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Intervention Summary

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Forever Free

Forever Free is a drug treatment program for women who abuse drugs and are incarcerated. The intervention aims to reduce drug use and improve behaviors of women during incarceration and while they are on parole. While they are incarcerated, women participate in individual substance abuse counseling, special workshops, educational seminars, 12-step programs, parole planning, and urine testing. Counseling and educational topics include self-esteem, anger management, assertiveness training, information about healthy versus dysfunctional relationships, abuse, posttraumatic stress disorder, codependency, parenting, and sex and health. The program lasts 4-6 months. Women participate in 4 hours of program activities 5 days per week. After graduation and discharge to parole, women may voluntarily enter community residential treatment. Residential treatment services include individual and group counseling. Some women also participate in family counseling, vocational training/rehabilitation, and recreational or social activities.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: December 2006
1: Drug use
2: Parole outcomes
3: Employment after incarceration
Outcome Categories Crime/delinquency
Drugs
Employment
Ages 26-55 (Adult)
Genders Female
Races/Ethnicities Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Correctional
Geographic Locations No geographic locations were identified by the developer.
Implementation History Forever Free has been implemented at the California Institution for Women, a female-only State prison in Riverside County, California, since 1991.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: December 2006

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Prendergast, M. L., Wellisch, J., & Wong, M. M. (1996). Residential treatment for women parolees following prison-based drug treatment: Treatment experiences, needs and services, outcomes. Prison Journal, 76, 253-274.

Study 2

Hall, E. A., Prendergast, M. L., Wellisch, J., Patten, M., & Cao, Y. (2004). Treating drug-abusing women prisoners: An outcomes evaluation of the Forever Free program. Prison Journal, 76, 81-105.

Prendergast, M. P., Hall, E., & Wellisch, J. (2002). 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: UCLA Drug Abuse Research Center.

Supplementary Materials

Hall, E. A., Baldwin, D. M., & Prendergast, M. L. (2001). Women on parole: Barriers to success after substance abuse treatment. Human Organization, 60, 225-233.

Prendergast, M., Hall, E., Baldwin, D. M., & Wellisch, J. (1999). A qualitative study of participants in the Forever Free Substance Abuse Treatment Program. Report to the California Department of Corrections. Los Angeles: UCLA Drug Abuse Research Center.

Prendergast, M., Hall, E., Wellisch, J., & Baldwin, D. M. (1999). A process evaluation of the Forever Free Substance Abuse Treatment Program. Final report to the National Institute of Justice. Los Angeles: UCLA Drug Abuse Research Center.

Outcomes

Outcome 1: Drug use
Description of Measures Drug use was measured using structured interviews. Interviewers asked respondents to report frequency of drug use over the past year and during the past 30 days. Respondents were asked about 13 categories of drugs as well as drugs not specified in the categories.
Key Findings In a study of outcomes for 180 women 1 year after their release from prison, 8% of Forever Free participants reported drug use in the past 30 days, compared with 32% of the comparison group (p = .001). A total of 50.5% of Forever Free participants reported any drug use in the past year, compared with 76.5% of comparison group participants (p = .001).

In a study of outcomes for 64 women 1 year after their release from prison, a lower percentage of women who had participated in Forever Free and residential aftercare reported any heroin use in the past year (5.3%) than those who had not received aftercare (21.7%) and those in the no-treatment comparison group (40.9%). A total of 10.5% of Forever Free plus residential aftercare clients reported past-year amphetamine use, compared with 8.7% of those who did not participate in aftercare and 22.7% of the no-treatment comparison group. A total of 21.0% of Forever Free plus residential aftercare clients reported using cocaine or crack in the past year, compared with 69.5% of those who did not participate in residential care and 50.0% of the no-treatment comparison group.
Studies Measuring Outcome Study 1, Study 2
Study Designs Quasi-experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 2: Parole outcomes
Description of Measures Parole outcome data were collected using a structured interview. "Discharged/active with no return" was considered success. "Discharged/active returned to custody" and "in prison" were considered failures. In one study, reincarceration data were obtained from the Offender-Based Information System (OBIS).
Key Findings In one study, 68.4% of Forever Free graduates who entered residential treatment had not returned to custody 1 year after release on parole; 52.2% of Forever Free graduates who did not enter residential treatment had not returned to custody, while only 27.2% of women in a no-treatment comparison group had not been returned to custody (p < .05). In a second study, 49.5% of Forever Free graduates compared with 74.7% of a no-treatment comparison group reported being arrested in the year following release from prison (p = .001).
Studies Measuring Outcome Study 1, Study 2
Study Designs Quasi-experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)
Outcome 3: Employment after incarceration
Description of Measures Postincarceration employment was assessed with structured interviews. Participants were asked if they were employed, how many hours they worked per week, and the amount of their weekly take-home pay.
Key Findings In a study of outcomes among 180 women 1 year after release from prison, 65.3% of Forever Free participants, compared with 44.7% of comparison group participants, were employed. The groups were equivalent in hours worked per week and weekly take-home pay.
Studies Measuring Outcome Study 2
Study Designs Quasi-experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 26-55 (Adult) 100% Female 38.6% White
37% Black or African American
22.8% Hispanic or Latino
1.6% Race/ethnicity unspecified
Study 2 26-55 (Adult) 100% Female 34.6% Black or African American
33.6% White
22% Hispanic or Latino
9.8% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Drug use 2.8 3.1 2.8 3.3 2.3 3.5 2.9
2: Parole outcomes 3.1 3.1 2.8 3.3 2.8 4.0 3.2
3: Employment after incarceration 3.0 2.5 2.5 3.0 2.5 3.5 2.8

Study Strengths

The interview tools used in both studies were developed from other instruments with established reliability and validity. The researchers demonstrated effort to match comparison groups. Data analysis was appropriate.

