Transcript Powerpoint

Family Drug Treatment Courts
and Juvenile Drug Courts:
Outcomes, Costs and Promising
Practices
NADCP Conference
May 2008
Michael W. Finigan, Ph.D.
Scott W. M. Burrus, Ph.D.
Shannon M. Carey, Ph.D.
Juliette R. Mackin, Ph.D.
www.npcresearch.com
Informing policy,
improving programs
May 2008
4380 SW Macadam Ave. Suite 530
Portland, OR 97239
Presented by NPC Research
Are Family Treatment Drug
Courts Effective?
Results from two studies
and five sites
Informing policy,
improving programs
May 2008
Four of the study sites were funded by the
Substance Abuse and Mental Health Services
Presented by NPC
Research
Administration,
Grant No. 270-02--7107
Study Introduction: The FTDC
National Evaluation
A study
conducted by
NPC Research
May 2008
A federally funded
national evaluation
funded by the Center
for Substance Abuse
Treatment, SAMHSA
Presented by NPC Research
Four FTDCs in
the study:
•Santa Clara, CA;
• San Diego, CA;
• Washoe, NV;
• Suffolk, NY.
3
Study Introduction:
The Harford County, MD Evaluation
A separate, stand-alone study
conducted by NPC of the Harford
County, Maryland Family Recovery
Court (FRC) located in Bel Air, MD.
Funded by SAMHSA and the Maryland
Office of Problem Solving Courts.
May 2008
Presented by NPC Research
4
Five Sites With Different FTDC Models

Harford: Single, dedicated treatment provider for
the entire program.

San Diego: System-wide reform, the “Substance
Abuse Recovery Maintenance System” (SARMS),
with FTDC for non-compliant parents

Santa Clara: Mostly traditional FTDC model; some
systems changes

Suffolk: Neglect cases only, many children not in
out-of-home placements

Washoe: Traditional FTDC model
May 2008
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5
Sample Demographics
 Site-level
samples (treatment vs.
comparison) were well-matched, with
very few significant differences in
demographic, risk, or case
characteristics
 California
sites had larger Hispanic
populations
 Suffolk
site had no meth users; this was
the most common drug at the other 3
national sites
May 2008
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6
Data Collection Strategies
Administrative record review
• Treatment, court, and child welfare
records
Qualitative parent and key stakeholder
interviews and court observations
Cost data from the State of Maryland
and Harford County, MD.
May 2008
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7
Treatment Outcome Questions
Compared to Control Parents, Did
Parents in FTDC:
• Enter treatment at a higher rate?
• Enter treatment more quickly following
their child welfare petition?
• Spend more time in treatment?
• Complete treatment at a higher rate?
May 2008
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8
Likelihood of Treatment Entry
Drug Court
Comparison
86%
83%
100%
80%
73%
67%
% Mothers
60%
61%
60%
61%
60%
40%
20%
0%
San Diego
Santa Clara*
Suffolk*
Washoe
* Statistically significant at p<.001.
May 2008
Presented by NPC Research
9
Days to Treatment Entry
Drug Court
140
Comparison
133
120
120
107
114
110
100
100
84
Days
80
58
60
40
20
0
San Diego
Santa Clara
Suffolk*
Washoe
* Statistically significant at p<.001.
May 2008
Presented by NPC Research
10
Days Spent in Treatment
Drug Court
Comparison
330
350
298
297
300
250
Days
200
179
154
150
172
135
132
100
50
0
San Diego
Santa Clara*
Suffolk*
Washoe*
* Statistically significant at p<.001.
May 2008
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Percent Completing
at Least One Treatment
Drug Court
Comparison
100%
85%
% of mothers
80%
69%
61%
62%
60%
41%
29% 31%
40%
32%
32%
37%
20%
0%
Harford**
San Diego
**Statistically significant at p<.001.
May 2008
Santa
Suffolk**
Washoe*
Clara**
*Statistically significant at p<.01.
Presented by NPC Research
12
Child Welfare & Court System
Outcome Questions
Did children of FTDC parents spend
less time in out-of-home care?
Did FTDC cases reach permanency
faster?
Were children of FTDC parents
reunified at a higher rate?
May 2008
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13
Time in Out-of-Home Placement
Site
Drug Court
Comparison
Harford
mean days*
N=53
136
N=26
443
San Diego
mean days
N=824
226
N=463
232
Santa Clara
mean days
N=194
190
N=1,112
218
Suffolk
mean days
N=262
114
N=496
82
Washoe
mean days*
N=165
199
N=245
336
* Statistically significant at p<.001.
