Enhanced Case Management

Case management (CM) and motivational interviewing as part of a comprehensive program.

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The intervention consisted of case management (CM) enhanced with motivational interviewing strategies delivered to women at high risk for drinking during pregnancy as part of a comprehensive fetal alcohol syndrome (FAS) epidemiology and prevention program. Participants received case management for an average of 17.2 months. Case management was delivered to individuals in person and over the phone.

Outcomes

Estimates of changes or differences in alcohol-related problems and the stability of those changes or differences. 

Medium/Mixed Level of Change

The risk of experiencing an alcohol exposed pregnancy was modestly reduced at 6 months. 

This study enrolled a high-risk sample and showed positive results among a subset of participants. Thirty-one percent of the women receiving case management entered some type of formal alcohol or drug treatment. Both intoxication and frequency of alcohol consumption was reduced at 6-month follow-up but the drinking reports at 12 months were higher than at baseline for women still in case management (n = 37). The majority of pregnancies resulted in normal deliveries.

Costs

Two domains estimating start-up and ongoing expenses. 

High start-up and moderate maintenance costs due to extensive training and staffing requirements. 

Start-up costs include two workers per location, plus a trainer/supervisor providing training and quality assurance. The ongoing cost would be moderate due to the time and labor-intensive nature of the intervention.

Cultural Engagement

Two indicators of cultural and Tribal/community contributions. 

No report of cultural inclusion; low level of Tribal involvement. 

No cultural engagement is described other than mention of community leader support for prevention and case management. Tribal councils were reported to have collaborated closely with the project staff.

Women at high risk for an alcohol exposed pregnancy in 4 AI/AN communities. 

The setting was four American Indian communities in Northern Plains states. Participating were 137 Native women with a mean age of 25 years. Eligibility criteria included drinking during pregnancy or prior fetal alcohol spectrum (FAS) diagnosed births.

Staffing Needs

Credentials and/or background of personnel who delivered the intervention. 

Certified Professional

Credentials and background of field staff not specified. 

The field staff (a prevention site manager and a case manager at each of four sites) were trained and overseen by a licensed social worker who also provided supervision and coordination of activities. Other than the social worker, no specific background is indicated.

Research Design

Methods employed to gather research data. 

Pre-/post-intervention data

Developmental stage of research

Stage of development of the evidence supporting this intervention. 

Early Stage

Early-stage research with moderate but unstable change and unclear effectiveness due to low retention. 

Spotty data and lack of a random sample impeded full demonstration of the power of case management in Tribal communities. There were considerable missing data, which might have introduced significant bias in the follow-up analyses. Yet the overall conclusion that there were only one or two documented cases of FAS in a sample of more than 100 Native American women at high risk suggests that this approach is promising.

Potential

Narrative offered by expert reviewers providing overall comments or evaluations about the intervention. 

Additional research is required to determine the efficacy of this promising approach. 

Because the basic principles of case management and motivational interviewing are theoretically sound and have shown some efficacy, these results point to the need for wider testing. If combined with cultural tailoring to broaden the appeal and greater incentives for remaining in the program and completing assessments, this case management approach would be worth testing in more Native communities.

References

Primary 

May PA, Miller JH, Goodhart KA, et al. Enhanced case management to prevent fetal alcohol spectrum disorders in Northern Plains communities. Matern Child Health .2008;12(6):747-759. https://www.ncbi.nlm.nih.gov/pubmed/18026824 . https://doi.org/10.1007/s10995-007-0304-2 .

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