Transcript Program Evaluation - American Bar Association

Montana Drug Treatment Courts
Brenda K. Roche, Ph.D., LP
Neuropsychologist/Program Evaluator
Eastern Montana Meth Summit
April 22, 2005
Montana Treatment Courts















Missoula Youth Drug Court
Mineral County Youth Drug Court
Bozeman Adult Felony Drug Court
Yellowstone County Family Drug Treatment Court
Lewistown Family Treatment Court
Custer County Family Treatment Court
Butte Silver Bow Family Treatment Court
Billings Adult Misdemeanor Drug Court
Missoula Adult Mental Health Court
Cascade County Adult Drug Court
Chippewa Cree Youth Wellness Court
Crow Youth Wellness Court
Ft. Belknap Youth Wellness Court
Ft. Peck Youth Wellness Court
Northern Cheyenne Youth Wellness Court
Treatment Drug Court Team







Judge
Drug Court Coordinator
DPHHS Case Workers /Juvenile Probation
Officer / Adult Probation Officer
Treatment Providers
Defense Attorney(s), Guardians Ad Litem
Prosecuting Attorney
Court Appointed Special Advocate (CASA)
YCFTDC Adult Demographics
6/14/01 – 12/9/04

33 Females, 5 Male

Ethnicity
–
–
–
–

Caucasian = 25 (65.8%)
Native American = 8 (21.1%)
Hispanic = 4 (10.5%)
Bi-Racial = 1 (3%)
Age at Intake
–
–
–
–
18 to 21 years old = 5 (13%)
22 to 30 years old = 19 (50%)
31 to 40 years old = 11 (29%)
40+ years old = 3 (8%)
YCFTDC Adult Demographics
6/14/01 – 12/9/04

Marital Status at Intake
–
–
–
–
–
–

18 Single
7 Married
6 Living with Significant other
5 Divorced
1 Separated
1 Widowed
Living Arrangement at Intake
–
–
–
–
–
–
–
–
10 Renting
7 Michel’s House
6 Significant Other’s House
5 Homeless
3 Living with Friends
3 Relatives
3 Motel
1 Owned House
Drugs of Choice

1st Choice
–
–
–
–

Methamphetamine (24)
Marijuana (8)
Alcohol (5)
Prescription Meds (1)
2nd Choice
–
–
–
–
–
Marijuana (15)
Methamphetamine (8)
None Identified (7)
Alcohol (7)
Prescription Meds (1)
Child Demographics
6/14/02 – 12/9/04

36 Males, 32 Females

Ethnicity
– Caucasian = 32 (47%)
– Native American = 21 (31%)
– Hispanic = 13 (19%)
– African American = 2 (3%)

Ages at Intake
– Infants = 12 (18%)
– 1 to 3 year olds = 26 (38%)
– 4 to 5 year olds = 11 (16%)
– 6 to 12 year olds = 14 (21%)
– 13 to 14 year olds = 5 (7%)
Living Arrangements for
Children at Intake
Foster Care (32)
 Kinship Care (21)
 With Parent at Michel’s House (Residential
Treatment) (6)
 Group Home (3)
 Guardianship Placement (2)
 Out of State Relative Placement (2)
 Born in Drug Court remained with parents (2)

Graduation/Termination 6/14/01 – 12/9/04

Participant Status (N = 38)
– Active = 11 (28.9%)
– Expelled = 13 (34.2%)
– Graduated = 11 (28.9%)
– Opted to Quit = 2 (5.4%)
– Case Transferred = 1 (2.1%)
Child Permanency
6/14/01 – 12/9/04

Child Status (N = 68)
–
–
–
–
–
–
Reunified & Dismissed = 16 (23.6%)
Out-of-home = 15 (22.1%)
Adopted or final stages of Adoption = 11 (16.1%)
Reunified & Active = 9 (13.3%)
Relinquished adoption in process = 9 (13.3%)
Parental rights terminated adoption in process = 4
(5.8%)
– Placed with father = 4 (5.8%)












