Promising - One study
Date: This profile was posted on March 19, 2013
An intensive outpatient substance abuse treatment program for pregnant and postpartum women. The program is rated Promising. Newborns of mothers enrolled in the program had significantly heavier mean birth weight; a longer gestational age; were significantly less likely to be admitted to the neonatal intensive care unit; and were less likely to have positive toxicology screens compared with infants of mothers who enrolled postpartum.
Program Goals/Target Population
Project Link is a hospital-based, intensive outpatient substance abuse treatment program for pregnant and postpartum women. The program integrates specialized substance abuse treatment services with maternal and child health care to improve the health and well-being of pregnant women and their children. The program was developed at the Women and Infants Hospital of Rhode Island in 1991.
The project involves a variety of clinical personnel, including a project director, a clinical coordinator, social workers, and case managers. Staff combine their expertise in mother-and-child health and substance abuse treatment with cultural competence and information about community resources.
Project Link offers intensive and nonintensive outpatient treatment (group and individual) to pregnant women with substance abuse and mental health illnesses. The program also provides case management, parenting and self-care education, and onsite child care.
Pregnant women receive intensive outpatient services from Project Link 3 to 5 days a week for 3 hours a day, which includes 1 hour of individual therapy and 1 hour of case management. There are also group sessions that address issues such as early recovery, relapse prevention, parenting skills, domestic violence, and self-care.
Outpatient services can include one to two individual therapy sessions a week or one to two group sessions a week. The group sessions also address early recovery, relapse prevention, parenting skills, domestic violence, and self-care. Both programs include supervised urine screens, breathalyzers, psychiatric evaluations, and medication management.
In addition, the program collects and distributes donated items, such as blankets, diapers, and baby clothes.
Mean Birth Weight
The analysis conducted by Sweeney and colleagues (2000) showed that newborns of mothers who enrolled in Project Link during pregnancy had significantly heavier mean birth weight (3,059 grams; that is, about 6¾ pounds) than newborns of mothers who enrolled postpartum (2,669 grams; about 5.88 pounds). In addition, a significantly lower percentage of newborns of prenatal enrollees were low birth weight, compared with newborns of women who enrolled postpartum (19.5 percent versus 40.2 percent, respectively). The regression analysis, which adjusted for individual differences known to affect outcomes, also showed that infants of prenatal enrollees were significantly heavier (418 grams heavier) and about one third as likely to be born with low birth weight compared with infants of postpartum enrollees.
The gestational age for newborns of mothers who enrolled during pregnancy was almost 2 weeks longer (mean gestational age of 38.6 weeks) compared with infants whose mothers enrolled postpartum (mean gestational age of 36.7 weeks). The difference in gestational age between the groups was statistically significant. The regression analysis confirmed that infants of prenatal enrollees were on average 2 weeks older in terms of gestational age and one fifth as likely to be born before 37 weeks’ gestation compared with postpartum enrollees.
Apgar scores at 1 minute and 5 minutes were significantly lower for infants of mothers who enrolled postpartum than infants whose mothers enrolled during pregnancy. The regression analysis confirmed this result.
Neonatal Intensive Care Unit Admission
Infants born to mothers who enrolled during pregnancy were significantly less likely to be admitted to the neonatal intensive care unit (NICU). A little over 25.0 percent of infants whose mothers enrolled during pregnancy were admitted to the NICU, compared with 35.6 percent of infants whose mothers enrolled postpartum (a significant difference). The regression analysis confirmed that infants of prenatal enrollees were half as likely to be admitted to the NICU as infants of postpartum enrollees.
Infant Toxicology Status at Birth
Mothers who enrolled in Project Link during pregnancy postpartum were significantly less likely to have infants whose toxicology screens were positive compared with mothers who enrolled postpartum (21.8 percent versus 57.5 percent, respectively). The regression analysis confirmed this result.
Sweeney and colleagues (2000) evaluated Project Link using a quasi-experimental design, since randomization of pregnant substance-abusing women to treatment/nontreatment groups was not ethically possible. The study included all women who enrolled in Project Link either prenatally or postpartum and who delivered a newborn between May 1, 1992, and Dec. 31, 1995. Infants born to women enrolled in Project Link during pregnancy were compared with those born to women who did not receive Project Link services until after delivery.
Women who enrolled during pregnancy were referred by the prenatal care provider. They received a comprehensive package of substance abuse treatment services, including individual and group counseling and case management. Women who enrolled postpartum were referred by staff in the labor and delivery suite or the postpartum inpatient units. They received prenatal care but did not receive substance abuse treatment services during pregnancy.
The study sample included 87 women who enrolled in Project Link while pregnant and 87 women who enrolled postpartum. The women who enrolled while pregnant had an average age of 26.9 years and were 54 percent white and 33 percent African American (the other 13 percent were not specified in the study). The women who enrolled postpartum had an average age of 27.6 years and were 51 percent white and 39 percent African (the other 10 percent was not specified in the study). There were no significant differences between the groups in age, race, education, and income. For substance abuse histories, there were also no significant differences in age at initiation of drug use, frequency of use, and relationships with partners and family members with drug problems. Those women who enrolled while pregnant were more likely to have been in treatment previously and were more likely to admit difficulty in abstaining.
The pregnancy outcomes of interests were birth weight, gestational age, Apgar scores at 1 minute and 5 minutes, neonatal intensive care unit admission, and infant toxicology status at birth. These outcomes were chosen because they are known to be negatively affected by intrauterine substance exposure and were considered indicators of infant morbidity.
Pregnancy outcome data was analyzed using univariate and multivariate approaches. The univariate analysis used Rothman’s odds ratio test for the tests of proportion and t-test of means for continuous variables. The multivariate model used ordinary least squares regression and logistic regression to control for individual characteristics that could affect the outcomes, including prior treatment involvement and prenatal care.
There is no cost information available for this program.
Information about Project Link can be found on the program’s Web site.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1
Sweeney, Patrick J., Rachel M. Schwartz, Noreen G. Mattis, and Betty Vohr. 2000. “The Effect of Integrating Substance Abuse Treatment With Prenatal Care on Birth Outcome.” Journal of Perinatology