on existing programs and services in the community, and as such community-level partnerships are critical. Partners include public and non-profit organizations who work to address alcohol and drug use, mental health concerns, housing, and violence.
• Training and technical assistance: PCAP staff receiving intensive, specific training related to the PCAP model as detailed by the University of Washington’s Department of Psychiatry and Behavioural Sciences. In addition, PCAP staff receive training on resources available through local partners, and yearly refresher training on the PCAP Model and Program Delivery, Motivational Interviewing, The Brain Story, Privacy and Confidentiality, Naloxone Training, FASD Training, TCPS-2 (CORE) Course on Research Ethics, and Outcome Tracker User training.
• Risk assessment tools: Limited information on this topic.
• Materials & resources: Limited information on this topic.

International Endorsements

The most recognized classification systems of evidence-based crime prevention programs have classified this program or initiative as follows:

• Blueprints for Healthy Youth Development: Not applicable.
• Crime Solutions/OJJDP Model Program Guide: Not applicable.
• SAMHSA's National Registry of Evidence-based Programs and Practices: Not applicable.
• Coalition for Evidence-Based Policy: Not applicable.

Gathering Canadian Knowledge

Canadian Implementation Sites

The Parent-Child Assistance Program (PCAP) was developed in 1991. In response to the growing number of families impacted by substance-use and the number of babies diagnosed with neonatal abstinence syndrome, New Brunswick Social Pediatrics adapted and launched PCAP in Saint John, New Brunswick, Canada in 2018. Beginning as a pilot project, PCAP is now expanding to additional sites in New Brunswick.

Through Public Safety Canada’s Gun and Gang Violence Action Fund, funding was provided to the Department of Justice and Public Safety to implement its 5-year plan on gun and gang violence. As part of that plan, the province implemented a Crime Prevention Conditional Grant fund to facilitate local-level crime prevention activities. PCAP received funding to continue to model in Saint John, and expand to additional sites, from 2022 until 2025.

Main Findings from Canadian Outcome Evaluation Studies

Study 1

A preliminary, descriptive study on the impact of the PCAP pilot project was conducted by Gander and colleagues in 2023. Researchers examined the outcomes of 71 PCAP clients in New Brunswick to explore the program’s impact on the lives of birthing people who use substances. For more information, refer to the Gander et al. (2023) publication.

Results demonstrated that:

• Reducing barriers and stigma, while using a harm reduction approach, can help lead families impacted by substance use to healthier outcomes and more community connections.
• Eighty percent (n = 8) of subsequent pregnancies (10 total) were considered “non-exposed”, meaning there was no substance or alcohol use during pregnancy.
• Upon program exit, 69% (n = 49) of clients were abstinent from using substances, 41% (n = 29) were engaged in recreation activities, 37% (n = 26) in skills training, and 18% (n = 13) were enrolled in academic or vocation activities while in the program.

Study 2

In 2014, Xuan Thanh and colleagues conducted a cost-benefit analysis, comparing the actual cost associated with PCAP to the net monetary benefit of the program. The study utilized the number of women who had been served by the Alberta FASD-CMC PCAP from 2008 to 2011 (N = 366). Due to the scope of the analysis, the study solely focused on birthing people who used alcohol (44%), and the remaining sample (56%) were excluded because they used other substances. For more information, refer to the Xuan Thanh et al. (2014) publication.

Results demonstrated that:

• PCAP is cost-effective and the net monetary benefit is significant.
• PCAP prevented an estimated 31 cases of FASD among the 366 clients in a 3-year period, reflecting a net monetary benefit of $22 million.

Study 3

In 2017, Pei and colleagues leveraged a participatory research approach, conducting quantitative and qualitative analysis, to evaluate PCAP’s implementation in Alberta First Nation Communities. The evaluation sought to provide information about PCAP’s implementation and its outcomes. For more information, refer to the Pei et al. (2017) publication.

Results demonstrated that:

• PCAP works well in First Nation communities (i.e., staff reported a high degree of fidelity to the PCAP model), and mentors are able to deliver culturally respectful services through the model.
• Evaluation of client and family outcomes was limited, but anecdotal findings from Advocates suggested that there were observed increases in clients’ positive community experiences and independence, and observed decreases in clients’ feelings of stigmatization, isolation, and stress levels.

Cost Information

In 2013, the average cost for one woman per year was $6,918. The PCAP cost savings per woman over the three-year period was estimated at $19,782. It was estimated that preventing one case of FASD would result in $97,000 of incremental cost savings (Thanh et al., 2015).

References

Gander, S., Campbell, S.A., Fana, N., Lunney, S., & Estrella, C.M. (2023). Parent Child Assistance Program. New Brunswick Social Pediatrics. https://www.cureus.com/posters/2788-parent-child-assistance-program

Pei, J., Tremblay, M., Carson, E. & Poth, C. (2017). Parent-Child Assistance Program (PCAP) in Alberta First Nation Communities: Evaluation report. PolicyWise for Children & Families in collaboration with the University of Alberta. https://canfasd.ca/wp-content/uploads/2018/02/PCAP-FN-Report_Revised_FINAL_10262017.pdf

Xuan Thanh, N., Jonsson, E., Moffatt, J., Bennett, 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. https://doi.org/10.1007/s10488-014-0537-5

New Brunswick Social Pediatrics. (n.d.). Parent-Child Assistance Program. https://www.nbsocialpediatrics.com/parent-child-assistance-program

For more information on this program, contact:

University of Washington, Parent-Child Assistance Program (PCAP)

Department of Psychiatry and Behavioural Sciences

Addictions, Drug & Alcohol Institute

1959 NE Pacific St., Box 356560, Seattle, WA 98195-6560

Telephone: (206)543-7155

Email: sastoner@uw.edu

Website: https://pcap.psychiatry.uw.edu/