Evaluation Report: PreCISE Program

RESEARCH SUMMARY

Evaluation Report: PreCISE Program
July 2001-December 2002

Date: July 2003
Authors: Elaine Wolf and Susan Adair

Summary

PreCISE ( Prevention through Comprehensive Information, Support, and Education) is a voluntary program that seeks to prevent the acquisition or transmission of HIV among high-risk ex-offenders with a drug use history. Program activities consist of daily on-site education and support groups; outreach in the form of presentations and distribution of educational materials; follow-up for referrals; and weekly on-site acupuncture treatments for detoxification and relapse prevention. The study focused on questions of process and outcome. In general, the program was found to have been implemented in a way that is consistent with its design. Notable findings related to program outcomes were that retention was highest among HIV-positive clients and those who were not currently under criminal justice supervision.

HIV Prevention and Policies Related to Health and Criminal Justice

HIV prevention programs that target criminal justice system-involved populations represent an effort to curb the spread of infection among an extremely high-risk group. The rate of HIV infection among prison and jail inmates has been shown to be seven times higher than the general population (Bureau of Justice Statistics, 2003; Centers for Disease Control; US Census Bureau). The PreCISE program offers free access, daily educational and support sessions, connections with other related programs, food, transportation, acupuncture, and recreational and educational activities to ex-offenders with drug use histories HIV-infected and non-infected referrals alike. Many PreCISE clients also belong to such typically hard-to-reach groups as residents of temporary or institutional housing, those in transition from periods of incarceration, and those in recovery from drug addiction. The satisfaction with program services that clients report is primarily based on their perception of its providing a reliably caring and supportive atmosphere. The program's success in reaching its target population, providing incentives for retention, and promoting client satisfaction shows that a voluntary, service-oriented, and client-centered approach can serve to promote the reduction of risky behaviors with at-risk groups who are typically difficult to engage in non-mandated programs. Engagement in such programs can have a considerable public health payoff.

Background

PreCISE is located in Brooklyn, NY and is administered by the Center for Community Alternatives (CCA), a private, not-for-profit agency providing direct services to professionals and clients in the criminal and juvenile justice and related human services systems. PreCISE seeks to prevent the transmission of HIV by targeting adults who have histories of criminal justice system involvement and substance use and who are at risk of becoming HIV positive or transmitting the disease.

The goals of the PreCISE program are to prevent the acquisition of HIV among high risk HIV-negative men and women ex-offenders with a drug use history and to prevent the transmission of HIV by HIV-positive persons in this target group.

Program components consist of daily on-site education and support groups covering five harm- and risk-reduction themes; outreach in the form of presentations and distribution of educational materials to individuals and groups in the community; follow-up for referrals to program participants and outreach recipients; and weekly on-site acupuncture treatments for detoxification and relapse prevention.

Daily education and support groups are facilitated by the program's Group Facilitator with the assistance of trained peer educators. These groups provide emotional support, education related to drug relapse prevention, and opportunities to learn and master skills related to harm and risk reduction to prevent primary and secondary HIV infection.

The client population consists of men and women in roughly a two-to-one ratio, who are typically in their 40s and African American. Slightly over half report being HIV-positive, all report some drug use history, one- third are past or current IV drug users, and about half are recently-released inmates or currently on probation or parole. About half are assessed by the intake interviewer as being inadequately housed.

The program is funded by Medical & Health Research Association (MHRA) of New York City / HIV CARE (Comprehensive AIDS Resources Emergency) Services.

Main Findings

Individuals who are HIV positive and are not on probation or parole have significantly higher rates of attendance than those who are not. Clients reported that notable program strengths included a caring and dedicated staff, well-trained peer educators, and a welcoming environment that provides them with an incentive for getting out and about and gives them a structure for sustaining recovery. In general, the process evaluation concluded that the program is reaching its target population and delivering the services intended in ways that are conducive to meeting program goals. Recommendations included refining a protocol for the collection of outcome data and the establishment of regularly scheduled times for staff reflection and client focus groups.

The Study

Justice Strategies, the research, training, and policy initiative of the Center for Community Alternatives, conducted the evaluation of the PreCISE program between October 2001 and December 2002.

Questions Addressed

Generally, the study focused on questions of process and outcome: the extent to which the program has been implemented in accordance with its design and the extent to which the program achieved its goals.

Approach

The evaluation included seven site visits to the program between October 2001 and September 2002. Data collection activities conducted during those visits included two focus groups with clients, observation of three group sessions, and observation of three outreach activities. Fieldnote data from these activities informed the program description in the full report and the interpretation of quantitative data. They also revealed specific ways in which clients value the services they receive from PreCISE and their affiliation with CCA in general. Records of group attendance and information collected at program enrollment and exit provided the basis for an analysis of issues of program exposure, while information from 24 completed surveys of client satisfaction revealed clients' assessments of strengths and recommendations for programmatic changes. The research protocol was approved by the Institutional Review Board for Human Subjects at Syracuse University.

References

Bureau of Justice Statistics. 2003. HIV in Prisons, 2000. http://www.ojp.usdoj.gov/bjs/pub/ascii/hivp00.txt

Centers for Disease Control and Prevention. HIV/AIDS Update. http://www.cdc.gov/hiv/pubs/facts.htm#Surveillance

US Census Bureau. http://www.census.gov/main/www/cen2000.html