The RWC/PPW demonstration projects were undertaken by CSAT on the premise that, once the need for and value of such projects was demonstrated, many of the projects that were initiated with CSAT seed-money funding would be able to find other ways of sustaining themselves after the CSAT funding period ended. The cross-site study findings strongly support the elements of this premise:

• The need for such treatment facilities is demonstrated by projects’ consistent success in filling their beds with clients who manifestly required residential care: once they became operational, most projects ran at close to full capacity.
• The value of the treatment such facilities provide is demonstrated by the pregnancy and client outcome findings highlighted above.
• The success of the projects in becoming institutionalized/sustained past the initial period of CSAT demonstration grant funding is indicated by the cross-site finding that all but 3 of the original 50 RWC/PPW projects have obtained continuation funding.

As part of the cross-site study, an intensive sustainability sub-study was conducted with 36 of the 39 RWC/PPW projects first funded in 1993. The study documented that sustainability required a great deal of planning and effort by local project directors and, often, by their state-level counterparts at the single state agency that is responsible for public substance abuse treatment programs in the state. After much work documenting the need for and effectiveness of the local RWC/PPW project, most successful projects ultimately persuaded their state legislatures to pick up some or all of the costs of operating their projects. In some cases, state support was supplemented by further federal grant support and/or foundation funding.

The cross-site study findings to date have been highly encouraging in suggesting that the gender-specific interventions provided by RWC/PPW residential projects for pregnant and parenting women can have substantial beneficial effects in:

• reducing otherwise high risks of adverse pregnancy outcomes;
• helping women overcome long-standing chemical dependencies and associated life problems; and
• assisting women to strengthen their parenting skills and increase their capabilities to maintain/regain custody of their children.

Caveats and Next Steps

The cross-site study findings to date have been highly encouraging in suggesting that the gender-specific interventions provided by RWC/PPW residential projects for pregnant and parenting women can have substantial beneficial effects in:

• reducing otherwise high risks of adverse pregnancy outcomes; helping women overcome long-standing chemical dependencies and associated life problems; and
• assisting women to strengthen their parenting skills and increase their capabilities to maintain/regain custody of their children.

Caveats. However, the cross-site data have limitations, including the following:

• The post-discharge period was only 6 months. It would be desirable to track post-discharge outcomes over a longer period.
• The client outcome data have some large gaps. Many projects were unable to obtain outcome data on women who did not stay long in treatment, and some projects had such low follow-up rates that their data were excluded from this outcome analysis. Our non-response adjustments may not have fully corrected for these problems.
• The client outcome findings are based mostly on self-report data of unknown accuracy. Nine projects did spot-check urinalysis tests to validate client self-report of post-discharge drug use. Positive urinalysis results were obtained for 15% of the tested clients, lower than the 27% who reported substance use during the month before the post-discharge interview. Problem mismatches were found for 6% of the tested clients, who reported having been drug-abstinent but whose urinalysis results were positive. Judging from these results, relapse underreporting was not a major problem.
• This paper reports pregnancy outcome findings only for pregnant clients who stayed in treatment through to delivery. Further study is needed to find ways of reducing attrition from this important subgroup.

• The costs and cost-benefits of RWC/PPW treatment;
• The extent to which client outcomes are associated with the kinds and amounts of specific services received in treatment;
• The benefits of treatment for clients’ children; and
• The extent to which certain project approaches or types of service are differentially effective for clients with different needs or circumstances.