May 2008
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Days to Permanent Placement
Drug Court
Comparison
800
700
600
500
Days
400
353
347
291
300
286
243
255
200
216
277 262
163
100
0
Harford
San Diego
Santa Clara*
Suffolk
Washoe
* Statistically significant at p<.05.
May 2008
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Percent Reunified
Drug Court
Comparison
100%
91%
76%
% of children
80%
60%
60%
45%
40%
57%
56%
44%
55%
45%
30%
20%
0%
Harford*
San
Diego*
Santa
Clara*
Suffolk Washoe**
* Statistically significant at p<.05. ** Statistically significant at p<.001.
May 2008
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Summary: Outcomes for FTDCs
Strong treatment outcomes: FTDC parents
more likely to enter treatment, spend more
time in treatment, and complete treatment
Longer time to permanent placement for
FTDC parents could be explained by the
longer treatment stays
Less time in Out of Home Placements:
FTDC children spent more of this time with
their parents
May 2008
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Outcomes for FTDCs, cont’d
FTDC children were
more likely to be
reunified with their
parents at the end
of the case
May 2008
Presented by NPC Research
18
Black Box Analysis (National Study)
How do
FTDCs work?
May 2008
Presented by NPC Research
What factors
influence
program
outcomes?
19
Unpacking the “Black Box” of Family
Treatment Drug Court
Outcome analysis tells us whether
FTDCs work
Analysis of parent characteristics and
experiences with services can begin
to tell us about how, why, and for
whom FTDCs work
A preliminary look within the FTDC
sample
May 2008
Presented by NPC Research
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Conceptual Model for Understanding
How FTDC Works
FTDC
Treatment
Child Welfare
Outcomes
Parent
Characteristics
May 2008
Presented by NPC Research
21
Key Questions About FTDC
 Key FTDC Variables:
• Time to enter FTDC
• Time spent in FTDC
• Number of FTDC hearings
• FTDC graduation
 Selected Outcomes:
•
•
•
Days in treatment,
Treatment completion
Reunification
May 2008
Presented by NPC Research
22
FTDC Experiences and Substance Abuse
Treatment Outcomes
Variable
Statistically
Significant?
Nature of Relationship to
Treatment Outcomes
Time to FTDC entry
(petition to entry)
No
No relationship
Longer time spent
in FTDC
Yes
Longer stays in tx
More tx completion
More FTDC
appearances
Yes
Longer stays in tx
More tx completion
FTDC graduation
Yes
Longer stays in tx
More tx completion
May 2008
Presented by NPC Research
23
FTDC Experiences and Reunification
Variable
Statistically
Significant?
Nature of Relationship to
Reunification
Faster time to
FTDC entry
No
No relationship
More time spent
in FTDC
Yes
More reunification
More FTDC
appearances
Yes
More reunification
FTDC graduation
Yes
More reunification
May 2008
Presented by NPC Research
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Key Questions
 Does time to treatment entry relate to
outcomes:
• Time spent in treatment
• Treatment completion
• Reunification
 Does time spent in treatment relate to:
• Treatment completion
• Reunification?
 Does treatment completion relate to
reunification?
May 2008
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25
Treatment Experiences and
Treatment Completion
Variable
Statistically
Significant?
Nature of Relationship to
Treatment Outcomes
Faster time to
treatment entry
Yes
Longer treatment stays
Higher rates of treatment
completion
Longer time in
treatment
Yes
Higher rates of treatment
completion
May 2008
Presented by NPC Research
26
Treatment Experiences
and Reunification
Variable
Statistically
Significant?
Nature of Relationship to
Reunification
More time to
treatment
No
No relationship
More time spent in
treatment
No
No relationship
At least one
treatment completion
Yes
More likely to be reunified
May 2008
Presented by NPC Research
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Do Parent Characteristics
Influence Outcomes?
Parent characteristics examined:
•
•
•
•
•
•
Demographic variables
History of substance abuse, mental health
Child welfare history
Maternal risk factors
Child risk factors
Psychosocial characteristics (perceived stress,
perceptions of control, social support)
May 2008
Presented by NPC Research
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Summary: Influences of
Parent Characteristics
No strong, consistent
pattern of differences for
different “types” of parents
May 2008
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How Do FTDCs Work? Summary of Findings
from Quantitative Data
Speed of Tx entry
Duration of Tx
FTDC
Treatment
Child Welfare
Outcomes
Parent
Characteristics
May 2008
Presented by NPC Research
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Does FTDC Influence Reunification “Above and
Beyond” its Effect on Treatment Completion?
