PCAP and Support for Mothers and Families

Prevention Through Relationship: PCAP and Support for Mothers and Families

Therese Grant and UW colleagues helped shift FASD prevention toward long-term advocacy, support and practical help for mothers and families.

FASD prevention is often reduced to a message: avoid alcohol during pregnancy. UW’s work in Washington shows that prevention is also a relationship, a support system, and a public health strategy. It requires accurate diagnosis, trusted community connections, practical help, and sustained investment in families.

That relationship-based approach is central to the Parent-Child Assistance Program, known as PCAP, and to the broader prevention model that developed alongside FAS DPN. Together, these efforts show how prevention can move beyond warning labels and public awareness campaigns into direct support for pregnant and parenting women, birth mothers, and families.

Therese Grant, PhD, Professor of Psychology and Behavioral Sciences, developed the Washington Parent-Child Assistance Program in 1991; a program that has been replicated worldwide. Grant’s work grew from a deep understanding that many women at risk for alcohol- or drug-exposed pregnancies face complex barriers, including trauma, poverty, unstable housing, mental health challenges, substance use disorders and limited access to care. Prevention in that context cannot rely on information alone.

PCAP grew out of listening to mothers and learning from their lived experiences. The program was designed to help high-risk mothers address substance use, rebuild their lives and prevent future alcohol- and drug-exposed births. That goal requires more than a brochure or referral. It requires advocates who can help women connect with treatment, housing, health care, transportation, benefits, parenting supports and other services over time.

The PCAP model is important because it treats prevention as a long-term relationship. Case managers work with women over an extended period, meeting them where they are and helping them build stability. The work is practical, persistent, and nonjudgmental. It recognizes that mothers want healthy lives for themselves and their children, and that many need sustained advocacy to reach that goal.

FAS DPN’s work connects to prevention in a different but complementary way. Diagnostic evaluations can identify individuals affected by prenatal alcohol exposure and provide recommendations for services. They can also help identify birth mothers who may benefit from community-based supports like PCAP. In that way, diagnosis can become a pathway to prevention, not only for the person being evaluated but also for families who may need additional help.

Within the FAS DPN, Susan J. (Astley) Hemingway, PhD, has helped frame diagnosis as part of a prevention pathway. Her public health work connects clinical findings, data, training, and recommendations with the broader goal of reducing risk and improving supports for families.

This link between diagnosis and prevention is important. Without diagnosis, families may struggle for years without a clear explanation of a child’s needs. Without prevention supports, mothers may remain disconnected from services that could reduce future risk and improve family health. FAS DPN and PCAP show why prevention, diagnosis and intervention must be understood as connected parts of the same public health continuum.

Washington’s FASD history also shows why comprehensive prevention matters. Public education, clinical diagnosis, targeted intervention, surveillance, data systems, and state policy all contributed to Washington’s prevention infrastructure. No single strategy could do the work alone. The public health achievement came from combining research, services, training, policy, and community support.

FASD prevention publications have described significant declines in maternal drinking during pregnancy in Washington during the 1990s, along with a decline in FAS prevalence among children in a King County foster care population born during that period. Those changes were associated with a broader prevention environment that included screening, diagnosis, prevention services, public education, data collection, and state support.

The language around prevention must be careful. FASD prevention should never be framed as blaming pregnant and parenting women. Many women who are at risk have experienced trauma, poverty, unstable housing, mental health challenges, substance use disorders and limited support. A public health approach asks what systems, relationships and services can reduce risk and improve outcomes for mothers and children.

That is why PCAP is so important to the UW story. It represents prevention through relationship. It works from the understanding that mothers and families are more likely to thrive when they have sustained advocacy, practical help, and access to coordinated services.

Prevention is not separate from diagnosis or intervention. It is part of a continuum that includes clinical care, family support, community services, and public policy.