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Program Profile: Delaware CREST Outreach Centers

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on May 21, 2019

Program Summary

This is a residential work-release program that uses therapy, counseling and treatment for offenders with a history of substance use who are reentering society. The program is rated Promising. There were statistically significant increases in participants being injection-free at 6 months and being drug-free after 3 years; however, there were no statistically significant effects in condom use (at 6 months) or being arrest-free (after 3 years).

Program Description

Program Goals/Target Population
CREST Outreach Centers is the residential work-release portion of the continuum of substance abuse treatment for drug-involved offenders reentering society, which is offered by the Delaware Department of Correction (DOC). The 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 is focused on the program that allows offenders to participate in the CREST Outreach Centers, without participating in the KEY Program.

Program Components
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 Outreach Centers, 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 of treatment:
  • 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 profile for:

Evaluation Outcomes

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Overall, mixed results were found regarding the effectiveness of the CREST Outreach Centers. At the 6-month follow up, there was no statistically significant effect on condom use; however, the CREST group had statistically significant lower rate of injection drug use. 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
The analyses by Martin, Butzin, and Inciardi (1995) showed a statistically significant reduction in the rate of injection drug use for the CREST group at the 6-month follow up, compared with the no-treatment comparison group.

Condom Use
The CREST group showed slightly higher condom use at the 6-month follow up, compared with the no-treatment comparison group; however, this difference was not statistically significant.

Study 2
Martin and colleagues (1999) found that 37 percent of the CREST group was arrest-free, compared with 30 percent of the comparison group at the 3-year follow up; however, this difference was not statistically significant.

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 Centers (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)
The sample comprised offenders who were assigned to work release after prison and had a history of chronic, heavy drug use, but had not participated in the prison therapeutic community. Participants were randomly assigned to either the CREST group or the comparison group.

The review of this study focused on the comparisons between the CREST group (with no prior prison-based treatment) 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. Due to the random assignment process, the CREST and comparison groups did not differ on most baseline measures.

Subjects were interviewed just prior to leaving prison and again about 6 months after release. Self-reported measures were also 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), but 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 CREST group (n=157), with no prior prison-based treatment, and the initial regular work-release 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 CREST group was 77 percent male, 74 percent African American, 24 percent white, and 2 percent Hispanic. Their an average age was 29 years.

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 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-report 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. The authors conducted subgroup analyses on revised groups, including CREST dropouts and completers.
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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 KEY Substance Abuse Program and the CREST Outreach Centers (which was also rated Promising). All three programs now have separate program profiles on (see the Program Description for a link to the other programs). In addition, Martin and colleagues (1999) reported additional analyses for groups included in the study such as CREST dropouts (n=109) and completers (n=101). At 3 years post-intervention, 28 percent of CREST dropouts were arrest-free, compared with 29 percent of the comparison group; thus, dropouts fared worse than the comparison group (although the difference was not statistically significant). There was a statistically significant difference in being less likely to have been re-arrested (55 percent arrest-free) for the CREST completers than for the comparison group. In addition, while only 5 percent of the comparison group remained drug-free at the 3-year follow up, 17 percent of the CREST dropouts and 27 percent of the CREST completers remained drug-free. These differences were statistically significant.
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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):109–116.

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:

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: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Suburban, Urban

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

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

Targeted Population: Alcohol and Other Drug (AOD) Offenders

Current Program Status: Active

Listed by Other Directories: Campbell Collaboration