Themes and Variations among Seven Comprehensive Perinatal Drug and Alcohol Abuse Treatment Models

Abstract

In recent years, the prevalence of perinatal chemical dependency has become widespread, .crossing all ethnic and racial lines and every socioeconomic group (Chasnoff, Landress, & Barrett, 1990). Its potential effect on the health of women, children, families, and society has prompted support at the state and federal levels for comprehensive perinatal drug and alcohol treatment models (California Legislature, 1990; Doshan & Bursch, 1982; Graham & Timney, 1990; Jessup & Green, 1987; Novick, 1990; Reed, 1987; U.S. General Accounting Office, 1990). In California, legislation was enacted that funded a novel interdepartmental partnership within the California Health and Welfare Agency. The four agencies involved in this collaborative effort, called Options for Recovery (OFR), were the departments of Alcohol and Drug Programs, Developmental Services, Health Services, and Social Services. The OFR program provided comprehensive perinatal services to more than 2,600 individual pregnant or parenting women at seven pilot sites in both urban and rural parts of the state. The primary OFR program services included case management, residential and intensive outpatient treatment, perinatal medical care, and foster care services. These services were provided in a women-focused, women-sensitive manner to an ethnically and culturally diverse client population. The OFR program also emphasized coordinated service linkages both to prevent service duplication and to ensure that potential service gaps were not left unfilled. A state interagency task force, composed of representatives from the four collaborating state agencies responsible for the OFR program, was established to develop a statewide strategy for addressing the substance abuse treatment needs of pregnant and parenting women and their children. At each of the seven pilot sites, a local lead agency, accountable to the state, was given primary responsibility for implementing the OFR program. The management teams of each pilot project, which at a minimum consisted of alcohol and drug treatment program representatives and case management staff, reported to the local lead agency. Line staff who had ongoing responsibility for providing services for clients included drug and alcohol counselors, case managers, child development specialists, child care workers, parent educators, foster parent recruiters and trainers, mental health workers, and any other service provider that was part of the pilot's OFR program. An evaluation of the OFR program was conducted from 1991 to 1993. On the basis of information obtained through interviews, surveys, and focus groups with OFR staff, clients, and foster parents at all seven pilot sites, as well as quantitative data, the author identified a number of similar treatment and service themes and variations across all seven sites. This article describes both the commonalities and the differences observed during the course of the three-year evaluation. METHODS Qualitative Staff Data In-person interviews were conducted with members of the OFR State Interagency Task Force, staff from both the California Department of Alcohol and Drug Programs and alcohol and drug treatment programs at the local pilot project level, staff from each pilot's local lead agency, managerial and program staff at all pilot sites, foster parent recruiters and trainers, and county social services agency administrators. Interview questions focused on descriptive program information, program philosophy, indicators of success, service provision, staffing, interagency coordination, and program implementation. Program personnel at all seven pilot projects were also surveyed via self-administered, semi-structured survey questionnaires. The survey questions addressed the same issues as the interview as well as professional training and time management. Focus groups were conducted at 18 randomly selected provider sites from the pool of 73 treatment providers that participated in the OFR program. …