Program Profile: Delaware CREST Outreach Centers

This is a residential work-release program that uses therapy, counseling and treatment for persons convicted of a crime 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).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Target Population

CREST Outreach Centers is the residential work-release portion of the continuum of substance abuse treatment for drug-involved incarcerated persons 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 individuals. Each stage in the continuum corresponds to the person’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 individuals to go through the KEY Program and the CREST Outreach Centers. Alternatively, they can participate in the CREST Outreach Centers without participating in the KEY Program. This CrimeSolutions review is focused on the program that allows them 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 individuals recovering from substance abuse to continue their treatment as they transition into the community. Typically, they 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 they engage in full-time substance abuse treatment. During the next 3 months, they become involved in the work-release portion of the program and go through the following phases of treatment:

• Entry, evaluation, and orientation: Participants get used to life outside of prison.
• Primary: Counselors and participants explore the challenges and issues faced by individual participants and prepare appropriate responses to minimize the likelihood of relapse.
• Job-seeking: Develop job-seeking and interview skills.
• Work release: Maintain residence at CREST while working in the community.

Additional Information

View the program profile for:

• Delaware KEY/CREST Substance Abuse Program
• Delaware KEY Substance Abuse Program

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 was comprised of individuals 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 CrimeSolutions 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 CrimeSolutions 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.

Re-review

The KEY/CREST Substance Abuse Program was originally reviewed and rated Promising for CrimeSolutions 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 re-reviewed 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 CrimeSolutions (see the Program Description for a link to the other programs).

Subgroup Analysis

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.

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

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

Following are CrimeSolutions-rated programs that are related to this practice:

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

Crime & Delinquency - Multiple crime/offense types

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They 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 adults who have been convicted of an offense.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?