Reentry Programs for Women Inmates
years, practitioners in just about every field took research
conducted primarily with male subjects and applied the findings
to women. Recently, however, researchers have begun to question
the applicability of those findings to women-and the answer
has been mixed.
One area in which the applicability of gender-neutral data
has come under scrutiny is corrections. A recent report
of the National Institute of Corrections states that, at
the same time that the number of female inmates has been
increasing significantly, the criminal justice system has
too often—and with difficulty—tried to implement
with women inmates “policies and procedures that…[were]
designed for male offenders.”
This practice may be ineffective because studies show that
female inmates must overcome unique social, emotional, and
physical challenges that impede their ability to integrate
smoothly back into society following a period of incarceration.
Change is now well under way. Inmate rehabilitation programs
are being developed specifically for female inmates. Older
programs originally designed for male inmates are being
evaluated to see how appropriate they are for incarcerated
NIJ studies looked at drug addiction treatment and other
rehabilitation programs for female inmates in various jurisdictions.
These studies point out the distinct treatment needs of
female inmates and examine ways that programs addressing
these unique requirements can help women successfully reenter
society after incarceration.
The KEY/CREST Programs
WHAT IS A THERAPEUTIC
One type of treatment program that has gained prominence
for treating drug addicts in prison is the therapeutic
community model. Therapeutic communities in the prison
environment are based on the concept that the addict must
be removed from the general population and placed in a
separate area in which the negative influences of prison
are decreased in order to create an environment that allows
for positive behavior change. In a therapeutic community
model drug treatment program, drug addiction is often
viewed as a symptom, rather than the cause, of dysfunctional
behavior in the addict's life.
The Delaware Criminal Justice Council received a grant
from NIJ to evaluate the gender appropriateness of two therapeutic
community drug rehabilitation programs: (1) The KEY program
at Baylor Women's Correctional Institute and (2) CREST,
a work release program at Sussex Correctional Institute.
Therapeutic Communities for Women
Prior research has shown that the therapeutic community
model, originally designed for men, can be successful for
women if modified. For example, the success of women in
therapeutic community programs is increased when the atmosphere
is less confrontational and when female counselors are present.
Additionally, women bring with them a host of personal issues-such
as a history of sexual abuse and problems in maintaining
relationships with their children-that must be addressed.
These problems are distinct from those usually faced by
male drug addicts.
During implementation of the KEY program, researchers observed
the need for aftercare to maintain the positive changes
in KEY graduates. To meet this need, Delaware obtained funding
in 1990 from the National Institute on Drug Abuse to establish
the first work-release program (CREST) based on the therapeutic
community model. Research since the implementation of KEY
and CREST has found that addicts who attend both KEY and
CREST have lower recidivism rates than those without KEY
or CREST program experience.
Four Failure Factors
The report submitted by the Delaware Criminal Justice Council
shows that of the various demographic and social factors
affecting a woman who enters the KEY program, four will
have the most impact on whether she will succeed. A female
inmate is at higher risk of failure if she has any one of
these four factors:
- She has a psychiatric history (formal diagnosis
and/or emotional/psychological difficulties).
- She has contemplated suicide.
- She has attempted suicide.
- She has difficulty controlling her temper or
her behavior is hostile or violent.
The Council's report demonstrates that the first 5 weeks
are critical for a new KEY participant. If she is to fail,
she will likely fail during this treatment orientation period.
However, if she remains in the program through the 49th
week (the midpoint of the treatment cycle), she will likely
remain in the program and be successfully discharged from
The Criminal Justice Council contracted Beth Bonniwell
Haslett of the University of Delaware to analyze the curriculum
used in KEY and CREST and to assess the two programs. Haslett
concluded that the programs were gender appropriate, but
made two main recommendations:
- The CREST program should be made single-sex, like the
KEY program at Baylor. Haslett observed that when women
clients were interrupted or challenged by men, they often
fell silent, which tended to hinder the therapeutic process.
