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JFAS Int 2006;4:e22 - November 10, 2006
Special Supplement
Breaking the Cycle: Measures of Progress 1995-2005

Mary Motz, Margaret Leslie, Debra J. Pepler, Timothy E. Moore, Patricia A. Freeman

Abstract
Breaking the Cycle (BTC) is one of Canada's first early identification and prevention programs for pregnant women and mothers using alcohol and other substances, and their young children. Women and children served at BTC experience a host of complex conditions of risk including mental health problems, domestic violence, homelessness, poverty, medical vulnerabilities and maltreatment. These conditions are exacerbated by the families' alienation from health and social supports.

Since 1995, BTC has developed a comprehensive, cross-sectoral, relationship-based range of integrated services through a single-access model, with home visitation and outreach components. BTC has been the subject of ongoing and uninterrupted local evaluation since 1995.

Part 1 of this 10 year evaluation reviews BTC's relationship with CAPC Guiding Principles and Health Goals of Canada; and reviews the impact of substance use during pregnancy and in the postnatal environment.

Part 2 traces the development of BTC since 1995. It outlines the program background, describes the partnership and governance structure, and reviews the BTC program model, services, philosophy and strategies.

Part 3 presents 10 years of data on a sample of approximately 770 substance-involved women and their children, and how BTC is engaging this hard-to-reach, high risk and marginalized part of the population. These data confirm that children at BTC are exposed to multiple risk factors that place them at risk for health and neurodevelopmental problems, child maltreatment and disorders of attachment and regulation. Nevertheless, clinical data indicate that:

  • BTC children are functioning within the normal range of development, and developing along a trajectory that is consistent with their age over time;
  • There was a significant decrease in parenting stress for BTC mothers over time, and the slope of change is significantly more profound for those mothers who were engaged during pregnancy;
  • There were significant increases on measures of postnatal attachment and quality of attachment. BTC mothers also reported increased knowledge and confidence regarding services in the community at discharge, as well as a significant increase in social support from family and friends.

Part 4 of the report describes the significant knowledge exchange activities undertaken by BTC staff, including regional, national and international training, publications and resource development. Part 5 outlines future directions for BTC.

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