The impact of intensive case-managed intervention on substance-using pregnant and postpartum women.

This study examines the impact of the Women's Intervention Services and Education (WISE) Project in serving substance-using pregnant and postpartum women through an array of case-managed services and supports. A descriptive analysis of multiple outcome indicators was performed on 152 women who had a minimum 6 months of exposure to WISE services at the time of the analysis. The variables used in the analysis to assess client and program outcomes included substance use, employment, arrests, incarceration, birthweight, and social support. This group of women showed statistically significant improvements across each of these multiple outcome indicators from pre-WISE to WISE discharge. Although the findings of this study are not conclusive because no control group was employed, the results are encouraging and supportive of a growing body of literature that suggests that pregnant and postpartum polydrug-using women can be responsive to case-managed, intensive intervention, with aftercare support.

The structure of attrition during appraisal.

Most attrition research has focused on dropping out once the patient has arrived at the clinic. However, many potential patients, who are in need of service, do not contact clinics. Such patients are said to be in the appraisal stage of treatment. Discontinuation of appraisal, for whatever reason, can be termed "attrition." Such attrition has not received adequate attention. A conceptual model of the appraisal process is given, and a review is made of current research bearing on the conditions under which appraisals continued or discontinued by an individual. Recommendations for future research are made.