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Program Profile

Forever Free

Evidence Rating: Promising - One study Promising - One study

Program Description

Program Goals/Target Population

The Forever Free program at the California Institution for Women (CIW) began as the first comprehensive prison-based substance abuse treatment program in the United States for incarcerated women. The program works to reduce the incidence of substance abuse, the number of in-prison disciplinary actions, and recidivism following release to parole by providing a range of treatment services to meet the needs of participants. Forever Free consists of two parts:

  • An intensive 6-month program provided to women inmates near the end of their incarceration period

  • Community-based residential treatment for women who graduated from the program and volunteer to continue treatment while on parole

Services Provided

While incarcerated, women inmates in the Forever Free program are housed in a 120-bed residential unit and participate in program services 4 hours per day, 5 days per week. The time spent in treatment is in addition to a participant’s 8-hour-per-day work or education assignment. In-prison services include individual substance abuse counseling, special workshops, educational seminars, 12-step programs, parole planning and urine testing. In addition, individual and group sessions cover a number of subjects believed to be crucial to women’s recovery, including self-esteem, anger management, assertiveness training, healthy versus disordered relationships, abuse, posttraumatic stress disorder, codependency, parenting, and sex and health.

 

Upon graduation from Forever Free and discharge to parole, women can voluntarily enter a community-based program provided by a variety of treatment organizations in Southern California. Each of these programs is residential and has a designated number of treatment slots for Forever Free graduates. The expected length of stay in a program is 6 months. Program services vary across sites, although basic services such as individual and group counseling are common to all programs. Most programs also offer family counseling, vocational training/rehabilitation, and recreational or social activities.

 

Program Theory

The program follows a cognitive–behavioral curriculum stressing relapse prevention (Gorski and Miller 1979, Marlatt 1985). The Gorski curriculum was designed to assist clients in identifying symptoms of post-acute withdrawal and relapse and teach clients skills and strategies to successfully deal with them.

Evaluation Outcomes

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Study 1

Arrests and Reincarceration

Hall and colleagues (2004) found that for measures of crime and recidivism, the bivariate analyses showed that significantly fewer Forever Free participants reported having been arrested or convicted during parole compared to the comparison group. About half of the Forever Free group had been arrested since their release from CIW and half had been convicted since release. By comparison, 75 percent of women in the comparison group reported arrests since release and 71 percent reported convictions. Although a smaller percentage of Forever Free participants reported being reincarcerated in jail or prison than the comparison group (50 percent versus 62 percent), the difference was not statistically significant.

 

A separate analysis looking at the effect of increasing increments of treatment exposure on reincarceration found that as treatment exposure increased from no treatment in prison or on parole to treatment both in prison and during parole, reincarceration significantly decreased.

 

The multivariate analysis showed that at 6 months after release, approximately 33 percent of the comparison group had been reincarcerated, whereas only 13 percent of the Forever Free participants had been reincarcerated. At 1 year post-release, the rate for comparison women was 44 percent in contrast to approximately 33 percent of Forever Free women.

 

Drug Use

Although a large percentage of both treatment and comparison women reported they had used drugs at least once since release, Forever Free participants reported significantly less drug use than the comparison participants (50.5 percent and 76.5 percent, respectively). Drug use in the 30 days prior to the follow-up interview was much lower than 12-month use, with 8 percent of Forever Free participants reporting drug use in contrast to 32 percent of the comparison group.

 

The multivariate analyses showed that age predicted drug use, with younger subjects being more likely to engage in drug use in the year since release. Primary drug also predicted drug use, with heroin users more likely to return to drug use than primary alcohol or methamphetamine users.

 

Employment

Significantly more Forever Free women (65.3 percent) were employed at the time of the follow-up interview than women in the comparison group (44.7 percent). Of those working, there were no statistically significant differences in mean hours worked per week or in mean weekly take-home pay. Take-home pay for both groups averaged less than $8 per hour. In addition, participation in a residential treatment during parole appears to have been a key factor in improving chances of being employed for both the Forever Free group and the comparison group. After controlling for background characteristics through multivariate analyses, however, there was no significant treatment effect on the employment status of Forever Free women. The number of days in post-release residential treatment, along with education, remained a significant predictor of employment.

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Evaluation Methodology

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Study 1

A program evaluation by Hall and colleagues (2004) used a prospective, longitudinal design to look at the outcomes among 214 women who either participated in the Forever Free program or participated in a comparison condition. The treatment group consisted of 119 female clients entering the program between October 1997 and June 1998 who volunteered to participate in the study. The comparison group consisted of 95 women enrolled in Life Plan for Recovery, an 8-week substance abuse education course, between April and November 1998. There were no statistically significant differences between the treatment and comparison groups at study intake on most measures. Women in both groups were about 35 years of age. They averaged about 16 prior arrests and 8 prior incarcerations, and most were incarcerated for a drug offense. The sample was approximately 34 percent African American, 33 percent White, 21 percent Latina, and 7 percent Other.