Study Weaknesses

The sample sizes were small, allowing limited comparisons.

Readiness for Dissemination
Review Date: December 2006

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Center for Substance Abuse Treatment. (2006). Therapeutic community curriculum: Participant's manual (DHHS Publication No. [SMA] 06-4122). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Center for Substance Abuse Treatment. (2006). Therapeutic community curriculum: Trainer's manual (DHHS Publication No. [SMA] 06-4121). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Covington, S. (1999). A woman's journal (participant workbook from Helping women recover: A program for treating substance abuse, criminal justice edition). San Francisco: Jossey-Bass.

Covington, S. (2000). A woman's way through the twelve steps. Center City, MN: Hazelden.

Covington, S. (2002). Women in recovery: Understanding addiction. Carson City, NV: The Change Companies.

Covington, S. (2003). A healing journey: A workbook for women (participant workbook from Beyond trauma: A healing journey for women). Center City, MN: Hazelden.

De Leon, G., Melnick, G., & Center for Therapeutic Community Research. (1993). Therapeutic community Survey of Essential Elements Questionnaire (SEEQ)--Short form. New York: Community Studies Institute.

Fry, R., Johnson, S., Melendez, P., & Morgan, R. (1998). A parent's guide to changing destructive adolescent behavior. Ontario, CA: Parent Project.

Gordon Graham and Company, Inc. (1993). A framework for recovery. Bellevue, WA: Authors.

Gordon Graham and Company, Inc. (1998). A framework for breaking barriers. Bellevue, WA: Authors.

Gorski, T. (1997). The GORSKI-CENAPS model: An overview. Homewood, IL: Author.

Gorski, T., & Trundy, A. (2000). Relapse prevention counseling workbook: Practical exercises for managing high-risk situations. Homewood, IL: Terence T. Gorski.

Handouts:

  • AWARE Questionnaire--Revised
  • Client Satisfaction Survey
  • Client Satisfaction Survey Procedure
  • Client Satisfaction Survey Report
  • Covington, S. (2005). Helping women recover: Creating gender-responsive services [PowerPoint handout].
  • Group Schedule
  • NREPP Overview of Forever Free Substance Abuse Program
  • NREPP Overview: Training and Support Resources
  • PowerPoint slide presentations from trainings and workshops
  • Training and workshop overviews
  • Treatment Components
  • Workshop Schedule

Hermes, S. (1998). Assertiveness: Practical skills for positive communication. Center City, MN: Hazelden Foundation.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
1.3 0.5 0.5 0.8

Dissemination Strengths

The program uses best-practice materials from a variety of expert resources targeted to this specific population. Some training materials are provided for topic areas relevant to the intervention. A client satisfaction survey and a standardized therapeutic community fidelity measure are provided to support quality assurance.

Dissemination Weaknesses

The program materials are specific to one implementation site and may not be easily adapted or transferred to other implementation sites. The relationship between the submitted program materials is unclear. While implementation, program goals, and recommendations for staffing are addressed in some of the materials, the guidance across these materials is inconsistent. No support resources specific to the program and its implementation are provided. The connection between the quality assurance measures provided and the program model is unclear. Materials state that one implementation site was engaged in external quality reviews, but no standards or protocols for evaluation or quality assessment are provided.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Implementation materials, training, technical assistance/consultation, and quality assurance materials Contact the developer Contact the developer

Additional Information

Forever Free was designed as an integrated system of services including multiple interventions. The cost of the program is $17 per day per participant. Most women stay in treatment between 3 and 6 months, yielding a total per-client cost of $1,500 to $3,000.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Hall, E. A., Prendergast, M. L., Wellisch, J., Patten, M., & Cao, Y. (2004). Treating drug-abusing women prisoners: An outcomes evaluation of the Forever Free program. Prison Journal, 76, 81-105.

Jarman, E. (1993). An evaluation of program effectiveness for the Forever Free Substance Abuse Program at the California Institution for Women, Frontera, California. Sacramento: California Department of Corrections, Office of Substance Abuse Programs.

* Prendergast, M. L., Wellisch, J., & Wong, M. M. (1996). Residential treatment for women parolees following prison-based drug treatment: Treatment experiences, needs and services, outcomes. Prison Journal, 76, 253-274.

Contact Information

To learn more about implementation, contact:
David Conn, Ph.D.
(858) 573-2600
dconn@mhsinc.org

To learn more about research, contact:
Elizabeth A. Hall, Ph.D.
(310) 267-5501
ehall@ucla.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.