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.
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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.