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Program Profile: Delaware KEY/Crest Substance Abuse Programs

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 07, 2011

Program Summary

This program uses a drug treatment continuum of prison-based therapeutic community and residential work release for drug-involved offenders. The program is rated Promising. Results showed statistically significant increases in remaining drug-free after 3 years and increases in condom use after 6 months; however, there were no statistically significant effects in being injection-free (after 6 months) or arrest-free (after 3 years).

Program Description

Program Goals/Target Population
KEY/CREST is a corrections- and community-based multistage substance abuse treatment program for drug-involved offenders. The Delaware Department of Correction (DOC) provides a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) therapeutic community treatment for drug-involved offenders. Each stage in the continuum corresponds to the offender’s changing correctional status: incarceration, work release, and parole or community supervision.

The substance abuse treatment programs offered by the DOC allow for drug-involved offenders to go through the KEY Program and the CREST Outreach Centers. Alternatively, offenders can participate in the CREST Outreach Centers without participating in the KEY Program. This review was focused on the program that allows offenders to participate in the KEY Program, followed by participation in the CREST Outreach Centers.

Program Components
KEY Program. KEY is the first component of the DOC’s substance abuse treatment continuum. It is a prison-based, therapeutic community program designed as a total treatment environment that is discipline-based and isolated from the rest of the prison population. The treatment perspective of the KEY program is that drug abuse is a disorder; addiction is the symptom, not the essence of the disorder. Therefore, the primary goal of KEY is to change negative patterns of behavior, thinking, and feelings that predispose an offender toward drug abuse. Inmates receive behavioral, cognitive, and emotional therapy that focuses on changing behavior first and emotion last.

Inmates typically become involved in the KEY program during the last 12 to 18 months of incarceration. They are provided with a routine that is disciplined and regimented and are required to complete program assignments that are seen as essential to treatment. KEY staff members provide oversight to treatment programming, which is scheduled 7 days a week. Inmates have access to staff counselors every day, if they feel the need to discuss issues related to their treatment and recovery. Inmates also meet twice a week with their caseload group (other inmate program participants) to discuss issues related to recovery.

CREST Outreach Centers. CREST is the second component of the substance abuse program. The CREST Outreach Centers are residential work-release centers based on the therapeutic community model, which allow offenders recovering from substance abuse to continue their treatment as they transition into the community. Typically, offenders work during the day and return to their assigned center at night for therapy, counseling, or treatment.

The CREST program is usually 6 months in duration. The first 3 months are spent entirely at the CREST Center, where offenders engage in full-time substance abuse treatment. During the next 3 months, offenders become involved in the work-release portion of the program and go through the following phases:
  • Entry, evaluation, and orientation: Offenders get used to life outside of prison.
  • Primary: Counselors and offenders explore the challenges and issues faced by individual offenders and prepare appropriate responses to minimize the likelihood of relapse.
  • Job-seeking: Offenders develop job seeking and interview skills.
  • Work release: Offenders maintain residence at CREST while working in the community.

Additional Information
View the program profiles for:

Evaluation Outcomes

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Overall, mixed results were found regarding the effectiveness of the KEY-CREST Substance Abuse Program. At the 6-month follow up, there was no statistically significant effect on rates of injection drug use; however, the KEY-CREST group had statistically significant higher condom use rates. At the 3-year follow up, there was no statistically significant effect on arrest rates; however, there was a statistically significant effect on being drug-free. Overall, the preponderance of evidence suggests the program had a positive impact on program participants.

Study 1
Martin, Butzin, and Inciardi (1995) found that although the rate of injection drug use was reduced for the KEY-CREST group, the effect was not statistically significant, compared with the no-treatment comparison group at the 6-month follow up.

Condom Use
The KEY-CREST group showed a statistically significant higher condom use at the 6-month follow up, compared with the no-treatment comparison group.

Study 2
Martin and colleagues (1999) found that 43 percent of the KEY-CREST group was arrest-free, compared with 30 percent of the comparison group at the 3-year follow up; however, this different was not statistically significant.

The KEY-CREST participants were more likely to be drug-free (23 percent) at the 3-year follow up, compared with the comparison group (6 percent). This difference was statistically significant.
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Evaluation Methodology

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Study 1
The first study by Martin, Butzin, and Inciardi (1995) used a quasi-experimental design to examine the differences among 457 subjects, recruited between the summer of 1990 and the spring of 1994, who participated in the following conditions:
  • Primary treatment in prison at KEY program with no subsequent treatment (KEY group, n=43)
  • Primary treatment in prison at KEY program and secondary (transitional) treatment at CREST Outreach Center (KEY-CREST group, n=32)
  • Primary treatment at CREST with no prior prison-based treatment (CREST, n=176)
  • No treatment other than HIV/AIDS prevention education (comparison, n=206)
Subjects in the KEY-CREST group were not assigned randomly, but by prison personnel who determined eligibility based on institutional classification screening, criminal history, and correctional counselor interviews.

The review of this study focused on the comparisons between the KEY-CREST group and the no- treatment (other than HIV/AIDS prevention education) comparison group.

The sample was mostly male (81 percent), African American (72 percent), with the remaining participants mostly white. There were a few statistically significant differences between the groups at baseline. The KEY-CREST group included more African American participants who, on average, had longer criminal histories. Also, all of the KEY-CREST subjects were male, as there was no therapeutic community available for female inmates at the time. There were no other statistically significant differences between the treatment and comparison group on baseline characteristics.

