Transcript Powerpoint - NPC Research

Are Family Treatment Drug
Courts Effective?
Results from two studies
and six sites
October 2008
Scott W.M. Burrus, Ph.D.
Shannon Carey, Ph.D.
Mike Finigan, Ph.D.
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
Six Sites With Different FTDC Models

Baltimore City: System-wide reform serving families
with at least one child that has never been involved
with child welfare

Harford: Single, dedicated treatment provider for
the entire program.

San Diego: System-wide reform 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
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Sample Demographics
 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
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Final Study Samples
Site
Drug Court System
Comparison
Baltimore
200
200
Harford
53
26
438
(104 DC, 334 SARMS,
pooled for analysis)
100
205
117
84
239
127
992
1350
San Diego
Santa Clara
Suffolk
Washoe
Total May
N=2008
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553
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Data Collection Strategies
Administrative record review
• Treatment, court, and child welfare records
Parent interviews (National Study only)
• A subset of 253 parents across the 4 sites were
interviewed up to 4 times during their case
• These data not presented here
 Qualitative parent and key stakeholder interviews
and court observations
 Cost data from the State of Maryland and Harford
County, MD.
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Part I: Outcome
Analysis
MAIN QUESTION: DO FTDC’S RESULT IN
BETTER TREATMENT & CHILD WELFARE
OUTCOMES, COMPARED TO
TRADITIONAL FAMILY COURT?
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Treatment Outcome Questions
Compared to parent who did not
participate in the program, did
parents in FTDC:
• Enter treatment more quickly following
their child welfare petition?
• Spend more time in treatment?
• Complete treatment at a higher rate?
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Days to Treatment Entry
Drug Court
Comparison
133
140
120
120
107
100
110
114
100
88
84
Days
80
57
60
58
40
20
0
Baltimore
City*
San Diego Santa Clara
Suffolk*
Washoe*
* Statistically significant at p<.001.
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Days Spent in Treatment
Drug Court
Comparison
350
298
330
297
300
250
Days
179
200
150
172
154
138
135
132
82
100
50
0
Baltimore
City*
San Diego
Santa
Clara*
Suffolk*
Washoe*
* Statistically significant at p<.001.
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Percent Completing
at Least One Treatment
Drug Court
Comparison
100%
85%
80%
69%
% Mothers
64%
62%
61%
60%
41%
36%
40%
32%
29% 31%
37%
32%
20%
0%
Baltimore Harford**
City*
San
Diego
**Statistically significant at p<.001.
May 2008
Santa
Clara**
Suffolk** Washoe*
*Statistically significant at p<.01.
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Child Welfare & Court System
Outcome Questions
Did children of FTDC parents spend
less time in out-of-home care?
Were children of FTDC parents
reunified at a higher rate?
Were FTDC parents less likely to
become involved with the CWS
subsequent to their case?
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Time in Out-of-Home Placement
Site
Drug Court
Comparison
Baltimore City
mean days*
N=200
252
N=200
346
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.
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Permanency Outcomes
Time to permanent placement
Permanency decisions:
• % reunification
• % another permanency outcome
About one-fourth (24%) of children had not yet
reached permanency at the end of study window:
•
•
•
•
•
•
Baltimore:
Harford:
San Diego:
Santa Clara:
Suffolk:
Washoe:
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35%
51%
20%
12%
57%
13%
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Days to Permanent Placement
* Statistically significant at p<.05.
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Percent Reunified
Drug Court
Comparison
100%
91%
76%
80%
% of children
70%
60%
60%
45%
45%
40%
56%
57%55%
44%
45%
30%
20%
0%
Baltimore
City*
Harford*
San Diego*
Santa
Clara*
Suffolk
Washoe**
* Statistically significant at p<.05. ** Statistically significant at p<.001.
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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
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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
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Part II: Black Box Analysis (National Study)
How do
FTDCs work?
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What factors
influence
program
outcomes?
18
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
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Conceptual Model for Understanding
How FTDC Works
FTDC
Treatment
Child Welfare
Outcomes
Parent
Characteristics
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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
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FTDC Processing Variables
San
Diego
Santa
Clara
Suffolk
Washoe
Days from petition to
drug court entry
227A
101
N.A.
105
Days spent in drug
court
209C
355
449B
353
17
(approx.
2 per
month)
15
(approx.
1 per
month)
31
(approx.
2 per
month)
25
(approx.
2 per
month)
Number of drug court
appearances
A
San Diego is significantly different from Santa Clara and Washoe.
B Suffolk is significantly higher than all other sites.
C San Diego is significantly lower than all other sites.
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Drug Court Graduation
San Diego
Santa Clara
Suffolk
Washoe
100%
84%
77%
80%
58%
60%
44%
40%
29%
30%
20%
26%
18%
13%
13%
3%
5%
0%
Graduated
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Terminated
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Still Enrolled
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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
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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
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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?
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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
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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
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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)
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Summary: Influences of
Parent Characteristics
No strong, consistent
pattern of differences for
different “types” of parents
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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
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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
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Part III: Qualitative
Parent Interviews
WHAT FEATURES OF DRUG COURT
MOST INFLUENCE PARENTS’
RECOVERY AND ABILITY TO MAKE
PROGRESS ON THE CASE PLAN?
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Qualitative Parent Interviews
Brief, open-ended questions asked of 219
parents, and in-depth qualitative interviews
with 30 parents
 Interviews provide contextual data to
facilitate the interpretation of the quantitative
data
 Parents’ perspective of what facilitates the
drug court process
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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
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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.”
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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.”
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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.
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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.”
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Part IV: Cost Study
DO POTENTIAL SOCIETAL COST
SAVINGS RESULT FROM FTDC
PARTICIPATION?
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Part IV: Harford Cost Study Results
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Cost Study Findings
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Cost Study Findings
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Harford 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.
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Baltimore City Cost Study Findings
Non-FRC cases are more costly; most costs are
child welfare-related
$7,000,000
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$-
$6,706,615
$4,612,327
FRC Cases
May 2008
Child Welfare Costs
Non-FRC
Cases
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Baltimore City Cost Findings, Cont.
After taking into account FRP program
costs and State of Maryland alcohol and
drug treatment costs:
The total net cost saving of the FRP for
200 cases is $1,004,456 or $5,002 per
served family
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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.
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For More Information:
The final report is posted on NPC’s
website: www.npcresearch.com
E-mail Scott Burrus
[email protected]
Article on an earlier phase of the FTDC
study: Green, Furrer, Worcel, Burrus & Finigan
(2007). How Effective Are Family Treatment Drug
Courts? Outcomes from a Four-Site National
Study, Child Maltreatment 12(1), 43-50.
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Discussion Questions
What are the ways that you use data as a
part of your work in drug court?
Hand out of data used for FDC evaluation
 How does this data overlap with what
you use regularly?
What are the challenges to collecting data?
Which data is most difficult for you to
collect?
What are some ideas for overcoming these
challenges?
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