Description:   The Team for Infants Endangered by Substance abuse (TIES) at Children’s Mercy Hospital provides comprehensive, multi-disciplinary, community-based services to pregnant and postpartum women and their families affected by substance abuse.  They have supported families in Jackson County, MO since 1990 with funding from the U.S. Department of Health and Human Services (HHS) Abandoned Infants Assistance Program (AIA) and matching funds from the Jackson County Community Backed Anti-drug Tax (COMBAT).  Services include early intervention, case management, home visits, referrals to drug treatment and an array of other community services, developmental screening, parent/child interaction assessment, parenting training, and peer support.  Training is provided to professionals and paraprofessionals, and community collaboration is fostered.  The Institute has assisted Children’s Mercy Hospital since the inception of the TIES Program, fulfilling key roles of model development, grant writing, applied research, evaluation, child assessment, parent/child interaction assessment, and publication of findings.  In 2010, TIES also received federal support from the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) through the Kansas Department of Health and Environment (KDHE) to replicate the TIES model in Wyandotte County, KS as a Promising Approach in the Kansas application.  The Institute has assisted CMH in solidifying the TIES model through development of a Blueprint to aid in the replication of the model.  A matched comparison group design is being prepared for implementation to further strengthen the evidence of the effectiveness of the TIES model for this multi-challenged population.


Project Contact:               Kathryn L. Fuger, 816.235.5351, and Jovanna M. Rohs, 816.235.5373,

Project Period:                 1989-2014

Annual Funding:              $150,000

Funding Source:               HHS AIA and COMBAT through Children’s Mercy Hospital and HHS HRSA MIECHV to KDHE through Children’s Mercy Hospital

Core Functions

Applied Research: Longitudinal assessments of development, interaction, family needs, and support systems are conducted and evaluated by Institute staff and trainees.  A research design in which two alternative ways of supporting families through a Parenting Resource component of TIES is being implemented.  New instruments and processes to measure fidelity to the TIES model are being implemented in both Kansas and Missouri.  The TIES model was approved as a “promising approach” in home visitation for replication in Wyandotte County, Kansas.  The replication study incorporates both an implementation study and an effectiveness study.  A blueprint was developed to document the TIES decision-making model for serving this multi-challenged population.  Plans to compare the outcomes of the TIES Program with a matched comparison group are underway in both Missouri and Kansas.

Community Services and Supports:  Institute faculty participate in the TIES Advisory Council and the Kansas City Task Force on Families Affected by Substance Abuse.

Information Dissemination:Institute and TIES staff offer presentations and poster sessions at various local, state, and national conferences and submit publications. Recently a publication describing the findings from the previous 4-year grant cycle was developed for widespread dissemination.

Interdisciplinary Personnel Preparation: Numerous graduate student employees participate in database management. This project also provided archival data for a doctoral dissertation. Institute staff occasionally offer course infusion concerning the project.


Significant Project Activities and Outcomes

Between 10/2009 and 9/2013, the TIES Program provided comprehensive services and service coordination to 123 pregnant or postpartum women and their families in Jackson County, MO for up to 2 years after delivery.  IHD faculty conducted infant assessments, surveys of needs and psychosocial factors, and satisfaction surveys.  Replication began in Wyandotte County, KS in 2012.

Notable outcomes among the families served in Jackson County, MO from 2009 to 2013 include:

  • Improvement over time on all major goals (drug issues, parenting, child health, maternal health, housing, and economic stability);
  • Improved environment (n=57) and improved family interactions (n=55) from intake to discharge;
  • Positive birth outcomes for infants of families served prenatally:
  • Mean of 3,075 grams, 4 of 44 with low birth weight  (n=44),
  • Mean gestational age of 39 weeks (n=44),
  • Consistently high satisfaction of participants with the TIES Program (>95%) and high self-perception of successful goal completion (>85%) at 3, 9, 18, and 24 months after delivery;


Institute’s Role

Participate in writing grant proposals

Assist in original and ongoing model development, program design, and research design

Conduct implementation study and process evaluation

Conduct an effectiveness study and outcome evaluation

Interview participants, conduct assessments of mothers and children, and confer with program staff about recommended interventions

Program information is submitted annually to the national AIA Cross-Site Evaluation.

Submit program information to National Cross-Site Evaluation annually



Federal grant applications (multi-year funding in 1996, 2000, 2004, 2009, and 2013)

Five final reports summarizing findings from 23 years of program operation

Dissertation addressing the patterns of social support for drug-affected families

Critical thinking: A method to guide staff in serving families with multiple challenges, Topics in Early Childhood Education, 1997

Thirty-six-month outcome of prenatal cocaine exposure for term or near-term infants: Impact of early case management,   Journal of Developmental and Behavioral Pediatrics, 2000

Impact of Early Case Management on School-Age Outcome of Children with Prenatal Cocaine Exposure, Journal of Developmental and Behavioral Pediatrics, 2006

Team for Infants Endangered by Substance abuse (TIES) Implementation Blueprint, 2014



Systems Change:  This program maintains an active community consortium of human service agencies to develop ongoing funding opportunities and collaborative programming.

Personnel:  Student trainees participate in consortium meetings, data collection, analysis, and reporting.

Leveraging: Institute staff participated in writing AIA HHS grants (funded).  Funds leveraged from COMBAT (Community Backed Anti-Drug Tax) provide the opportunity to add to these services.  Funds from HUD, Missouri Department of Mental Health, and local foundations have been leveraged to open a transitional housing unit for drug-involved families.  The MIECHV funding was leveraged to strengthen the evidence for the TIES model and replicate it within the bi-state Greater Kansas City area.