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The Research
The Intervention The Research
The Science Behind the Package
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.
Interventions
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, R.J. 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.
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The Intervention
A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that
identifies HIV/AIDS prevention interventions with demonstrated
evidence of effectiveness. REP supports 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 intervention components that must
be maintained without alteration to ensure program effectiveness.
The core elements of Project START include:
- 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.
- Use a client-focused, personalized, incremental risk reduction approach.
- Use assessment and documentation tools to provide a structured program.
- 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.
- 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.
- Conduct enrollment and schedule two pre-release sessions within 2 months
before a client’s release.
- 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.
- Provide condoms at each post-release session.
- 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. Program Training
Supervisors and program staff from agencies adopting Project
START attend a 4-day training in which they learn how to conduct the
program, practice program delivery skills, and identify agency-specific
implementation strategies.
Technical Assistance
To be determined
Timeline for
Availability
Development of the REP package is underway. Pilot testing of the
package is complete. Final versions of the REP materials will be
available soon.
For More Information
on Project START Package
Barry Zack, Project START Dissemination Group, email:
barryzack@thebridginggroup.com
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