- KEY and CREST should reassess the hierarchy structures
of the programs to be more therapeutic for women. The
imposition of strict rules and harsh consequences for
breaking those rules may provide needed structures for
males in rehabilitation programs, but women do better
in an environment where support and encouragement are
What Participants Had to Say
When asked, program clients considered the programs gender
appropriate overall, but many expressed a wish that the
programs have more female-only encounter groups. They also
thought there should be more programming to help addicts
make peace with their families and maintain contact with
their children. Although Haslett recommends that the programs
be made single-sex, participants thought that the coed nature
of the CREST program was a benefit, providing an opportunity
to develop healthy and positive attitudes and behaviors
toward the opposite sex. This view was shared by program
A difference of opinion emerged concerning the confrontational
aspects of the programs, in which participants can challenge
each other's behavior. Many women, citing histories of family
violence, did not like the shouting and verbal sparring
that often resulted from these parts of the programs. Some
complained that there was more "tearing up" than "building
up." Older women tended to be more uncomfortable with confrontation
and felt "disrespected" when challenged by younger peers.
Many thought more emphasis should be placed on bonding among
participants and less on confrontation. (Program directors
cited the potential for sexual activity and dependency as
the reason that relationship building is limited and controlled
in these programs.) The women generally viewed the programs'
strict rules as providing structure and instilling the idea
that the world outside had rules that had to be followed.
Most participants agreed that the programs offer an addict
a way to "straighten up" and that, in the end, the addict
has to want to change for the programs to work.
The Forever Free Program is a voluntary, intensive residential
treatment program for women inmates with substance abuse
problems at the California Institution for Women in Corona,
California. The residential program is followed by voluntary
community residential treatment during parole. Forever Free
began as a 4-month program and has since returned to that
duration; at the time of this evaluation, however, it was
briefly extended into a 6-month program.
Forever Free stresses relapse prevention and approaches
addiction as a disease. It also teaches offenders to identify
symptoms and develop unique skills and strategies for dealing
Some sessions are devoted to issues especially important
to women's recovery, including self-esteem, anger management,
assertiveness training, healthy relationships, physical
and psychological abuse, posttraumatic stress disorder,
codependency, parenting, sex, and health.
Women participating in the Forever Free Program were compared
with women attending Life Plan for Recovery, an 8-week substance
abuse education course. This group was chosen for comparison
because participants had similar backgrounds and demographics
and similar motivation for treatment (voluntary participation
in substance abuse education). The women in both groups
were about 35 years of age and averaged about 16 prior arrests
and 8 prior incarcerations. Most had been incarcerated for
a drug offense. In addition, they were poor, ethnically
diverse, undereducated, and they worked in low paying jobs.
The study demonstrates the effectiveness of the Forever
Free Program for women offenders both in terms of their
involvement in the criminal justice system and in other
aspects of their postrelease lives (e.g., employment, relationships
with children, and services needed and received). Women
in both the treatment and comparison groups were followed
up 1 year after release.
Criminal justice measures. Forever Free Program
participants reported being rearrested and/or convicted
at a significantly lower rate than participants in the comparison
group (40 percent versus 60 percent).
Drug use. In contrast to the comparison group, a
significantly lower percentage of Forever Free participants
reported any drug use since release from custody (51 percent
versus 77 percent).
Employment. Two-thirds of Forever Free participants
were employed at the time of the followup interview compared
to less than half of the comparison group. Participating
in residential treatment during parole apparently improved
all subjects' chances of being employed.
Psychological functioning. At the 1-year followup,
Forever Free participants had significantly better psychological
functioning than members of the comparison group.
Treatment motivation and treatment attendance. Postrelease
interviews revealed that drugs were a greater problem for
the comparison group than for the Forever Free participants.
Members of the comparison group also had a greater desire
for additional help than the treatment group. However, Forever
Free participants felt that they had greater control over
their drug-use behaviors.
Relationships with children. In contrast with the
comparison group, a larger number of Forever Free women
had custody of all of their children postincarceration (48
percent versus 28 percent). Twice as many Forever Free women
rated themselves as doing well in their parenting than did
members of the comparison group.
