Alberta’s First Steps Program

Evaluation findings of program modeled on the Parent-Child Assistance Program (PCAP)

The Alberta First Steps program is modelled on the Parent–Child Assistance Program (PCAP), which began in 1991 at the University of Washington. It is an intensive three-year one-on-one mentoring program for women at high risk for giving birth to a baby exposed to prenatal alcohol. The primary aim of the program is to prevent future alcohol and drug exposed births among high-risk mothers who have already delivered at least one exposed child. The model has been evaluated and replicated across North America.

The First Steps program began in Edmonton, Alberta in the fall of 1999 with the hiring of three mentors and a program manager.  Since that time, the program has grown to employ six mentors, one program supervisor, and a program manager. Mentors work with women and their families over a period of three years beginning during pregnancy or within six months after the birth of a child. Mentors are paraprofessionals and carry a maximum caseload of 15 families. They provide personalized and intensive support in a number of areas ranging from family planning and accessing substance use treatment to advocacy and case management to providing parenting support and developing support networks.

An evaluation study of First Steps between 1999 and 2007 found:

  • The mean age of participants was 26 years
  • Most had had an unplanned pregnancy (88%), and after the birth of their child had an average of 2.6 children; 63% had custody of at least one child.
  • Nearly half of the clients enrolled were of Aboriginal ethnicity (49%)
  • Over the course of the program, regular use of a family planning method increased from 36% to 56%
  • Welfare use decreased from 92% to 72%
  • After the birth of their child (either before or shortly after program began), 71% did not have a subsequent pregnancy.
  • In terms of substance use, 44% were abstinent from drugs and 35% were abstinent from alcohol at program exit.
  • During their enrollment in the program, 93% of clients had been clean and sober (with no relapses) for at least one month.

From a theoretical perspective, the program is based on relational theory (related to the concept of therapeutic alliance), stages-of-change theory (which utilizes motivational interviewing strategies), and harm reduction theory (which focuses on reducing risks associated with alcohol and drug use as well as other risk behaviors).

The Parent-Child Assistance Program is an example of an indicated prevention program which focuses on individuals at highest risk for delivering a child with FASD, i.e., women who misuse alcohol during pregnancy or who have already delivered a child with FASD and continue to use alcohol.

In terms of cost-effectiveness, Grant (2010) reports that PCAP costs approximately $15,000 USD per client for the three-year program, including intervention, administration and evaluation. The estimated average lifetime cost for an individual with FASD is at least $1.5 million. If PCAP were to prevent a single new case of FASD, the estimated lifetime cost savings would be equivalent to the cost of the PCAP intervention for 102 women.


Grant, T. (2010). Preventing FASD: The Parent-Child Assistance Program (PCAP) Intervention with High Risk Mothers (pp. 193-206). In Riley, E.P., Clarren, S., Weinberg, J., and Jonsson, E. (editors), Fetal Alcohol Spectrum Disorder: Management and Policy Perspectives of FASD, Wiley-Blackwell.

Rasmussen, C., Kully-Martens, K., Denys, K., Badry, D., Henneveld, D., Wyper, K., Grant, T. (2010). The Effectiveness of a Community-Based Intervention Program for Women At-Risk for Giving Birth to a Child with Fetal Alcohol Spectrum Disorder (FASD). Community Mental Health Journal, DOI: 10.1007/s10597-010-9342-0.

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