Transcript Participants are identified early and promptly placed in

Family Drug Court Fundamentals
and Evidence Based Practices
Presented by
William S. Owens
Associate Juvenile Judge
Des Moines, Iowa
March 30, 2015
1
Treatment courts can be messy…
and it usually takes a team…
that knows how to work together…
to pick participants up when they
fall...
and help them keep slogging
along…
so in the end...it’s all worth it!
Defining the Key Components
• Participants are identified early and
promptly placed in drug court program.
– Eligibility based on written criteria
– Candidates promptly advised of
expectations
– Trained professionals screen participants
– Appearance before Judge occurs promptly
– Participants promptly ordered into
treatment
Treatment courts where participants entered within
50-days of “incident” had a 63% greater reduction in
recidivist behavior
45%
40%
35%
30%
25%
20%
39%
15%
10%
24%
5%
0%
Participants enter
Participants enter
program within 50-days program more than 50of incident
days after incident
Percentage reduction in
recidivist behavior
Defining the Key Components
• Using a non-adversarial approach
agency counsel, GAL and parents’
counsel collaborate while still protecting
client rights.
– Prosecutors and defense counsel should
participate in design, screening and caseprocessing policies
– Consistency and stability require judges,
prosecutors and defense counsel to be
assigned for sufficient time to build sense of
teamwork and collaboration
Judge’s role…
Traditional Court
Family Treatment Court
Judge calls “balls and strikes”
Judge is educated on substance abuse;
Engages all the parties; and
Leads a multi-disciplinary team focusing
on addressing parental substance abuse
Judge seeks evidence of compliance with
services and orders of the Court
Judge actively engages parent participants
in dialogue; and
Uses incentives and interventions to
address parent behavior
Judge bases decisions on written reports
and evidence presented by counsel
Judge inquires of parents, team, and
others regarding parents’ compliance with
program requirements
Judge relies on witness testimony offered
by the parties
Judge relies on information from
participant, the team, and others involved
in providing parents a continuum of
services
Parent’s attorney role
Traditional Court
Family Treatment Court
Does the talking in Court and directs the
client NOT to talk
Educates the parents regarding the court
process, appropriate way to interact with
the court and the team; and
Assists the client when speaking to the
judge
Focuses on protecting the parent’s rights
and “winning” the case
Focuses not only on protecting parent’s
rights, but also on advocating for services;
Supports parent needs to achieve selfidentified short and long-term goals
Cross-examines clinicians and social
workers and challenges negative
statements about client
Develops a working relationship with DHS
staff and clinicians;
Questioning geared to supporting
parent’s goals and the coordinated
treatment plan
Focuses on simply completing “tasks” in
case plan
Advocates for quality, evidence based or
informed services and interventions
linked to sobriety and long-term stability
DHS caseworker role
Traditional Court
Family Treatment Court
Requests report from substance abuse
clinician;
Develops case plan recommendations
Works with substance abuse clinician as a
part of a multi-disciplinary team;
Incorporates clinician recommendations
into a comprehensive case plan for client
Provides a report to the court, but
otherwise not an active participant in
court proceeding
Works with the judge and treatment
providers as a part of a team that
develops comprehensive case plan for
client;
Takes active role in court review to
address needs of client
Has limited familiarity with substance
abuse treatment modalities and clinical
needs of client suffering from substance
abuse and/or mental health disorders
Is familiar with substance abuse
treatment and treatment needs of clients;
Works closely with team to develop and
help assist client in working through
comprehensive treatment/case plan
Substance Abuse Clinician Role
Traditional Court
Family Treatment Court
Limited, if any, direct involvement in CINA
case or proceedings
Provides clinical information during
staffing process and treatment review
hearings
Provides a report to be attached to the
case plan, or admitted as an exhibit
Reports proactively submitted to team
and parties;
Reports are discussed during staffing and
with client during court reviews
Keeps all information confidential;
Unfamiliar with legal terms and the
process in court
Discusses information with releases of
information by the client;
Understands the CINA process, familiar
with legal terminology, and makes
recommendations in the context of the
legal proceedings
Defining the Key Components
• Abstinence is monitored by frequent
alcohol and other drug testing
– Random testing in accordance with
established principles
– No less than twice weekly during the first
several months of participation
– Procedures must be certain/reliable
– Prompt reporting of results to Court –
results reported within 48-hours had 68%
higher cost savings
– Prompt action by Court on positive test
Treatment courts where participants were
tested at least 2x per week in Phase 1 had 61%
higher cost savings
0.35
0.3
0.25
0.2
0.15
0.1
Percent increase in cost
savings
29%
18%
0.05
0
Participants tested 2x per Participants tested LESS
week
than 2x per week
Defining the Key Components
• A coordinated strategy governs
responses to participant compliance.