Subjects were interviewed just prior to leaving prison and again about 6 months after release. Self-reported measures were collected on sexual activities, criminal history, drug abuse treatment history, psychosocial and mental health status, and sociodemographics. The two outcome measures of interest were intended as a rough index of risk of HIV infection. One measure was the use of any injection drugs since release, and the other measure was report of condom use. The primary mode of statistical analysis was logistic regression, with additional chi-square analyses.

Two other outcomes of interest, drug-free and arrest-free, were measured at a later timepoint (Martin et al. 1999). The study authors did not conduct subgroup analyses.

Study 2
A follow-up study by Martin and colleagues (1999) looked at the outcome results 1 year and 3 years after participants left work release. The study examined the same four groups as the previous study by Martin, Butzin, and Inciardi (1995). The study authors also looked at results from participants who received no in-prison treatment, were assigned to regular work release, were CREST dropouts, were CREST graduates without aftercare, and were CREST graduates with aftercare. However, the review of this study focused on the comparisons between the initial KEY-CREST group (n=68) and the initial comparison group (n=165).

The comparison group was predominately male (82 percent), 68 percent African American, 27 percent white, and 4 percent Hispanic. Their average age was 29 years. The KEY-CREST group was 74 percent male, 85 percent African American, and 13 percent white. Their average age was 31.

The outcome measures of interest were relapse (drug-free) and recidivism (arrest-free). Each outcome variable combined information from repeated self-report and official data. To be considered drug-free, the study participant must have reported no illegal drug use and tested negative for drugs on the urine screen at every follow-up point. Similarly, arrest-free was measured as no self-reports of arrest and no official arrest record for new offenses since release from prison (excluding parole violations). The study authors relied on bivariate and multivariate logistic regression to analyze the data and did not conduct subgroup analyses of KEY-CREST participants.
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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 KEY/CREST Substance Abuse Program was originally reviewed and rated Promising for in 2011. The original review combined the evaluation results of the KEY/CREST Substance Abuse Program with the evaluation results of the CREST Outreach Centers and the KEY Substance Abuse Program. When the KEY/CREST Substance Abuse Program was rereviewed in 2018, the Promising rating was maintained, and the results were separated from those of the CREST Outreach Centers and the KEY Substance Abuse Program. All three programs now have separate program profiles on (see the Program Description for a link to the other programs).
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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
Martin, Steven S., Clifford A. Butzin, and James A. Inciardi. 1995. “Assessment of a Multistage Therapeutic Community for Drug-Involved Offenders.” Journal of Psychoactive Drugs 27(1):109–16.

Study 2
Martin, Steven S., Clifford A. Butzin, Christine A. Saum, and James A. Inciardi. 1999. “Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare.” The Prison Journal 79(3):294–320.
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Additional References

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

Butzin, Clifford A., Steven S. Martin, and James A. Inciardi. 2002. “Evaluating Component Effects of a Prison-Based Treatment Continuum.” Journal of Substance Abuse Treatment 22:63–69.

Falcon, William D. 2002. “Corrections-Based Drug Treatment: Delaware’s Key-Crest Programs.” Promising Approaches to Addressing Crime. Philadelphia, Pa.: The Jerry Lee Center of Criminology, Forum on Crime & Justice.

Inciardi, James A., Steven S. Martin, Clifford A. Butzin, Robert M. Hooper, and Lana D. Harrison. 1997. “An Effective Model of Prison-Based Treatment for Drug-Involved Offenders.” Journal of Drug Issues 27(2):261–78.

Inciardi, James A., Steven S. Martin, and Clifford A. Butzin. 2004. “Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders After Release from Prison.” Crime & Delinquency 50(1):88–107.

Martin, Steven S., James A. Inciardi, and Daniel J. O’Connell. 2003. “Treatment Research in OZ–Is Randomization the Ideal or Just Somewhere Over the Rainbow?” Federal Probation 67(2):53–60.

Martin, Steven S., Daniel J. O’Connell, Raymond Paternoster, and Ronet D. Bachman. 2011. “The Long and Winding Road to Desistance from Crime for Drug-Involved Offenders: The Long-Term Influence of TC Treatment on Rearrest.” Journal of Drug Issues 41(2):179–96.

Robbins, Cynthia A., Steven S. Martin, and Hilary L. Surratt. 2009. “Substance Abuse Treatment, Anticipated Maternal Roles, and Reentry Success of Drug-Involved Women Prisoners.” Crime & Delinquency 55(3):388–411.
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Related Practices

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Following are 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

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

Rehabilitation Programs for Adult Offenders
This practice includes programs that are designed to reduce recidivism among adult offenders by improving their behaviors, skills, mental health, social functioning, and access to education and employment. Offenders may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adult offenders.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Crime & Delinquency
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Program Snapshot

Age: 18+

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Suburban, Urban

Setting (Delivery): Residential (group home, shelter care, nonsecure), Correctional, Other Community Setting

Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Group Therapy, Individual Therapy, Residential Treatment Center, Vocational/Job Training, Therapeutic Communities

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

Current Program Status: Active

Listed by Other Directories: Campbell Collaboration