Homeless Female Offenders Returning to the Community

In the last decade, the numbers of incarcerated females has tripled, making women the most
rapidly growing group of offenders in the United States. When compared to incarcerated
males, female offenders have a higher rate of being sentenced for drug crimes; moreover,
they are often injection drug users (IDUs), have sexual partners who are IDUs, and are often
forced into the sex trade for survival. As many as 50% of female offenders report physical
and/or sexual abuse; further, traumatic abuse, chronic emotional distress, and internalized
stigma resulting from being a felon and a drug-user, have a profound effect on the women's
self-esteem, leading to feelings of hopelessness and depression, delayed recovery and
reintegration, increased risky behaviors, and health concerns. Not surprisingly, women who
have been incarcerated are nearly twice as likely to experience mental illness compared with
non-offending women; further, 44% recidivate within a year due to possession of a controlled
substance. In particular, among homeless female offenders (HFOs), both parolees and
probationers report ongoing challenges for successful re-entry. These include unstable
housing, disorganized lives, unemployment, and limited access to health and social services.
While the Los Angeles County Department of Probation has provided guidance for successful
programs in its California Blueprint Master Plan for Female Offenders, the suggested
strategies of enhancing empowerment, positive coping, and job skills, and providing
peer-mentored approaches have not yet been implemented or evaluated. In Phase I of this R34,
our team of University of California Los Angeles, San Francisco, and Irvine researchers plan
to utilize our successful community participatory approaches to refine a gender-sensitive
criminogenic needs -focused intervention program, Female Ex-Offender Mentoring in Care
(FEM-CARE), with the help of a community advisory board, composed of HFOs and addiction
staff; and finalize strategies which will be validated by focus group sessions with HFOs. In
Phase 2, we will randomize 130 HFOs participating in one of two residential drug treatment
programs to assess the impact of the FEM-CARE or a Health Promotion control program on
reduction of drug and alcohol use and recidivism. This study is based upon our team's
history of promoting theoretically-based, culturally sensitive nurse-led interventions that
are enriched with criminal justice theoretical perspectives, and have resulted in
significant reductions in drug and alcohol use among homeless persons, many of whom have had
a history of incarceration. Our most recent successes in engaging male parolees in
nurse-supported peer mentorship, our team's expertise in enhancing stigma reduction among
vulnerable women, and our criminal justice experts have informed this study. Finally, recent
formative research with HFOs has revealed a desire for peer role models to support and
enhance knowledge of and access to healthcare, promote positive coping, stable housing, and
job skills, and to reduce stigma and depressed mood; all of these factors can result in
novel programs designed to prevent drug and alcohol use and reduce recidivism. This
foundation and strong community support garnered has led to the design of our proposed
intervention program.

Inclusion Criteria:

- female parolees or probationers enrolled in a six-month program at one of two
residential treatment (RDT) programs,

- convicted for a drug crime, and

- reported homeless on their RDT entry form

Exclusion Criteria:

- female parolees or probationers not currently enrolled in a six-month program at one
of two residential treatment (RDT) programs,

- not recently convicted for a drug crime, and

- not reported homeless on their RDT entry form