Parent-Child Assistance Program

Parent-Child Assistance Program (P-CAP)

Helping women develop healthy relationships and access resources

About P-CAP

The Parent-Child Assistance Program (P-CAP) is a 3-year home visitation program that offers individualized support for individuals who:

Are pregnant or have given birth in the past six months
Used drugs and/or alcohol during pregnancy
Live in Calgary or surrounding areas, Willow Creek, Vulcan, or within the Municipal District of the Foothills

P-CAP helps individuals to:

Learn strategies to address drug and alcohol use
Access community resources such as healthcare, housing and legal supports
Build healthy relationships with their families, friends and community
Prevent future births impacted by drug or alcohol use

Referrals for P-CAP may come from Children Service’s caseworkers, professional or a self-referral.

P-CAP is funded by CFAN.

Contact Us

For more information about P-CAP, contact us at:

pcap@mcmancalgary.ca

Program Referral Instructions

Please complete the form below, or download the form and send the completed document to: pcap@mcmancalgary.ca

- PCAP Referral Form

Referral Form

Client Name *

First

Last

Client # *

Date of Referral *

Phone *

Have you accessed PCAP programming in the past?

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Referral Source

Name *

First

Last

Phone *

Agency/Position *

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Client

Age & D.O.B. *

# of Children *

(incl. Target child whether or not born):

Marital Status *

Highest Grade Completed in School *

Primary Language *

Canadian Citizen, Landed Immigrant, Visa? *

Eligibility for Enrolment

(Client must meet all three conditions to be enrolled).

Pregnancy Status:

Currently Pregnant *

Due Date

Prenatal Care/Physician *

Postpartum Status:

Date of Delivery

Hospital of Delivery

Complications

Is the Client Currently Pregnant or Within 6 Weeks Postpartum? *

Self-Report of Alcohol or Drug Use During Pregnancy

Alcohol/Drug(s) of Choice

Positive Toxicology Screen(s)

Mother

Positive Toxicology Screen(s)

Baby

How often was alcohol consumed during pregnancy

Daily
Weekly
Monthly

Average amount of use per week

Prenatal Care

Where *

(name of clinic/physician)

Any unusual factors in prenatal care? *

(ie. prenatal care in jail, high risk pregnancy)

Natural Supports Involvement

(ie. family, friends, etc.)

Immediate family Involvement *

(ie. prenatal care in jail, high risk pregnancy)

Is the father of the baby involved? *

Is there a significant other involved? *

Relatives involvement *

Friends *

Anyone else you can all for support? *

Involvement with Community Services During Pregnancy

(ie. family, friends, etc.)

Alcohol/drug treatment now or during pregnancy?

(describe)

Mental Health services?

Other community services involved?

Children Services involvement?

Housing?

Legal Services?

Domestic Violence?

Other Programs?

Other pertinent information

(ie. Physical/verbal aggressive behaviour, current drug/alcohol use, mental health concerns etc…)

Name

Resources

Made by Momma: provides healthy meals, baby essentials, and children’s items to families in need.
Father’s Moving Forward Program: provides support to young fathers
Prenatal Outreach Support Team (POST): provides supports and services for pregnant women with complex needs

Calgary Food Bank
Calgary Fetal Alcohol Network (CFAN)
CUPS: provides health and childhood development services

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