Sanctions Given
6/14/01 – 12/2/04 (N = 244)
Reprimand/Reminder by Judge = 43.4%
Community Service = 14.1%
Treatment Response = 11.5%
Writing Essay/Paper or watch video = 6.1%
Increase Court Appearances = 5.7%
Fines = 5.7%
Termination from Drug Ct = 4.5%
Jail Time = 2.9%
House Arrest = 2.5%
Curfew/turning in cell phone keys = 2%
Jail Time Suspended = 1.2%
Repeat Phase = .4%
Incentives Given (N = 884)
6/14/01 – 12/2/04












Praise /Acknowledgement= 49.2%
Fish Bowl = 21.7%
Gift card or small gift = 7.0%
Fish Bowl and Praise = 5.7%
Applause = 2.9%
Reduce court appearances = 2.9%
Increase in Child Visits = 2.9%
Financial Assistance = 2.6%
Treatment Response = 1.9%
Reunification = 1.5%
Graduation = 1.0%
Ticket to Community Event = .7%
Incentive & Sanction Comparison
6/14/01 – 12/2/04

Incentives per participant
–
–
–
–

Average = 26.9
Minimum = 1
Maximum = 72
Mode = 19
Sanctions per participant
–
–
–
–
Average = 7
Minimum = 1
Maximum = 17
Mode = 3
Drug Testing Results
6/14/01 – 12/2/04
4,030 Drug/Alcohol Tests Given
 Negative = 90.9%
 Failed to Show = 4.8%
 Positives = 2.5%
 Dilute Samples = 0.8%
 False Positives = 0.6%
 Lab Errors = 0.2%
 Prescribed Medication = 0.1%
 Staff Error = 0.1%
Drug Testing Results
6/14/01 – 12/2/04

90% Participants have Failed to Show at least once

51% Participants have tested positive at least once

30% Participants have provided Dilute Samples at
least once

2% Participants have had False Positives at least
once
CD/MH Treatment Services
6/14/01 – 12/9/04











Inpatient = 24
Intensive Outpatient = 25
Aftercare = 18
Individual Psychotherapy = 18
Day Treatment = 12
Relapse Prevention = 11
Michel’s House = 11
Detox = 9
Matrix = 7
Social Support = 6
Women’s Recovery Group = 4
# of Months in Program
6/14/01 – 12/9/04

Expelled Participants
– Median = 17 weeks
– Range = 1 – 72 weeks

Active Participants
– Median = 35 weeks
– Range 1 – 62 weeks

Graduates
– Median = 64 weeks
– Range = 51 – 94 weeks

Participants Who Quit
– Median = 44 weeks
– Range = 17 – 70 weeks
Preliminary Participant* Outcomes
6/14/01 – 12/9/04

Employment
– At intake = 29%
– 6 Month Follow-up = 70%
– 12 Month Follow-up = 70%

No Substance Use in Past Month
– At intake = 10%
– 6 Month Follow-up = 82%
– 12 Month Follow-up = 83%
* This includes all participants; those that graduated, were terminated, and
remain active.
Preliminary Child Outcomes
6/14/01 – 12/2/04

Comparison Group (N=37)
– Parental Rights Terminated and children still in care = (34%)
– Parental Rights Terminated and children Adopted = (15%)
– Reunified with parent = (22%)
– Tribal Transfer = (15%)
– Placed with father = (12%)
– Emancipation at 16 = (3%)
*Permanency Established = (67%)
*Parental Rights Terminated = (49%)
*Parental Rights Relinquished = (0%)

YCFTDC Children (N=68)
*Permanency Established = (77%)
*Parental Rights Terminated = (7.5%)
*Parental Rights Relinquished = (17%)
Preliminary Child Outcomes
6/14/01 – 12/2/04
Time In Care for Children
– Active YCFTDC Participant’s Children
» Median 203 days
» Range 78 – 405 days
– Expelled YCFTDC Participant’s Children
» Median 500 days
» Range 145 – 822
– Graduated YCFTDC Participant’s Children
» Median 345 days
» Range 60 – 661 days
– All YCFTDC Participant’s Children
» Median 399 days
» Range 60 – 822 days
– Control Group Children
» Median 1225 days
» Range 388 – 4234 days
Treatment Needs