 

The main outcome variables included crime or recidivism rates, drug use, and employment. Measures were taken from study participants at intake and follow-up, approximately 1 year after women were released from prison (between September 1999 and August 2000). For the follow-up interviews, 101 interviews were completed with Forever Free program participants (85 percent of the original sample) and 79 interviews were completed with the comparison group (82 percent of the original sample).

 

Information was collected on subjects’ criminality, including age at first arrest, lifetime arrests, most serious charge for current case, arrests and incarcerations since release, and incarceration status. Information was also collected on subjects’ substance abuse history and treatment for the periods before intake and since release, including primary substance of abuse, age of first use, age of first regular use, day of use in the 30 days before incarceration, use since release, use in the 30 days before the follow-up interview, use per day, and street value per day for the following drugs: alcohol, amphetamines/methamphetamines, barbiturates, cocaine (crack), cocaine (powder), heroin and other opiates, marijuana, PCP, tranquilizers, and other drugs. The California Department of Corrections Offender-Based Information System provided additional information on subjects’ incarceration history, including date and charge of each incarceration, parole release date, parole region and status, and date and reason for return to custody (new charge or parole violation).

 

The study used bivariate analyses, including chi-square analysis and t-tests, to determine program effects on outcome measures. In addition, multivariate analyses, including logistic regression and Cox regression, were used to find any predictors of long-term success while controlling for background characteristics.

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Cost

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There is no cost information available for this program.
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Other Information

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The Forever Free program was closed in 2010 due to state budget cuts. A similar program was created for female inmates based on the design of Forever Free. The new program is being run at a correctional facility in Bakersfield, Calif.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Hall, Elizabeth A., Michael L. Prendergast, Jean Wellisch, Meredith Patten, and Yan Cao. 2004. “Treating Drug-Abusing Women Prisoners: An Outcome Evaluation of the Forever Free Program.” The Prison Journal 84(1):81–105.
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Additional References

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These sources were used in the development of the program profile:

Gorski, Terence T., and M. Miller. 1979. Counseling for Relapse Prevention. Hazel Crest, Ill.: Alcoholism Systems Associates.

Marlatt, G. Alan 1985. “Relapse Prevention: Theoretical Rationale and Overview of the Model.” In G.A. Marlatt & J.R. Gordon (eds.). Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behavior. New York, N.Y.: Guilford, 3–70.

Prendergast, Michael L. 2001. An Outcome Evaluation of the Forever Free Substance Abuse Treatment Program: One-Year Post-Release Outcomes. Final Report to the National Institute of Justice. Los Angeles, Calif.: Drug Abuse Research Center.
http://www.ncjrs.gov/pdffiles1/nij/grants/199685.pdf

Prendergast, Michael L., Jean Wellisch, and Mamie Mee Wong. 1996. “Residential Treatment for Women Parolees Following Prison-Based Drug Treatment: Treatment Experiences, Needs and Services, Outcomes.” The Prison Journal 76(3):253–74. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)
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Program Snapshot

Age: 18+

Gender: Female

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Suburban, Urban

Setting (Delivery): Correctional, Other Community Setting

Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Cognitive Behavioral Treatment, Gender-Specific Programming, Therapeutic Communities

Targeted Population: Females, Alcohol and Other Drug (AOD) Offenders, Prisoners

Current Program Status: Not Active

Listed by Other Directories: Campbell Collaboration, National Registry of Evidence-based Programs and Practices

Program Developer:
David Conn
Senior Vice President of Corrections and Rehabilit
Mental Health Systems, Inc.
9465 Farnham Street
San Diego CA 92123
Phone: 858.573.2600 ext: 310
Website
Email

Researcher:
Elizabeth A. Hall
UCLA Integrated Substance Abuse Programs
11075 Santa Monica Blvd., Suite 100
Los Angeles CA 90025
Phone: 310.267.5501
Website
Email

Training and TA Provider:
David Conn
Senior Vice President of Corrections and Rehabilit
Mental Health Systems, Inc.
9465 Farnham Street
San Diego CA 92123
Phone: 858.573.2600 ext: 310
Website
Email

Training and TA Provider:
Terence Gorski
President and Founder
The CENAPS Corporation
6147 Deltona Blvd.
Spring Hill FL 34606
Phone: 352.279.3068
Fax: 352.596.8002
Website
Email