Services needed during parole. Women in the comparison
group reported greater needs for services than the Forever
Free group. These services included transportation, medical
treatment, life skills training, and vocational training.
The Forever Free group appeared much better able to obtain
such services for themselves.
Another significant finding of the Forever Free study is
the importance of treatment after release from custody.
For example, women who attended community residential treatment
were much more likely to be employed at followup. In light
of this evidence, criminal justice system policymakers may
consider encouraging community residential aftercare for
women participating in prison-based treatment programs for
This study demonstrates the effectiveness of the Forever
Free Program for women. And while most therapeutic community
treatment programs last 12 months, the Forever Free Program
lasts only 4 months (although it lasted 6 months at the
time of this study). The fact that the program was able
to demonstrate its effectiveness in a shorter time period
than most programs may indicate that other programs could
replicate Forever Free's success rate by emulating its curriculum-and
save valuable tax dollars in the process.
Some incarcerated women receive a dual diagnosis of substance
use disorder and posttraumatic stress disorder (PTSD). PTSD
can be recognized in women with extensive histories of interpersonal
violence. PTSD can compound the effects of substance abuse
and increase the chance of criminal recidivism.
Seeking Safety is a cognitive-behavioral treatment developed
in 1992 by Lisa Najavits at Harvard Medical School/McLean
Hospital. It is designed for people dealing with both substance
use disorder and PTSD or other trauma-related symptoms.
Seeking Safety is a flexible treatment that can be used
for men and women, in group or individual therapy settings,
in outpatient or residential treatment facilities. Sessions
focus on developing skills designed to combat both substance
addiction and PTSD. For example, distraction techniques
can be used to calm the triggers of both drug abuse and
PTSD. The goal is to help clients attain a sense of self-control
that will avert dangers in their behavior (e.g., self-inflicted
injury), in their relationships (e.g., the risk of HIV infection),
and in their thinking (e.g., addiction-related cognitive
The NIJ-funded study evaluated the initial impact of this
approach in a group of women inmates in the Discovery Program,
a substance abuse program at the Adult Correctional Institute
in Rhode Island. There were two pilot studies. One pilot
study involved six inmates who received Seeking Safety treatment.
The other study involved participants who were randomly
assigned either to a control group of 10 women who received
treatment as usual or an experimental group of 12 women
who received Seeking Safety treatment as an adjunct to treatment
Researchers conducted assessments pretreatment, posttreatment
during incarceration, and postrelease. Preliminary findings
from the group of six women are promising. In particular,
these women showed a significant improvement in PTSD symptoms
at posttreatment as well as at 6 and 12 weeks postrelease.
Three of the six women no longer met the criteria for PTSD
3 months after treatment-a significant finding given that
most individuals who receive treatment for PTSD take, on
average, 36 months to recover from this disorder.
However, the random assignment study finds no differences
between the test and control groups on any of the indices
of interest (including PTSD symptoms, drug use, and recidivism).
Significant differences between the Seeking Safety treatment
group and the treatment-as-usual group were likely difficult
to detect due to the small size of the control group and
an appreciable attrition rate (30 percent) within the group.
The finding that 33 percent of the women who received Seeking
Safety treatment returned to prison 3 months postrelease
and that women in the treatment group were more likely than
members of the control group to return to prison (50 percent
versus 10 percent) may be explained by the fact that members
of the treatment group had a greater severity of drug use
than did members of the control group prior to entering
prison, putting the treatment group at greater risk for
recidivism. These findings also indicate that women who
received Seeking Safety treatment may not have successfully
transferred skills learned in the program once they left
incarceration and reentered the community. Further investigation
is needed to determine whether an extension of the Seeking
Safety treatment to the postrelease period might improve
on the treatment program's effectiveness in reducing recidivism.
The Rhode Island Programs
Another study on the appropriateness of rehabilitation
programs for female inmates examined discharge planning
offered by the Rhode Island Department of Corrections (RIDOC).
