The purpose of this randomized clinical trial is to examine if extended case management can correct deficiencies in existing clinical programs for drug abusing pregnant women. We propose to provide and link a broad array of services including medical care, mental health treatment, social services, educational service, and vocational services. Subjects will be randomly assigned to three groups: Control group, experimental group receiving case management, experimental group receiving telephone assisted case management. Subjects in all three group have access to the Ohio Medicaid benefits for prenatal care, pediatric visits, and inpatient detoxification. In addition, the project will provide all subjects with outpatient intensive detoxification for five weeks, a telephone and subsidy for local phone calls. Subjects in the first experimental group will be assigned to 2 case managers. Subjects in the second experimental group will be assigned to 1 case manager and a host of computerized telephone services. These computerized services include 1) facilitation (filling applications to social and vocational services, setting up appointments, checking on no-show appointments, allowing providers to leave and receive messages from the patient), 2) social support (initiating phone contact between patient and role model organizing telephone group counseling), 3) education (point-of-need education on drug abuse, prenatal care, and parenting to the patient the grandmother and patient's friends), and 4) biweekly telephone assessment of the child and the mother. Outcome variables of interest include: drug free status, maintenance within the health care system, proper utilization of eligible social services, utilization of well child care, weight at birth infant growth and development, and the incidence of child abuse and neglect. Data will be analyzed using time series analysis. The project demonstrates the ability of a computer and telephone lines to provide an extensive array of services to drug abusing pregnant women. The components of technology (i.e. provision of care through telephone lines, use of computers to educate and reduce isolation of patients, and case management) have been proven successful in other settings. The combination of these components and the application to drug abusing pregnant women is new, and the subject of the evaluation of this proposal. The technology is appropriate for the target population because it is relatively inexpensive beyond the development phase. It reduces the patient's isolation, a major risk factor for drug abuse and for child abuse. It reaches out to the patient's home environment and peer, thus it reduces the chances for relapse into old habits. It allows more effective follow-up of the patients, thus reducing the unnecessary hospitalization of mothers or infants. Finally, it is not hampered by the reading ability of this target population. This project is a demonstration of a intervention model that could be easily adopted at a National level.
