Project START: An Individual-level Intervention for People Being Released from a Correctional Facility and Returning to the Community

The Research

The Science Behind the Package

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Project START is based on research of an individual-level multi-session intervention for young men being released from a prison and returning back into the community. The main goal of Project START is to reduce HIV, sexually transmitted infection and hepatitis risk behaviors in the client’s life after incarceration. To do this, the program uses a client-centered step-by-step approach based on the conceptual framework of Incremental Risk Reduction. This framework encourages clients to become more aware of their risk behaviors and provides them with tools and resources to reduce their risks. It provides them with skills in prioritization of needs, problem solving, goal setting, strengthening motivation, decision making, and other skills clients may need to successfully carry out a personalized risk reduction plan. In addition, Project START helps clients identify and address other issues and challenges that they may face when released from a correctional setting into the community. These issues may include housing, employment, or living with substance use and mental health concerns.

Target Population
The original research targeted young men ages 18-29 who were being released from a prison back into the community. However, the intervention has been expanded to include any individual who is being released from a correctional setting back into the community. It can be used with men and women, people of all ages, and for people who are HIV-positive and people who are HIV-negative. Expansion of Project START to serve these different populations has proven to be successful in pilot sites though results were not tested for effectiveness.

The intervention consists of enrollment and two individual sessions scheduled within 60 days before release and four individual sessions scheduled 3 months after the client is released into the community. Each session lasts 60-120 minutes. During the pre-release sessions, program staff assesses the client’s knowledge of HIV, STIs, and hepatitis, conducts an HIV/STI/hepatitis risk assessment, and helps the client develop a personal risk-reduction plan. The client is provided information, skills, and referrals and is helped to identify incremental steps towards risk reduction. The client is also helped to develop a plan to address other life needs such as housing, employment, finances, substance abuse, mental health treatment, legal issues, and avoiding reincarceration. The post-release sessions involve a review of the client’s needs and goals and an update of the risk reduction and transitional plans. Additional sessions are also available for clients as needed during the intervention period. Condoms and facilitated referrals are provided to connect clients to services in the community at each post-release session as needed.

Research Results
Project START was tested at 8 prisons in 4 states; California, Mississippi, Rhode Island, and Wisconsin. Fewer men who participated in the multi-session program (Project START) reported unprotected anal or vaginal sex at six months after release.

For Details on the Research Design 
Wolitski RJ and the Project START Writing Group, for the Project START Study Group. Relative Efficacy of a Multisession Sexual Risk-Reduction Intervention for Young Men Released from Prisons in 4 States. American Journal of Public Health. 2006; 96(10): 1854-1861.

The Intervention

A Package Developed from Science 
Replicating Effective Programs (REP) is a CDC-initiated project that supports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original the original researchers in developing a user-friendly package of materials designed for direct service prevention providers. Project START is one of the REP interventions and is the product of extensive collaboration among researchers, community-based organizations, correctional facilities and public health departments. The package has been field tested in multiple correctional settings by non-research staff from community-based organizations and is now ready for program implementation.

Core Elements 
Core elements are program components that must be maintained without alteration to ensure program effectiveness.

The core elements of Project START include:

  1. Hold program sessions with clients transitioning back to the community from a correctional setting prior to release and continue sessions with the client after they are released into the community.
  2. Use a client-focused, personalized, incremental risk reduction approach.
  3. Use assessment and documentation tools to provide a structured program.
  4. Staff program with people who are familiar with HIV, STI, and hepatitis prevention activities and who are familiar with the specific needs of people being released from correctional settings.
  5. Staff-client relationships developed during pre release sessions must be maintained during post release sessions to promote client trust. Thus, the same staff member should conduct both pre-release and post-release sessions with his or her clients.
  6. Conduct enrollment and schedule two pre-release sessions within 2 months before a client’s release.
  7. Schedule four post-release sessions. Hold the first session as soon as possible, ideally within 48 hours of release. The next three sessions should be spaced out over 3 months after release.
  8. Provide condoms at each post-release session.
  9. Actively maintain contact with clients, using individual-based outreach and program flexibility to determine the best time and place to meet with them.

Package Contents 
The package contains: (1) program implementation manual providing background information and detailed guidance for planning, implementation, evaluation and maintenance and (2) supporting materials including sample client forms, evaluation and quality assurance forms, client worksheets, and client case examples.

Timeline for Availability 
Development of the REP package is complete. The intervention package and training will be made available in the future.

For More Information on the Project START Package 
To find out more about future trainings, please visit Effective Interventions.