Data suggests that anything less than 15
months of formalized treatment decreases
the success rate by approximately 63%.
Comments by Participants About
YCFTDC

How is your life different because of YCFTDC?
–
–
–
–
–
–
–
–
–
“It has made me realize how much I love my children.”
“I’m really busy – but that is good.”
“It has never been so good!”
“I have learned a lot about my behaviors that I wouldn’t
have.”
“I can’t jump through the hoops.”
“My kids have a mom now.”
“I never knew I could be so happy.”
“I just love spending time with my kids.”
“I feel like I can deal with things.”
Neuropsychological Evaluation








Identify neurocognitive barriers to successful treatment
Target education and vocational interventions
Provide information about children’s developmental
status and needs for parents and professionals
Psychological case management
Provide accurate diagnosis of co-morbid mental health
issues
Monitor growth and development through treatment
Provide evaluations regardless of financial resources
Evaluation as therapeutic intervention
Adult Neuropsychological Findings at
Intake (N = 34)


Co-Morbid Mental Health Diagnosis (96%)
Executive Functioning Deficits (82%)
–
–
–
–
–

Attention
Cognitive Flexibility
Working Memory
Problem-Solving
Organization
Learning Disabilities (77%)
– Math (92%)
– Reading (58%)
– Writing (25%)





Visual-Spatial/Organizational Deficits (76%)
Language Deficits (45%)
Memory Deficits (49%)
Below Average Intellectual Abilities (12%)
Above Average Intellectual Abilities (12%)
Adult Neuropsychological Findings at
Follow-up

6 Month Follow-up:
– Decline in Executive Functioning and Memory
Deficits.

12 Month Follow-up:
– Increase in Executive Functioning and Memory Skills.
– Mental Health Issues less distressing.

18 Month Follow-up:
– Continued Increase in Executive Functioning and
Memory Skills – close to average range.
– Mental Health Issues much less distressing.
Executive Dysfunction

Difficulty planning, organizing, managing
time, using working memory, delaying
responses and sustaining or shifting
attention so that an individual can set
priorities in responding to various
environmental stimuli
Working Memory

As straightforward as performing mental
math computations or as complex as
listening to a lecture, organizing the
information and relating it to previously
acquired knowledge.

Individuals rely on these abilities to follow
a sequence of instructions
Working Memory

Deficits can lead to problems with the
concept of time.
– Difficulty estimating how long a task will take;
and difficulty planning for contingencies.
» As a result they procrastinate and are
typically behind schedule.

Deficits can also create difficulties with
the ability to self-monitor readily.
– Leading to difficulties reading others' responses
and changing their behavior accordingly or
empathizing with others
Your Brain After Drugs
Dopamine Transporter Loss After
Heavy Methamphetamine Use
Comparison Subject
METH Abuser
Dopamine Transporters in Methamphetamine Abusers
Normal Control
Dopamine Transporters
(Bmax/Kd)
2.4
2.2
2.0
1.8
1.6
1.4
1.2
1.0
Normal
Controls
Methamphetamine Abuser
Meth
Abusers
p < 0.0002
Methamphetamine abusers have significant reductions in dopamine
transporters.
BNL - UCLA - SUNY
NIDA - ONDCP - DOE
Implication:
Compromised dopamine systems
contribute to the consequences
of drug addiction.
[C-11]d-threo-methylphenidate
Normal Control
DAT Recovery
with prolonged
abstinence from
methamphetamine
Methamphetamine Abuser
(1 month detoxification)
Methamphetamine Abuser
(24 month abstinent)
Source: Volkow, N.D. et al., Journal of Neuroscience, 21(23), pp. 9414-9418, December 1, 2001.
The Memory of Drugs
Front of Brain
Amygdala
not lit up
Nature Video
Back of Brain
Amygdala
activated
Cocaine Video
What memories do you associate with this image?
visual
-colour
-shape
smell
language
emotions
taste
auditory
Thinking Brain
Judgement Brain
Instinctual Brain
Pleasure Brain
Effects of Methamphetamine on the
Brain
Methamphetamine causes a marked increase in the
release of dopamine, a neurotransmitter
 This release can be 1000x normal levels
 Repeated use of meth causes the dopamine releasing
cells to die
 Methamphetamine also has effects on serotonin
 Addiction to meth is faster than to any other drug of
abuse
 A single dose of meth is about 500mg
(the weight loss dose is 5mg twice a day)

