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Week of 12 September 1997

Vol. I, No. 3

Feature Article

MOM's Project is a Model That Works

by Marguerite Lamb

The MOM's Project, an innovative program founded by School of Public Health Professor Hortensia Amaro to reduce drug and alcohol abuse among pregnant women, has been named one of 10 Models That Work by the U.S. Department of Health and Human Services (HHS).

A national campaign sponsored by HHS's Health Resources and Services Administration, Models That Work identifies and encourages replication of community-based health programs that have proven both successful and cost-effective. "Ours was the only substance abuse prevention program in the country to be honored as a Model," says Amaro, adding that a replication manual for the MOM's Project will be published this fall by HHS and distributed to interested public health agencies, hospitals, and community health centers nationwide.

HHS will also provide funding for Amaro and others on the project staff to travel to sites around the country to offer guidance and technical support should health professionals in other cities wish to start similar programs. "This is an exciting and important opportunity," says Amaro. "Substance abuse among pregnant women is a problem throughout the United States, in all areas and among all racial and ethnic populations, and there simply have not been a lot of prevention programs that have shown positive outcomes."

Healthy mothers, healthy babies

To date the MOM's Project has served more than 800 pregnant women from some of Boston's poorest neighborhoods, including Roxbury, Dorchester, Jamaica Plain, Mattapan, and the South End. Of these women, 80 percent have delivered healthy babies and 70 percent have stopped or significantly reduced their drug use.

SPH Prof. Hortensia Amaro's program to curb drug and alcohol abuse among pregnant women will be replicated nationwide. Photo: Vernon Doucette

SPH Prof. Hortensia Amaro's program to curb drug and alcohol abuse among pregnant women will be replicated nationwide. Photo: Vernon Doucette

What's the formula for success? Project staff focus on breaking down barriers to care by linking women with more than 300 community health and social service providers throughout the city. "Boston is rich with resources," says Amaro. "Rather than duplicate services, we collaborate with existing providers."

The MOM's Project staff helps to "walk women through the system," she points out. "We have found that it doesn't work with our clients to write down a [provider's] address and point them toward the door." That leaves a woman to find transportation, perhaps a babysitter for her children. She may have to contend with an abusive partner who feels threatened by her decision to kick drugs. And in most cases, by the time a woman arrives at the MOM's Project community center in Roxbury, her "self-esteem is in the gutter," says Amaro, and she is likely to need support to take those first steps toward recovery.

And for many of the program's clients, she adds, the road to recovery is complicated by obstacles that go well beyond addiction: 97 percent of the women who come to the project are unemployed and are living at or below the poverty level. One-third of the women are homeless or live in shelters or in welfare hotels. In addition to battling drugs, they are also trying to feed, clothe, and shelter themselves, and in many cases, their children. Where do staffers begin? "We begin where a woman tells us to begin," says Amaro. "That is how we build trust, how we build a relationship. There is no quicker way to lose someone than by not listening."

MOM's began in 1988 as a federally funded research project. Today, it employs a full-time staff of community outreach workers (some of whom are themselves recovering addicts), nurses, counselors, and child-care coordinators and is an integral part of the addiction and prenatal health-care services offered by the Boston Department of Health and Hospitals. The goal now, says Amaro, is to initiate similar programs statewide. "We have been talking to the Department of Public Health about providing technical assistance to agencies throughout the commonwealth that want to set up programs using what we have learned."

She and her colleagues have also been working to win support for the MOM's Project at the State House. "Our vision is to start a statewide network of mothers in recovery. We have been meeting with legislators and so far the response has been largely positive. A number of them have expressed interest in the MOM's Project for their own districts, which is en-couraging since often politicians don't know much about this subject or are unwilling to admit that their constituencies might need these kinds of services."

In persuading legislators, says Amaro, it often works to draw their attention to the bottom line: "For every dollar we spend in this country on substance abuse prevention and treatment, we save $7 on such things as hospitalization, incarceration, welfare, and foster care for children of addicted parents. There are major systems in this country that are bearing the burden of substance abuse, yet legislators seldom make this connection."

Last spring, however, the efforts of Amaro and others to bring statewide attention to the needs of pregnant women with addictions got a big boost on Beacon Hill when then-Governor William Weld declared May 12 Mothers in Recovery Day. Some 60 mothers were individually recognized for their triumph over addiction before an audience of about 450 health-care and social service providers, legislators, and other mothers in recovery. "The MOM's Project organized Mothers in Recovery Day," says Amaro, "as part of an attempt to close the gap between what we've learned about substance abuse among women, as well as about the cost-effectiveness of treatments, and current public policy surrounding this issue."