FTDC
(TX vs Control)
Treatment
Completion
.14***
.28***
Reunification
Parent
Characteristics
May 2008
Presented by NPC Research
31
Part III: Qualitative
Parent Interviews
WHAT FEATURES OF DRUG COURT
MOST INFLUENCE PARENTS’
RECOVERY AND ABILITY TO MAKE
PROGRESS ON THE CASE PLAN?
May 2008
Presented by NPC Research
32
Emotional Support
 Parents talked about how the drug court team,
and in particular the judge and the drug courtdedicated case workers, provide a support
system.
“The drug court team and the drug court case
worker have helped me a lot. My first case
worker, that wasn’t the drug court one, didn’t
spend much time with me, but my drug court
case worker always knew what was going on
with me, and helped me get what I needed to get
my kids back
May 2008
Presented by NPC Research
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Accountability and Collaboration
 Parents also explained how frequent hearings
and attendance in drug court provided
accountability for their behavior because:
• “the team knows what’s going on with you and
you get immediate support for whatever is going
on as soon as you need it.”
• “it’s helpful going every two weeks because
things can come up during that time, and in drug
court these problems are addressed quickly.”
May 2008
Presented by NPC Research
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Accountability and Collaboration,
cont’d
 Frequent court attendance means that the
judge and others are well informed about the
parents’ cases and able to provide
appropriate support for recovery and other
issues facing the parent.
“(attending drug court regularly) helps you feel
less alone, that someone knows what’s going on
in your life and the all the issues that you face,
they know how to support you and what you
need.”
May 2008
Presented by NPC Research
35
Practical Support
Participants in drug court receive practical
assistance. Parents talked about:
• how the drug court helped get them housing and
employment,
• helped with life improvement needs such as tattoo
removal, dentures and obtaining birth control.
These practical and external supports helped to
increase parents’ sense of confidence and ability to
make improvements in their lives.
May 2008
Presented by NPC Research
36
Sense of Accomplishment
 Parents who graduated from drug court spoke
eloquently about the significance of graduation.
Parents discussed how graduation from drug
court gave them a sense of accomplishment,
some for the first time in their life.
“It (graduation) was great. Everyone applauded for
me, I got a hug from the Judge, and they gave me
flowers. I felt like a beauty queen. I also felt that my
graduated meant that I finished something I started,
and this is the first time I ever accomplished
something like this in my life. Now I feel like I can
succeed in life.”
May 2008
Presented by NPC Research
37
Part IV: Cost Study
DO POTENTIAL SOCIETAL COST
SAVINGS RESULT FROM FTDC
PARTICIPATION?
May 2008
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38
Part IV: Harford Cost Study Results
May 2008
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Cost Study Findings
May 2008
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Cost Study Findings
May 2008
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Cost Study Conclusions
Because FRC families utilized less foster
care and were more likely to achieve
reunification, FRC cases were less costly to
the child welfare system than other CINA
cases.
The total potential societal cost savings per
year of Harford County FRC operation was
nearly $317,000, or approximately $12,000
per served family.
May 2008
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Putting It All Together—
What Have We Learned?
 FTDC’s work — Families have more positive treatment
and child welfare outcomes
 How FTDC’s work –
• Support for treatment entry, retention, and completion
• Combination of emotional support, accountability, and
service coordination – but how these work is largely
unknown
 Retention of families in FTDC programs is important to
success
 FTDC influence on child welfare recidivism needs
additional data and research
 Reduced time in foster care during and after the child
welfare case may result in potential cost savings of FTDC.
May 2008
Presented by NPC Research
43
Are Juvenile Drug
Courts Effective?