Understand Normal Development
Child Neuropsychological at Intake
(N = 62)



Language Delay / Disorders (69%)
Behavioral/Emotional Dysregulation (89%)
Learning Disabilities/Delayed School Readiness (77%)
– Dyslexia
– Writing
– Math






Executive Dysfunction (74%)
Motor Delays (57%)
Attentional Problems explained by other issue (49%)
Below Average Intellectual Abilities (37%)
Memory Difficulties (15%)
Attentional Problems not explained by other issue (5%)
Child Neuropsychological at Follow-up

6 Month Follow-up:
– Language Skills showing significant improvement but still
delays.
– Behavioral/Emotional Dysregulation is decreasing
– School performance improving.
– School readiness increasing.
– Improved Executive Dysfunction
– Motor Skills improving but still delays.
– Attentional Problems explained by other issues improved
significantly
– Memory Difficulties improving
– Attentional Problems not explained by other issue
improved.
Child Neuropsychological at Follow-up

12 Month Follow-up:
– Language Skills continuing to show significant
improvement almost in the average range.
– Behavioral/Emotional Dysregulation is continuing to
improve and almost in the average range.
– School performance improving significantly.
– School readiness increasing to average range.
– Improved Executive Dysfunction
– Motor Skills improving to almost average range.
– Attentional Problems explained by other issues improved
significantly to almost average range
– Memory Skills almost all in average range
– Attentional Problems not explained by other issue
improved significantly.
Language Disorders
 How
Do Children Learn to
Communicate?
– Need someone to interact with them
– Need to be actively engaged with people in
order for the communication experience to be
meaningful
Rate of Early Brain Development
Early Identification

Children whose language delay is identified
early have a significantly better chance of
developing necessary pre-reading and
academic skills than children whose delay is
not identified early.
How Can Early Language Delays
Affect A Child?

Behavioral dysregulation

Many children diagnosed as “emotionally disturbed”
have poor language and listening skills.

Low self-esteem

Poor academic performance

Social difficulties
Missoula Youth Drug Court




Operational in January 1997
Program capacity is 25
Daily average of participants enrolled is 18
42 females and 68 males have been accepted into
the program (total 110)
–
–
–
–

90 Caucasian
14 Native American
2 African American
4 Hispanic.
Status of Youth
–
–
–
–
43 graduated
49 terminated
3 moved away with their families
15 Active
Outcomes from Missoula Youth
Drug Court

The following statistics for Missoula YDC participants are based on
the time period after youth graduate or are expelled from Drug Court.
The Control Group was matched with the YDC participants on age of
first court involvement, substance abuse, type of charges, gender, and
ethnicity. The Control Group recidivism time period was started at the
age of the matched youth from the Drug Court. The data is from
1/1997 - 2/2002.
# of Encounters with Law Enforcement
Group
Expelled
Graduates
Controls

Mean
3.12
1.15
2.09
Range
0-13
0-7
0-11
The results indicate that graduates of YDC have statistically fewer
encounters with law enforcement compared to those in the expelled
group and those in the control group.
Outcomes from Missoula Youth
Drug Court
# Offenses Yth Cited for by Law Enforcement
Group
Expelled 4.15
Graduates
Controls 2.60

Mean
0-18
1.58
0-14
Range
0-10
The results indicate that graduates of YDC have statistically fewer citations than those
youth in the expelled or control groups.
% Yth with At Least 1 Encounter with Law Enforcement
Group
Expelled 69.7%
Graduates
Controls 63.8%