– Regular communication between Court and
treatment providers
– Responses explained to participants
– Responses to compliance vary in intensity
– Sanctions for noncompliance – statistically
when sanctions imposed immediately after
non-compliance it resulted in twice the cost
savings.
Defining the Key Components
• Ongoing Judicial interaction with each
participant is essential.
– Regular status hearings used to monitor
performance
– Time between hearings can be extended
– Status meetings with a number of
participants together
– Court uses incentives and sanctions to
address program compliance
Treatment courts where the judge spends
3 minutes or more per session had a 153%
reduction in recidivist behavior
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Percent reduction in
recidivism
43%
17%
Judge spends at least 3
min. per participant
Judge spends less than 3
min. per participant
Defining the Key Components
• Forging partnerships among drug
courts, public agencies, and community
based organizations generates local
support and enhances drug court
program effectiveness.
– Frequent meetings between Court, lawyers,
treatment and community to provide direction
– Drug court provides a critical role in forming
links between community and judicial system
– Use of Steering Committee
Defining the Key Components
• Monitoring and evaluation measure the
achievement of program goals and gauge
effectiveness.
– Goals clearly stated at outset to define
parameters of data collection
– Ideally an automated system of data
collection is used to monitor and evaluate
program
Use of evidence based and
evidence informed practices
“Those who are enamored of practice
without science are like a pilot who goes
into a ship without a rudder or compass
and never has any certainty where he is
going”.
Leonardo da Vinci
What does it mean to be
evidence-based?
• Evidence-based practice [EBP] is applying the
best available research evidence in the
provision of health, behavior, and education
services to enhance outcomes (Child Trends,
Research-to-Results Brief, June 2007).
• The American Psychological Association
defines EBP as “the integration of the best
available research with clinical expertise in
the context of patient characteristics, culture,
and preferences”.
What does evidence-based
mean and why is it important?
• The evaluation research shows the program
produces positive results
• The results can be attributed to the program
itself rather than other extraneous factors
• The evaluation is peer reviewed by experts in
the field
• The program is “endorsed” by a federal agency
or a respected research organization
More on why evidence is
important…
• Improves quality of care and services
• Increases likelihood of achieving desired
outcomes
• Have carefully described service components
• Improve consistency in delivering services –
fidelity to model
• More efficient use of available resources
What does it mean to be evidenceinformed?
• The program articulates a theory of change
and specifies identified outcomes through a
detailed logic model.
• The practice has a book, manual or training
that specifies the practice protocol.
• The practice is generally accepted in clinical
practice.
• Requires less rigorous research to support its
efficacy as a program or practice.
Parent Partner program
• Celebrates individuals how have overcome
obstacles through change, recovery and
accountability by using their skills to mentor
families who are currently navigating through
DHS system.
• Parent partners demonstrate advocacy and
effective communication, while holding families
accountable in meeting their case plan goals.
• Often the parent partner has personal experience
with domestic violence, substance abuse and
mental health and it is those experiences that
make parent partners beneficial to the families
currently receiving DHS services due to protective
concerns.
Parent Partner program
• Parent partners will:
– Work intensively with parents to promote
engagement in case plan activities
– Maintain connections between parents and
children
– Share insight and understanding about personal
experiences that will assist parents to be successful
– Assist in the goal of reunification, or in the
development of alternative permanency goals
– Connect parents with resources needed to complete
the case plan
– Provide encouragement, outreach and support
– Act as a role model, mentor, a resource and
support.
24/7 Dad’s program
• 24/7 Dad’s program is a 12-week evidence based
curriculum that empowers males to become
more involved, responsible, and committed in
their role as a father-figure.
• The program focuses on improving father’s selfawareness, caring for self, fathering skills,
parenting skills and relationship skills.
• The program covers the universal aspects of
fatherhood so that men of all cultures, races,
religions and ethnic backgrounds can benefit.
• The program is designed to provide
empowerment and support in a father friendly
environment.
Strengthening Families
• An evidence based prevention program focusing
on increasing family skills to support health child
development.
• The program includes parenting skill sessions that
address positive communication, family
functioning, discipline and guidance.
