Effectiveness of Child Case Management Services for Offspring of Drug-Dependent Women

Abstract

Female drug users and their children have many medical and psychosocial problems, yet they often fail to follow through with prescribed treatments. The present study describes a specialized, case management program for children, birth through age 2, exposed to drugs in utero. Evaluation of program efficacy was examined by comparing 2-year outcomes for women who received different intensities of these child case management services. Mothers who received higher intensity care were more likely to be abstinent from illicit drugs and to have retained custody of their child(ren) at 2-year follow-up than those with lower intensity services. Study findings support clinical and economic efficacy of this model of care.

• “Substance abuse”
• Outreach
• Home-visitation
• Family planning
• Foster care
• At-risk
• Drug exposure
• Case management

Resumen

Mujeres que abusan drogas y sus hijos presentan muchos problemas médicos y psicosociales, sinembargo con frecuencia fallan en seguir los tratamientos prescritos. El presente estudio describe un programa especializado para manejo de casos de niños, desde el nacimiento hasta los 2 años, que han sido expuestos a drogas en su vida intrauterina. La evaluación de la eficacia del programa fué realizada comparando el resultado a los 2 años en mujeres que habían recibido los servicios del manejo de casos con diferente intensidad. Madres que recibieron cuidados con mayor intensidad, tuvieron mayor probabilidad de presentar abstinencia del uso de drogas ilícitas y de mantener la custodia de sus hijos, que quienes recibieron servicios menos intensos. El estudio apoya la eficacia clínica y económica de este modelo de atención.

Résumé

Les femmes toxicomanes ainsi que leurs enfants ont de nombreux problèmes medicaux et psycho-sociaux, or elles finissent souvent par ne pas suivre leurs traitements préscrits. L’étude ci-jointe décrit un programme specialisé de gestion de cas d’enfants, de la naissance à l’age de deux ans, dont les mères se sont droguées pendant leurs grossesses. L’évaluation de l’éfficacité de ce programme a été faite en comparant les résultats au bout de deux ans pour un nombre de femmes ayant reçu des services d’encadrement pour leurs enfants d’une intensité variable. Les mères ayant reçu un degré de soins plus intensif ont eu plus tendance à s’abstenir de consommer des drogues illicites et à avoir retenu la garde de leur enfant au bout de deux ans que celles ayant reçu une intensité de services moindre. Les conclusions de l’étude soutiennent donc l’éfficacité medicale et économique de ce modèle de soins.

Additional information

Notes on contributors

Lauren M. Jansson

Lauren Jansson, M.D., is an Assistant professor of Pediatrics, and has directed the Pediatric component at the Center for Addiction and Pregnancy since its inception in 1991, where this research was performed.

Dace S. Svikis

Dace Svikis, Ph.D., is an Associate Professor in the Department of Psychology at Virginia Common-wealth University. She is also the Director of Research for the Institute for Women's Health. She has been involved in substance abuse treatment research for nearly two decades, with a primary focus on gender-specific treatment and perinatal addiction.

Peter Beilenson

Peter Beilenson, M.D., M.P.H., has been the Commissioner of Health for Baltimore City since 1992. Projects that he has been involved with in this capacity include drug treatment expansion for Baltimore, implementing needle exchange programs, contraceptive availability in schools for sexually active teenagers, immunization compliance, lead poisoning prevention, ensuring health care availability in every public school and leading a state-wide initiative for universal health coverage in Maryland. Dr. Beilensen is an Associate of the Department of Population and Family Health Services at Johns Hopkins School of Hygiene and Public Health.