RIDOC offers female inmates programs addressing substance
abuse, education and job training, life skills training,
and emotional and mental health.
The study finds that the programs at RIDOC appear to be
successfully matched to the needs of the steadily increasing
population of female inmates. Programs are staffed by culturally
diverse female role models who participate in both staff
and mentoring programs. The programs offer drug treatment
and multidimensional strategies for decision-making and
skillbuilding, which are generally recognized as beneficial
to women inmates. The programs are well received and well
attended-most women inmates (more than 70 percent) participate
in at least one type of program.
Overall, the results of the evaluation demonstrate that
the RIDOC programs produce some positive changes in incarcerated
women, such as increased confidence in life skills and reduced
substance use. Women who received counseling in both areas
were the most likely to believe they could get and keep
a job and avoid subsequent substance abuse problems. However,
none of the programs was able to reduce recidivism. Problems
encountered by the women after release-such as an abusive
partner-can overwhelm changes made prior to release. More
than one-third of the women left prison with no job, no
formal job training, no source of income, and less than
a high school education, placing them at a further disadvantage.
Moreover, many women who were recidivists were generally
ill-equipped to deal with the routine stresses of daily
life in the community and required strong social support
upon release from prison. Supervised transition settings
safe from violent partners, with opportunities to practice
skills learned in prison, may be appropriate.
Recognizing the Need for a Different Approach
Though the various treatment programs discussed in this
article differ in their details and approaches, all share
the premise that the needs of women inmates differ in many
respects-physically, emotionally, psychologically, and socially-from
those of their male counterparts. The implementation of
rehabilitation programs specifically designed with those
differences in mind can effectively address the needs of
female inmates and identify factors which may impede their
ability to succeed post release.
ABOUT THE STUDIES DISCUSSED IN THIS ARTICLE
This article is based on four studies conducted
for NIJ. The names of the study authors and their reports
- Garrison, Arthur, Process Evaluation Assessing the
Gender Appropriateness of the KEY/CREST Program, Final
Report to NIJ, grant number 99-RT-VX-K016, April 2002
The full report and Executive Summary are available from
Garrison is the director of criminal justice planning
for the Delaware Criminal Justice Council.
- Prendergast, Michael, Elizabeth Hall, and Jean Wellisch,
Outcome Evaluation of the Forever Free Substance Abuse
Treatment Program: One-Year Postrelease Outcomes,
Final Report to NIJ, grant number 99-RT-VX-K003, December
2001 (revised July 2002) (NCJ 199685).
The full report and Executive Summary are available from
Prendergast and Hall are researchers at the University
of California-Los Angeles Integrated Substance Abuse Programs,
Criminal Justice Research Group. Wellisch is an independent
consultant specializing in program evaluation and policy
- Quina, Kathryn, Collaborative Development of Individual
Discharge Planning for Incarcerated Women, Final Report
to NIJ, grant number 96-CE-VX-0012, December 2000 (NCJ
The full report is available from NCJRS (http://www.ncjrs.gov/pdffiles1/nij/grants/191202.pdf)
as is the Executive Summary (http://www.ncjrs.gov/pdffiles1/nij/grants/191195.pdf).
Quina is a professor of psychology and women's studies
at the University of Rhode Island.
- Zlotnick, Caron, Treatment of Incarcerated Women
With Substance Abuse and Posttraumatic Stress Disorder,
Final Report to NIJ, grant number 99-WT-VX-0004, July
2002 (NCJ 195165).
The full report is available from NCJRS (http://www.ncjrs.gov/pdffiles1/nij/grants/195165.pdf).
Zlotnick is an associate professor in the Department of
Psychiatry and Human Behavior at Brown Medical School.
 Bloom, Barbara, Barbara Owen, and Stephanie Covington, Gender-Responsive Strategies: Research, Practice, and
Guiding Principles for Women Offenders, Washington,
DC: U.S. Department of Justice, National Institute of Corrections,