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Program Profile: Forever Free

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 08, 2011

Program Summary

This prison-based substance abuse treatment program for women near the end of their incarceration period is designed to reduce substance use and recidivism following release. The program is rated Promising. The intervention group reported statistically significantly fewer arrests and reconvictions and less drug use at follow up compared with the comparison group. However, there was no statistically significant effect on reincarceration and employment.

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
Overall, Hall and colleagues (2004) found mixed results. Forever Free program participants reported statistically significantly fewer rates of arrests, reconvictions, and use of drugs, compared with the comparison group. But there were no statistically significant impacts on reincarcerations or employment. Overall, the preponderance of evidence suggests the program did have the intended effects on participants.

Arrests
About 50 percent of participants in the Forever Free program reported arrests since their release, compared with 75 percent of the comparison group, a statistically significant difference.

Reconviction
About 50 percent of the women in the Forever Free group reported having been convicted after release, compared with 71 percent of women in the comparison group, a statistically significant difference.

Reincarceration
There was no statistically significant treatment effect on reincarceration 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, there was a statistically significant reduction in drug use reported by Forever Free participants, compared with the comparison group (50.5 percent versus 76.5 percent, respectively).

Employment
There was no statistically significant treatment effect on the employment status of Forever Free women.
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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 (Including Subgroup Findings)

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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. With regards to additional analyses by Hall and colleagues (2004), multivariate analyses showed that age predicted drug use: younger subjects were statistically significantly more likely to engage in drug use in the year since release. Choice of primary drug also predicted drug use: heroin users were more likely to return to drug use than alcohol or methamphetamine users. Multivariate analyses also showed that the number of days in postrelease residential treatment, along with education, remained a statistically significant predictor of employment.
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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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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Incarceration-based Therapeutic Communities for Adults
This practice uses a comprehensive, residential drug treatment program model for treating substance-abusing and addicted inmates to foster changes in attitudes, perceptions, and behaviors related to substance use. The practice is rated Promising in reducing recidivism rates after release for participants in therapeutic communities.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types



Gender-Specific Programming for Incarcerated Females
The practice involves in-prison substance abuse and other types of treatment programs for incarcerated women with the goal of reducing recidivism. The practice is rated Promising. Women who participated in the treatment were significantly less likely to recidivate after release than women who did not participate in the treatment.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types



Adult Reentry Programs
This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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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
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