Transcript Treatment Quality

Treatment Quality
A Critical Issue for Drug Courts
NEADCP Conference, July 24, 2003
Will Brownsberger
Senior Criminal Justice Advisor to
Join Together
“Treatment works . . .”
• Great progress in treatment “technology”
– Cognitive-behavioral
– Motivational interviewing
– Understanding of dual-diagnosis needs
• Naturalistic statistical studies
But . . .
• Not all treatments work . . .
• No treatment works for everyone . . .
• Non-technological personal factors
important in substance abuse treatment . . .
– Empathy
– Social skills
– Peer group dynamics
Some facilities get better results . . .
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Technology
Implementation
Counselor personalities
Client personalities/attitudes
Hope and expectancy
. . . and some get worse results.
Not safe to assume quality . . .
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Chronic under-funding
High ownership turnover (20%?)
High management turnover (50%?)
High staff turnover
Hard to regulate -- many good reasons for
poor results
• Discouraging impressions from leaders
How do drug courts address
quality today?
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Professional deference
Gratitude for a bed . . . any bed
No oversight or performance measurement
Treatment role on drug court team often
supply driven
Pool referrals . . .
• Other drug courts
• Probation/parole/community corrections
• Other local agencies
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. . create a referral flow that can
cost-justify care management.
Care management . . .
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High quality assessment
Unbiased referral
Attention to client feedback
Follow-up and re-placement if necessary
Results measurement
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rewards the best providers
Treatment quality is only one issue . . .
• Carrots and sticks
• Power of the robe
• Evidence still accumulating on what matters
most in drug court protocols
. . . but it needs much more attention and
buyers have to lead.
Do no harm.
• Do not label complaints about treatment as “bad
attitude” or “relapse”
– Diminish trust
– Encourage bad faith
• Honor requests to change treatment providers.
• Accept treatment withdrawals followed by swift
appearances.
• Only modest sanctions for treatment disciplinary
infractions.
Thank you.
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Treatment quality is unacceptably uneven.
Pool referrals.
Use external care management.
Crave client feedback and credit it.
Do no harm.