Parent-Child Assistance Program (PCAP)
The Parent-Child Assistance Program was started in 1991 in the state of Washington as a pilot project to help substance-abusing mothers build healthier support systems and obtain resources that will enable them to maintain healthy independent lives. This is done through a “home visitation case-management model” in which mothers are paired with a case manager who will serve as their advocate. PCAP helps mothers obtain alcohol and drug treatment, stay in recovery, and work through issues related to their substance use. There are currently 12 sites in Washington with talks of expanding to 15 sites in July 2017. The King County site is one of the largest sites and I was grateful for the opportunity to meet with its site supervisor, Charlene (Lena) Takeuchi who has been with the program for over 18 years.
The KC site recently moved to a simple office building off Lake City’s busy Aurora Ave. As a result, the location is still working on unpacking and making it feel like home. Upon entering, there is a living room-like area filled with toys for all ages to welcome the families. There is a computer for mothers to use if they need to access any materials. It’s a simple setup where they meet with case managers to talk about their situation, but I imagine that most of the magic occurs during these interactions. The site’s most important possession is a whiteboard that shows where the case managers are for that day if they are out in the field and what vehicles they are using. Lena stresses the importance of having her case managers check in every couple of hours so she can make sure they are safe and accounted for.
Lena and I talked about the logistics of the program and the difficulties they have encountered. A lot of the women have significant trauma, either from family, friends, significant others, or the shame associated with substance abuse and pregnancy. This prevents them from seeking a lot of the care they need. She recalls a patient who was successfully enrolled in a treatment program at Swedish and on the day they had sent an advocate out to pick the patient up, the advocate was late. This led to the patient becoming worried and deciding to opt out of being admitted to rehab.
It was clear that PCAP has made an amazing amount of progress is gathering data about the role of traumatic events and substance abuse in pregnancy. This allows for continued funding as well as policy changes to help these mothers get the help they need.
Swedish OBGYN Chemically Using Pregnant Women’s Program – Ballard Campus
Swedish’s OBGYN treatment program specifically focuses on admitting pregnant women with substance use. It is led by Dr. Jim Walsh, an efficient yet compassionate and empathetic gentleman who entered the field of addiction by opportunity and chance. Having visited PCAP the day before, I was told that Dr. Walsh is an amazing presence in the field of OBGYN and addiction and is a valuable asset to the community.
The setup of the program is unique. For inpatient treatment, there are only a certain number of beds available. They prioritize women who are later in their gestational age and are at higher risk of having complications. During inpatient treatment, women eat together in a communal dining room, do several recovery classes together, and are given medication-assisted treatment. Dr. Walsh stresses the important of having medication-assisted treatment and points out the overwhelming evidence the shows that it works. He has seen countless times that simply believing in yourself (“having confidence”) is not enough because the stigma against those who abuse drugs during pregnancy is so strong that it often leads to isolation and relapse. He believes the program works because they take provide a supportive non-judgmental environment for women who are undergoing similar circumstances. This is particularly important in recovery groups when having someone who is not pregnant discussing their substance use disorder can make those who are pregnant feel more ashamed of their actions.
Swedish also has an outpatient drop-in clinic for those who are undergoing substance use but are not of high risk enough to be admitted. The clinic, located on Swedish’s First Hill, is open Tuesday afternoons and is fully staffed to provide treatment care. Here, women can learn about resources such as PCAP and look into addiction treatment programs that may be available to them in an outpatient setting.
When asking about how women find out about the Swedish program, Dr. Walsh talks about the close-knit community of women and the power of word of mouth. As someone who is interested in Family Medicine, OBGYN, and community health, I hope that this program at Swedish is still around when I am practicing so I can also recommend it to others.