When case management isn't enough: a model of paraprofessional advocacy for drug- and alcohol-abusing mothers.

The Seattle Birth to 3 Project is a paraprofessional advocacy model of enhanced case management designed to effectively intervene with high-risk, drug-dependent mothers. Postpartum women were enrolled based on their heavy use of drugs or alcohol during pregnancy and lack of connection to community services, including prenatal care. Each participant was assigned a paraprofessional advocate who worked intensively on a one-to-one basis with her and her family for 3 years postpartum. Six components of the model advocacy program are identified: establishing the relationship; identifying client goals; establishing linkages with service providers; using written agreements; role modeling and teaching of basic skills; and evaluating the outcome. Results for 51 women assessed after 1 year indicate significant areas of improvement including increased involvement with drug/alcohol treatment agencies, decreased drug use, increased use of birth control, and increased involvement with supportive and skill-building groups such as parenting classes.