Intervention Summary

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Friends Care

Friends Care is a stand-alone aftercare program for probationers and parolees exiting mandated outpatient substance abuse treatment. The aftercare program is designed to maintain and extend the gains of court-ordered outpatient treatment by helping clients develop and strengthen supports for drug-free living in the community. Program goals include reduced drug use and criminal activity. Friends Care offers individual counseling to explore and resolve issues in maintaining a drug-free and productive life and to support efforts to continue drug-free functioning; case management to assist in obtaining needed services; skills building in job seeking and appropriate workplace demeanor; family relationship strengthening; education on HIV prevention; crisis intervention; and a peer support group. The program provides services for up to 6 months following discharge from an outpatient facility.

Descriptive Information

Areas of Interest	Substance abuse treatment
Outcomes	Review Date: January 2008 1: Opiate and/or cocaine use 2: Use of any illicit drug 3: Criminal activity
Outcome Categories	Crime/delinquency Drugs
Ages	18-25 (Young adult) 26-55 (Adult)
Genders	Male Female
Races/Ethnicities	Black or African American Race/ethnicity unspecified
Settings	Correctional Other community settings
Geographic Locations	Urban
Implementation History	Friends Care was originally implemented and evaluated between 1997 and 2001 in Baltimore, Maryland. Three stand-alone aftercare facilities were established to serve probationer and parolee clients following discharge from six community outpatient treatment programs. The program served approximately 130 clients.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Review Date: January 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Brown, B. S., O'Grady, K., Battjes, R. J., & Farrell, E. V. (2004). Factors associated with treatment outcomes in an aftercare population. American Journal on Addictions, 13(5), 447-460.

Brown, B. S., O'Grady, K. E., Battjes, R. J., Farrell, E. V., Smith, N. P., & Nurco, D. N. (2001). Effectiveness of a stand-alone aftercare program for drug-involved offenders. Journal of Substance Abuse Treatment, 21(4), 185-192.

Outcomes

Outcome 1: Opiate and/or cocaine use
Description of Measures	Data on opiate and cocaine use were collected using the Texas Christian University intake and follow-up form. Respondents were asked to report their cocaine, opiate, and opiate and/or cocaine use during the past 30 days and 6 months using a 9-point scale ranging from 0 (never/not used) to 8 (about 4 or more times per day). Responses were aggregated to create measures of "any use" or "weekly or more use." Opiate use was defined as the use of heroin, heroin and cocaine mixed together, street methadone, or other opiates (i.e., opium, morphine, Demerol, Darvon). Cocaine use was defined as the use of crack/freebase, cocaine, or heroin and cocaine mixed together. Opiate and/or cocaine use was operationalized as the use of any opiate or cocaine-derived drug listed above.
Key Findings	At the 6-month follow-up, the percentage of clients reporting using opiates and opiates and/or cocaine at least weekly in the past 6 months was significantly smaller in the aftercare group than in the control group (3.2% vs. 11.8%, p < .05, and 4.3% vs. 17.6%, p < .01, respectively). The percentage of clients reporting using cocaine at least weekly also was smaller in the aftercare group than in the control group, but this difference did not reach statistical significance. After statistically controlling for demographic characteristics, mental health status, and community involvement, participation in aftercare services was shown to account for a significant reduction in any opiate and cocaine use during the same 6-month follow-up period. Specifically, compared with clients in the control condition, clients assigned to the aftercare condition were nearly one-fourth as likely to report using opiates one or more times (p < .01) and one-third as likely to report using cocaine one or more times (p < .05).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.9 (0.0-4.0 scale)