Results from two
studies
Informing policy,
improving programs
May 2008
Presented by NPC Research
Typical Characteristics
 Fast/expedited entry into drug and
alcohol treatment
 Intense supervision (court and
treatment; frequent drug testing)
 Collaboration between treatment, the
court, prosecution and defense
council
 Use the principals of behavior
modification such as rewards and
punishment (including jail as a
sanction)
May 2008
Presented by NPC Research
45
Outcome and Cost Evaluations:
Clackamas County Juvenile Drug Court and the
Harford County Juvenile Drug Court
 JDC studies: one in Oregon, one in
Maryland
 Clackamas N = 53; Harford N = 102
 Similar participant demographics
• 85-90% white
• Marijuana primary drug of choice
 Outcomes: Re-arrests, substance use,
detention/jail, costs/benefits
 Costs: Investment and Outcome costs to
taxpayer
May 2008
Presented by NPC Research
46
Juvenile Drug Court Outcomes
Re-arrests
Substance use
Detention/jail
Costs & benefits
May 2008
Presented by NPC Research
47
Harford: JJ Recidivism (2 yr)
Graduates Discharges
(n=37)
(n=38)
Drug Court Comparison
Sample
Group
(n=75)
(n=82)
Ave # Juvenile
Re-arrests
.2
1
.6
1
Ave #
Adjudication
Hearings
.5
.5
.5
.6
Ave # Days
Juvenile
Probation*
0
61
31
131
May 2008
Presented by NPC Research
48
Harford: JJ Recidivism (2 yr)
14
12
10
8
Graduates
6
All Drug
Court
Comparison
4
2
0
# of juvenile
justice
complaints
# of
Days in secure
adjudication
detention
hearings
May 2008
Days on Days in Shelter Days in Group
community
Care
Home
detention
Presented by NPC Research
49
Harford: Adult CJ Recidivism (2 yr)
Graduates
(n=37)
Discharges
(n=38)
Drug Court
Sample
(n=75)
Comparison
Group
(n=82)
Ave # arrests
.1
.3
.2
.2
Ave # days in
jail
1
5
3
8
Ave #days in
prison
0
6
3
11
20
78
49
65
Ave # days
parole/
probation
May 2008
Presented by NPC Research
50
Harford: Overview of Outcome Findings
HCJDC participants had 36% fewer
juvenile and adult arrests
HCJDC participants had 59% fewer
days on juvenile and adult
probation/parole
HCJDC participants had more days
in residential treatment
May 2008
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51
Clackamas: JJ Recidivism
Average Number of Re-Arrests Over 24 months
Average Number of Re-arrests
2.5
2
All
Participants
1.5
Graduated
1
Comparison
0.5
0
3
May 2008
6
9
12
15
Months
18
Presented by NPC Research
21
24
52
Clackamas: 24-month recidivism rate
2 years from drug court entry
• Graduates
• All Participants
• Comparison
29%
44%
82%
2nd year after drug court entry (1 year
post-program)
• Graduates
• All Participants
• Comparison
May 2008
14%
29%
50%
Presented by NPC Research
53
Clackamas
Mean Number of Re-Referrals and Arrests in 3-Month
Increments (non-cumulative)
Average # of re-arrests
0.5
0.4
Pre-enhancement
0.3
Post-enhancement
0.2
Comparison
0.1
0
3
6
9
12
15
18
Months
May 2008
Presented by NPC Research
54
Clackamas
Substance Use: Percent of Positive UAs in 2 Month
Increments
Percent positive UAs
0.3
0.25
0.2
Pre-enhancement
0.15
Post-enhancement
0.1
0.05
0
2
4
6
8
10
12
Months
May 2008
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55
Clackamas
Average # of Drug-Related Rearrests
Mean Number of Drug Related Re-Arrests in
3-Month Blocks
0.25
0.2
0.15
Pre-enhancem ent
Post-enhancem ent
0.1
Com parison
0.05
0
3
6
9
12
15
18
Months
May 2008
Presented by NPC Research
56
Cost Findings
What is the cost to the taxpayer
for a juvenile drug court?
What are the cost savings of
juvenile drug courts?
