Drinking History
Treatment
Withdrawal
Stabalization
Case Management
Service Delivery

Case Management

• Physical and mental health history
• Psychosocial status, including family history, parenting skills and knowledge and potential parenting problems (eg history of sexual abuse)
• Alcohol and other drug use, treatment and recovery status
• Support systems available to and used by the family, including General Practitioner
• Nutritional status of the mother and foetus
• Status of any unresolved legal issues, including outstanding warrants, domestic violence, child custody, adoption, foster care or divorce
• Environmental circumstances, including financial status and needs, housing conditions etc.
• Educational and vocational competencies
• Involvement with other social services

2. An Individual Care Plan

This should include the regular care plan with additional information gathered on arrangements for case management of the infant.

3. Discussion of the plan with the patient

This discussion should ideally also include other members of the health care service. In the UK this would include members of the alcohol treatment team who are working with the pregnant problem drinker. Agreement should be reached on a care plan and a designated member of the team should be identified as the team leader. This is of particular importance in this situation. Problem drinkers can often be very frightened of having to cut down or stop drinking. The person may even give different responses and information to different team members. For this reason one identified member of the team should take overall charge of decision making and ensure that any decisions are noted clearly in the case notes. Particularly if these include changes in the care plan.

4. Referrals to other agencies

There should be ongoing communication between all members of the team. These would include midwives, obstetrician, members of the alcohol treatment team and, later in the pregnancy, paediatrician, paediatric nurses, the relevant district nurses and health visitors.

5. Monitoring of the patient’s progress

It is important to maintain regular contact with the pregnant problem drinker during her pregnancy. This relationship may be a great importance in maintaining sobriety and forming a relationship which can continue after the birth of the baby. In the UK this may be a member of the alcohol team rather than the midwifery team. However, that person must be in regular contact with the designated team leader.

6. Ongoing case management support

"---at regular intervals, with termination ideally agreed upon by the patient and the case manager. Standards of success should be determined on an individual basis, but should allow a period of time for the patient to become adjusted to her drug-free status, to achieve self-sufficiency, and to feel confident about her parenting skills.

7 A review of the patient's individual care plan 

A review of the patient's individual care plan with revisions as needed during the recovery process