Effects of case management on retention in prenatal substance abuse treatment

INTRODUCTION

Participation in substance abuse treatment during pregnancy is associated with improved pregnancy results (1). Retention in treatment programs is conceit to be improved if case management is provided completely through pregnancy (2). Although there is no agreement forward definition, core elements of case management include assessment of the ne for health and social services, planning and coordination, monitoring to render certain that services are received and are satisfactory, and advocacy upon behalf of clients (3). The mechanism according to which case management may operate is study to include provision of emotional and tangible supports (such as providing transportation and housing) to allow substance-using women to retain appointments and concentrate on convalescence and by giving special attention (through domestic circle visit, etc.) to women who generally perceive stigmatized because of their substance use and slighted by health professionals (4). While the value of case management in treatment programs is recognized, little data exist documenting meanings on retention (2). The following is an evaluation of the impact of united case management program funded from the Center for Substance Abuse Prevention in succession the retention of pregnant substance-using women in unsalable article treatment. The evaluation was designed to examine the question: What tenor if any, does case management have upon retention in drug treatment?

MATERIALS AND METHODS

Sample Selection

All pregnant women calling to chronicle in the intensive outpatient treatment constituent of the Eleanor Hutzel redemption Program in Detroit, Michigan, from March 1990 [i]or[/i] part of to the other March 1992, were offered case management services between the walls of a federally funded demonstration delineate Mother-Infant Substance Abuse Network (MISAN). Four hundr and undivided women agreed initially to participate and their names and phone numbers were given to the MISAN brew Contact was attempted by phone or to one's home visit generally within 2 weeks of the referral. Ninety-two women (229%) could not be contacted on MISAN staff and most of these women (N = 88) did not detain their initial "pretreatment" appointment at the treatment center For the 309 women contacted, 15 refused to participate in case management services and 69 were no longer pregnant proper to abortion or they had already delivered. couple hundred and twenty-five women signed approval forms to become clients and all were interviewed in their hearthstones as part of the initial assessment. The concoct evaluation was approved by the Human Investigations Committee of Wayne State University.

Program Components

MISAN. Case management services were provided by dint of a team composed of couple social workers, one nurse, and the same paraprofessional located in the Detroit Health Department. After an initial in-home assessment to determine the client's ne for health and social services, a service plan was disentangleed with the client. Clients were linked with services by dint of written referral, and calls to agencies by means of MISAN staff to make appointments and to advocate onward behalf of clients. The throw out provided free transportation to substance abuse treatment and prenatal care if clients lacked transportation. The Healthy Baby Van, driven by the agency of a paraprofessional worker trained in the urgencys of low-income pregnant women and infants, transported women from to one's home to service and return through scheduled pickup. MISAN staff participated with substance abuse and prenatal clinic staff in case parleys in an effort to coordinate care for individual clients. Staff followed clients by the agency of home visits, telephone calls, and contacts in the prenatal clinic over pregnancy and the first year following delivery. Contacts were scheduled based onward client need for service, with monthly contacts at a minimum. All clients received a place of abode visit within 6 weeks of delivery. The mother's penurys assessment was revised at that time and the infant was evaluated by way of Denver Development testing and by way of assessment of need for services. Contacts with clients, moot points detected, and the number and nature of services provided were recorded forward daily service logs.

Eleanor Hutzel recruiting Center (EHRC). The substance abuse treatment agency, begun in 1972 has always serv women single with emphasis on coordination of substance abuse and medical treatment for pregnant and post-partum women and their children. Women with a generally received or recent history (within last 6 months) of alcohol and illicit unsalable article use are eligible for treatment, although exceedingly few clients use only alcohol. Women are generally seen within 2 weeks after they call, and must withhold two "pretreatment" appointments before they are admitted into the treatment program. Individual and form into groups counseling, pregnancy education classes, and vocational services are provided to women in the pregnancy program at least three times for week throughout pregnancy. Urine cloaks are performed as part of greatest in number visits. Methadone is provided to women addicted to heroin. Staff are similar to clients in ethnicity and form relative to sex and include an obstetrician (who also views patients at the prenatal clinic), psychiatrist, encourages social workers, substance abuse technicians, and an HIV (human immunodeficiency virus) specialist. Child care is available upon site. All pregnant women receive prenatal care pair blocks from the treatment facility and deliver nearby at Hutzel Hospital. The goal of the pregnancy program is to retain women in prenatal care and to improve pregnancy results The recovery program begins after delivery and its goal is to assist drug-free living.