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The Comprehensive Program Evaluation Project (CPEP) 

Program Development and Implementation

The Comprehensive Program Evaluation Project (CPEP) is a pilot program intended to serve substance abusing women and their young children. The project is a collaborative effort between the Department of Social and Health Services (DSHS), Division of Alcohol and Substance Abuse (DASA), Medical Assistance Administration (MAA), Research and Data Analysis (RDA), Children's Administration (CA) and the Department of Health (DOH).

The comprehensive program seeks to improve the health and welfare of substance abusing mothers and their young children by early identification of pregnant substance abusers, improved access to and coordination of health care services and chemical dependency treatment, and family-focused early intervention services for mothers and their children. 

This report emphasizes process evaluation and focuses on issues surrounding program development and implementation during the first service year, calendar year 2000. Preliminary data describing client characteristics, service utilization, and specific outcomes are included. The purpose of this evaluation is to describe practices that are demonstrated to be effective and challenges faced during program implementation.

• Three pilot sites -- Benton-Franklin Counties, Snohomish County, and Whatcom Count -- served 194 substance abusing women and their children in the first program year, January through December 2000.

• More than half (57%) of these women were over age 25, 73% were Caucasian, and 68% were single. Thirty-eight percent of these women were pregnant at program entry. These women have a total of 443 children, in addition to their unborn children, for an average total of 2.65 children per woman. Thirty-one percent of these children were living with their mothers.

• All 194 women received Targeted Intensive Case Management (TICM) with an average of 11 hours of case management per client per month. Case management services include conducting intake interviews, developing service plans, and coordinating comprehensive services.

• Over 80% of these women received chemical dependency treatment services, including residential (inpatient) and outpatient services. Ninety-two (47%) women received residential chemical dependency treatment, with an average stay of 90 days.

• Over 30% of enrolled women received transitional housing services, including assistance with obtaining transitional or subsidized housing. Twenty-seven (14%) women occupied transitional housing units. All residential treatment beds and transitional housing units are at capacity, and vacancies are filled immediately as they arise.

• Nearly 80% of enrolled women reported using illicit drugs or a combination of drugs and alcohol before CPEP enrollment. Twenty percent were at risk of using drugs or alcohol.

• The majority of women reported conventional parenting attitudes and behavior and understood the dangers involved in drug use; however, less than half (41%) of CPEP clients reported that they were able to handle most of their problems. Based on the Parenting Stress Index (PSI), program participants had high levels of parenting stress because of their own distress and not because they have difficult children.

• The low birthweight rate for infants born to CPEP clients (9%) was intermediate between that for infants born to known substance abusers (14%) and that for infants born to other Medicaid women in 1999 (6%).

• Challenges for community service providers included building a multidisciplinary team, establishing and maintaining service provision and professional boundaries, and cross-training pilot site staff.

Critical Implementation Factors
Communication among service providers has resulted in successful program implementation. The following key factors were identified:

• Preliminary planning, including discussion about the day-to-day activities, such as sharing information and conducting meetings, is required to serve this population.

• State and community providers must work together to share information, identiFiscal Year shared values, and build a team to meet the needs of this population.

• To communicate and reinforce the vision of this comprehensive program, State staff must provide leadership for community providers and staff. Similarly, community providers must provide on-going leadership to program-level staff.

• State staff must provide continuing support to programs by attending meetings, promptly answering questions, providing feedback about performance expectations, and helping to identiFiscal Year and meet training needs.

• Serving this population may require innovative ways to conduct business and providers must adapt their practices to the program model and the needs of this population.

• Having important resources, such as targeted intensive case management, residential treatment beds, and transitional housing units, in the same community allows women to stay in a familiar location and enhances the ability of service providers to communicate with each other.

Conclusion
The communication that takes place everyday between and among the service providers and State staff has been critical to the successful implementation of this program. This increased communication is a new and challenging way of conducting business -- a way in which service providers truly work together to meet the comprehensive needs of this population.

Modified: Wednesday November 02 2005

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