Dr Derauf raises several interesting points. First, he questions how the increased proportion of mothers of children receiving GWCC with positive screens for alcohol and other drug abuse might have affected the outcomes of the study, and how these differences were accounted for in the analyses. For the assessments of sense of competence as a parent, social isolation, and social support, we included analyses of change in status for each mother during the study period for each of these measures. This process would tend to minimize the effect of differences at baseline between the 2 study groups. For the functional outcomes such as return to work, return to school, becoming pregnant, and referral to Child Protective Services, we presented analyses without any adjustment for alcohol and other drug abuse. Even when controlling for alcohol and other drug abuse, as well as multiple other maternal baseline characteristics, no significant difference in any outcome was noted between mothers of children receiving GWCC and those of children assigned to the IWCC group. It is possible that unknown confounding was not adequately accounted for; given the multiple outcomes and analyses performed without finding a single significant difference, it seems unlikely that GWCC as conducted in this study had any profound effect on maternal outcomes.
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