Effects of case management on retention in prenatal substance abuse treatment

Participation in substance abuse treatment during pregnancy is associated with improved pregnancy outcomes. Case management has been proposed as one way to reduce barriers to receiving and continuing treatment. An evaluation was conducted on a case management program to retain pregnant women in drug treatment. Two hundred twenty-five pregnant women received case management services consisting of home visits, telephone counseling, transportation, and referral. All women contacted a substance abuse treatment center and most (56%) obtained treatment during pregnancy. Sociodemographic factors, personal and family history of substance use and drug treatment, protective services involvement, history of physical and sexual abuse, and need for tangible resources were assessed. Charts were reviewed at the substance abuse treatment center for number of visits and urine toxicology reports, and at the hospital for pregnancy outcome. Data were analyzed by LISREL path analysis. Five factors had significant path correlations to prenatal attendance at the substance abuse treatment center: history of protective services involvement, number of drugs ever used, currently receiving methadone, intensity of case management, and receiving transportation to drug treatment appointments. We conclude that case management, including providing transportation, contributes significantly to retention in substance abuse treatment during pregnancy.