Percentage
63.6%
The results indicate that fewer graduates of YDC have at least one encounter than those
youth who are expelled from YDC. However, there was no statistical difference
between youth from the control group and graduates in relation to having at least one
encounter with law enforcement.
Outcomes from Missoula Youth
Drug Court
% Youth Cited for at Least 1 Felony
Group
Expelled
Graduates
Controls

Percentage
21.2%
3%
27.1%
The results indicate that the percentage of YDC
graduates cited for at least one felony is statistically less
than the percentage of youth cited for at least one
felony in the expelled and control groups.
Lewistown Family Treatment Court



Established in June of 2002 with the combination
of Children’s Justice Act funds, Court
Improvement funds for setup costs, and TANF
funds for continuing expenses.
Spent approximately one year planning the
program before implementing program in 9/02.
Served 9 parents and 14 children between 9/02
and 4/05.
– 7 participants graduated.
– 2 participants were terminated.

All fourteen children have achieved permanent
placements.
Butte Family Treatment Court

Operational on 3/18/04

First year served 4 parents and 11 children.

Funded through Congressional Earmark
Money from Senator Baucus’ office.
Custer County Family Treatment Court

Operational in 7/04

First 9 months have served 4 adults and 10
children

Funded through Congressional Earmark
Money from Senator Baucus’ office.
Billings Adult Misdemeanor Drug Court

Obtained Bureau of Justice Administration grant
10/04

Became operational on 3/17/05

13 active clients

25% of slots reserved for DWI/DUI

Capacity of 50 per year
Mineral County Youth Drug Court

Operational in March 2001

To date served 10 youth and families

8 youth graduated

2 youth active
Bozeman Adult Felony Drug Court

Operational in October 1999

First 5 years served a total of 78 adults

Status of Clients as of 10/04
–
–
–
–

14 Active
35 graduated
1 deceased
28 terminated
First 5 years screened 132 potential clients
Advances in Science
Have Revolutionized Our
Fundamental Views of
Drug Abuse and Addiction
There is a Unique Disconnect
Between the Scientific Facts
and the Public's Perception About
Drug Abuse and Addiction
Drug Abuse Is A Preventable Behavior
Drug Addiction Is A Treatable Disease
Partnership for a Drug Free America
Initial Drug Use Is A
Voluntary Behavior…
A Person Chooses to
Take a Drug for the First Time
Why Do People Take Drugs
In The First Place?
People Take Drugs To:
Feel good (sensation seeking)
Feel better (self medication)
A Major Reason People Take
a Drug is They Like What
it Does to Their Brains
Many Things Are Happening During
the Transition Between Voluntary
Drug Use and Addiction…
A Major Task for Drug Treatment
is Changing Brains Back!
Pharmacologically
Behaviorally
We Need to Treat the
Whole
Person!
The Most Effective Treatment
Strategies Will Attend to All
Aspects of Addiction:

Biology

Behavior

Social Context
In Treating Addiction…
We Need to Keep Our Eye on
the Real Target
Drug Abuse Treatment Core Components
and Comprehensive Services
Medical
Financial
Housing &
Transportation
Core
Treatment
Intake
Assessment
Child
Care
Treatment
Plans
Group/Individual
Counseling
Abstinence
Based
Pharmacotherapy
Self-Help
(AA/NA)
Family
AIDS /
HIV Risks
Mental
Health
Urine
Monitoring
Case
Management
Vocational
Continuing
Care
Judicial
Monitoring
Educational
Legal
Adapted from Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)
Termination
Action
Preparation
Precontemplation
Maintenance
Contemplation
Stages of Change
Prochaska et al, 1991
Where to go from here?
Continue to follow participants
longitudinally.
 Obtain state funding to continue drug court
initiative.
 Expand drug court programs across the
state.
 Obtain funding to add neuroimaging
studies.
 Disseminate data.

“Coming together
is a beginning,
talking together
is a process,
and working together
is a success.”
--- Henry Ford
Contact Information
Brenda K. Roche, Ph.D., LP
Arrowhead Psychological & Behavioral Sciences, LLC
406-294-9510
[email protected]