Outcome 2: Use of any illicit drug
Description of Measures	Data on illicit drug use were collected using the Texas Christian University intake and follow-up form. Respondents were asked to report their illicit drug use during the past 30 days and 6 months using a 9-point scale ranging from 0 (never/not used) to 8 (about 4 or more times per day). Responses were aggregated to create measures of "any use" or "weekly or more use."
Key Findings	At the 6-month follow-up, the percentage of clients reporting using any illicit drugs at least weekly in the past 6 months was significantly smaller in the aftercare group than in the control group (5.3% vs. 17.6%, p < .05). After statistically controlling for demographic characteristics, mental health status, and community involvement, participation in aftercare services was shown to account for a significant reduction in illicit drug use during the same 6-month follow-up period. Specifically, compared with clients in the control condition, clients in the aftercare condition were nearly one-third as likely to report using any illicit drug one or more times (p < .01) and one-fifth as likely to report using any illicit drug weekly or more often (p < .01).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.8 (0.0-4.0 scale)

Outcome 3: Criminal activity
Description of Measures	Data on criminal activity were collected using the Texas Christian University intake and follow-up form. Respondents were asked to report their criminal activities during the past 30 days and 6 months. Specific measures included the number of days any illegal activity other than drug use was committed and the proportion of income derived from illegal activity.
Key Findings	At the 6-month follow-up, the percentage of clients reporting committing a crime in the past 30 days was significantly smaller in the aftercare group than in the control group (8.5% vs. 19.6%, p < .05). During the same 30-day period, clients in the aftercare condition also reported fewer days of criminal activity than those in the control condition (0.2 vs. 2.4 days, p < .01) and a smaller proportion of their income obtained from illegal activity (p < .01).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	2.6 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult) 26-55 (Adult)	74.6% Male 25.4% Female	95.8% Black or African American 4.2% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

1. Reliability of measures	4. Missing data and attrition
2. Validity of measures	5. Potential confounding variables
3. Intervention fidelity	6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Opiate and/or cocaine use	3.4	2.9	2.8	3.3	2.3	3.0	2.9
2: Use of any illicit drug	3.4	2.9	2.5	3.0	2.3	2.5	2.8
3: Criminal activity	2.5	2.2	3.0	3.0	2.3	2.8	2.6

Study Strengths

An experimental design was used to compare offenders receiving aftercare with those receiving services as usual. The researchers used random assignment and added nonrandomly assigned subjects only after the equality of groups was established. Multiple outcome measures were used; self-reported drug use measures were partially validated by urinalysis for the 6-month follow-up (i.e., 78% of participants reporting themselves as not using drugs in the past 30 days provided drug-free urine specimens). A manualized treatment protocol was employed, and training and oversight were provided. The researchers obtained excellent follow-up rates at 6 and 12 months. The sample size was adequate.

Study Weaknesses

Probationers and parolees living in the three catchment areas in which aftercare facilities were located were purposefully assigned to the intervention group, which weakened confidence in the study findings. The low initial participation rate in the study (54%) raised questions about other potential confounding variables, such as participant motivation, that could account for the findings. Limited information was documented on services outside the program that study participants received, reducing the ability to link outcomes to the program intervention. Underreporting of drug use was not accounted for in the analysis of drug outcomes.

Readiness for Dissemination

Review Date: January 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Brown, B. S., Farrell, E., & Voskuhl, T. C. (1999). Manual for the Friends Care program: A program of aftercare services for drug treatment court clients.

Friends Care program instructions for completion of community contact form

National Institute on Drug Abuse. (1985). Leader's manual: Job seekers' workshop (DHHS Publication No. ADM 85-1424). Washington, DC: U.S. Government Printing Office.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
2.0	1.3	1.3	1.5

Dissemination Strengths

The program manual provides a structured service delivery approach and exercises to help implementers practice the concepts being taught. The manual also provides guidance for connecting with other community support services, working with families, and complying with requirements of the legal system. Training is available through the developer upon request. Service reports and program forms are provided to support quality assurance.

Dissemination Weaknesses

Some concepts and terminology in the implementation materials are outdated. No guidance is provided for organizational implementation. No formal training curriculum is available. No guidance is provided for monitoring program outcomes.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Program manual (includes quality assurance tools)	Free	Yes
3-week, on-site training	Free	Yes
Consultation by phone or email	Free	No

Additional Information

Implementation requires a stand-alone facility that is easily accessible to the community and personnel to deliver the program.

Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation or research, contact:
Barry S. Brown, Ph.D.
(410) 837-3977
brownb@uncw.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.