May 2008
Presented by NPC Research
57
Harford: Average Program Costs per Participant
($11,689 - $41 per day)
Transaction Unit Costs
Ave #
Ave Cost
Drug Court
Appearances
$249.96
12.19
$3,047
Case
Management
$11.56
283 Days
$3,271
Individual D&A
Treatment
Sessions
$62.83
9.68
$608
Group D&A
Treatment
Sessions
$42.01
33.63
$1,413
Drug Tests (UAs)
$36.85
55
$2,027
May 2008
Presented by NPC Research
58
Clackamas: Program Transactions
Transaction
Unit Cost
Avg. # of
Program
Transactions
Avg. Cost per
Participant
DC Appearances
$373.83
29.55
$11,047
Case Management
$29.78
356.82 Days
$10,626
Individual
Treatment Sessions
$52.48
8.35
$438
Group Treatment
Sessions
$16.33
37.88
$619
Family Therapy
Sessions
$19.99
9.12
$182
Parent Support
Group
$9.54
26.41
$252
Parent Education
Classes
$9.33
4.47
$42
Drug Tests (UAs)
$6.00
70.96
$426
Drug Patches
$20.00
1.19
$24
Transaction
$23,656
Total Drug Court
May 2008
Presented by NPC Research
59
Clackamas Detention Costs Averaged per Youth
$12,000
Detention Costs
$10,000
$8,000
Year 1
$6,000
Year 2
$4,000
$2,000
$0
Graduated
Terminated
Comparison
Year 1
$747
$9,785
$2,598
Year 2
$393
$2,876
$1,791
May 2008
Presented by NPC Research
60
Harford: Options for High-Risk Youth
Placement Options
Cost Per Day
Harford Juvenile Drug
Court Program
$41
Detention
$296
Residential Treatment
$220
Emergency Shelter Care
$275
Community Detention
$24
May 2008
Presented by NPC Research
61
Clackamas Program/Placement Costs per Day
Placement Options
Cost Per Day
CCJDC Program
$66
Residential Treatment
$134
Shelter Care
$115
Short-term Detention
$187
Long-term Detention
$171
Adult Jail
$97
May 2008
Presented by NPC Research
62
Harford: Year 1, Year 2 and Cumulative
Outcome Costs
$20,000
$18,000
Total Average
Outcome Cost
$16,000
$14,000
Year 1
$12,000
YearAverage
2
Outcome Cost
Year 1
$10,000
Year 2
$8,000
$6,000
Study Group
$4,000
Year 1
$2,000
All Drug Court
Participants
Comparison
Group
May 2008
$0
Year 2
$9,704 All Drug Court$3,409
Participants
$8,774
Cumulative
Two Years
Cumulative
Two Years
$12,925
Comparison Group
$17,228
$8,481 Study Group
Presented by NPC Research
63
Harford: Overview of Cost Findings
HCJDC participant outcomes cost 60%
less per juvenile than the comparison
group.
The average cost of CJ system
outcomes for HCJDC participants in
the year following program involvement
was $5,072 less than the comparison
group.
May 2008
Presented by NPC Research
64
Harford: Overview of Cost Findings
72% in outcome costs savings for
Maryland Division of Corrections
Harford County Sheriff’s Office was
shown to experience a 44% savings in
outcome costs
24% in outcome cost savings for
Maryland Division of Probation and
Parole
May 2008
Presented by NPC Research
65
Per participant recidivism costs over 2 years
in juvenile drug courts
Clackamas County Oregon Juvenile Drug Court
• All Drug Court minus Comparison = $961 savings
• Graduates minus Comparison = $10,958 savings
Harford County Maryland Juvenile Drug Court
• All Drug Court minus Comparison = $5,702 savings
• Graduates minus Comparison = $7,508 savings
May 2008
Presented by NPC Research
66
Juvenile Drug Court
Promising Practices
May 2008
Presented by NPC Research
67
Clackamas Enhancements
Addition of Community Resource
Liaison position
• Find and create new community resources
including community service opportunities
• Work to link youth to community resources
Family Therapist almost at full-time
• Already required family therapy
• More home visits
• Required parenting class instituted
May 2008
Presented by NPC Research
68
Clackamas: Relationships/connections with
community agencies
Community Resource Liaison:
 Added a Family Representative
 Oregon Youth Authority
 Developed connections with
residential treatment programs
 Trained community guides
 Strong relationships with local
agencies and community leaders
May 2008
Presented by NPC Research
69
Clackamas: Program Response
Community Liaison: (Paradigm Shift)
 Arranges for (reserves) community service
slots each week and brings to team at client
progress meetings
 Increased the variety of community service
options
• Youth can choose a service that is meaningful to
them
• Youth that don’t do well together can be sent to
different service options
 Attends end of court session to sign kids up
May 2008
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70
Data Needed for
Outcome/Impact/Cost
Studies
May 2008
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71
QUESTIONS?
Thank you!!
May 2008
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72
Family Drug Treatment Courts
and Juvenile Drug Courts:
Outcomes, Costs and Promising
Practices
NADCP Conference
May 2008
Michael W. Finigan, Ph.D.
Scott W. M. Burrus, Ph.D.
Shannon M. Carey, Ph.D.
Juliette R. Mackin, Ph.D.
www.npcresearch.com
Informing policy,
improving programs
May 2008
4380 SW Macadam Ave. Suite 530
Portland, OR 97239
Presented by NPC Research