• The children’s sessions focus on social-emotional
development, communication skills, and healthy
behavior.
• The family sessions include structured activities
and the opportunity to practice new skills.
Celebrating Families!
• A 16-week evidence based program that
addresses the needs of children and parents in
families that have serious problems with alcohol
and other drugs.
• Each session begins with a family meal.
Afterwards family members break into age
groups for developmentally appropriate activities
led by group facilitators.
• The model is developed for children of alcoholics/
addicts and their parents.
Celebrating Families!
• Break cycles of drug use and violence/abuse
by teaching healthy living skills.
• Decrease use of drug and alcohol use and
reduce relapse by teaching all members of the
family about the disease of chemical
dependency and its impact on families.
• Positively influence family reunification by
integrating recovery into daily family life and
by teaching healthy parenting skills.
Iowa Family Treatment Court
analysis
Adult Indicator Highlights –
Access to Treatment
120
100
80
60
96.9
73.0
82.1
Did not enter treatmetn
40
20
0
Entered treatment
3.1
27.0
17.9
6 FDC Sites
Matched Comparison
Referred Comparison
Adult Indicator Highlights – Time
from Assessment to Treatment
80
70
60
50
40
30
20
10
0
44.4
32.1
30.7
0 to 7 days
31.7
6 FDC Sites
8 to 30 days
30.9
Matched
Comparison
30.7
Referred
Comparison
Adult Indicator Highlights – Time
from FTC entry to treatment
140
120
11.1
100
54.0
Entered treatment before
FTC entry or within 7-days
of entry
46.0
Entered treatment more
than 7 days after FTC
entry
80
60
84.7
88.9
40
20
0
15.3
6 FDC Sites
Matched
Comparison
Referred
Comparison
Adult Indicator Highlights – Care
assessed matches level received
100
90
80
70
60
50
40
30
20
10
0
84.9
81.2
83.8
Level assessed matches
with level received
Level assessed differs
from level received
15.1
6 FDC Sites
18.8
Matched
Comparison
16.2
Referred
Comparison
Adult Indicator Highlights – Percentage
successfully completing first treatment episode
100
90
80
70
60
50
40
30
20
10
0
65.1
56.3
45.5
Successfully completed
first episode of treatment
34.9
6 FDC Sites
43.7
Matched
Comparison
54.5
Referred
Comparison
Did not complete first
episode of treatment
Adult Indicator Highlights Retention in Treatment
250
200
150
233
Average number of days
in treatment for first
episode
100
50
66
100
0
6 FDC Sites
Matched
Comparison
Referred
Comparison
Adult Indicator Highlights Methamphetamine use by parents
100
90
80
70
60
50
40
30
20
10
0
4.3
9.4
21.4
3.6
86.3
100
No change in Meth use
75.0
6 FDC Sites
Matched
Comparison
Referred
Comparison
Increase in Meth Use
Decrease in Meth Use
Adult Indicator Highlights Alcohol use by parents
100
90
80
70
60
50
40
30
20
10
0
1.6
8.3
20.8
21.4
8.3
2.8
No change in Alcohol use
90.1
70.8
6 FDC Sites
Matched
Comparison
75.8
Referred
Comparison
Increase in Alcohol use
Decrease in Alcohol use
Adult Indicator Highlights Marijuana use by parents
100
90
80
70
60
50
40
30
20
10
0
4.5
10.6
10.5
18.8
9.4
No change in Marijuana
use
84.8
89.5
Increase in Marijuana use
71.9
Decrease in Marijuana use
6 FDC Sites
Matched
Comparison
Referred
Comparison
Adult Indicator Highlights Criminal behavior by parents
100
0.5
3.0
2.2
95
90
13.1
12.1
13.4
Decrease between intake
and discharge
85
80
Increase in arrests
between intake and
discharge
85.0
84.8
84.3
75
6 FDC Sites
Matched
Comparison
Referred
Comparison
No arrests at intake and
discharge
Adult Indicator Highlights Employment
70
60
50
62.7
57.6
40
30
20
10
Unemployed
41.5
29.4
FT Employed
46.2
26.2
12.9
12.3
11.1
6 Pilot Sites
Matched
Comparison
Referred
Comparison
0
PT Employed
Child Indicator Highlights –
Percent of children at home
80
70
60
50
40
76.3
30
20
10
0
Children remain at home
43
9.2
6 FDC Sites
Referred
Comparison
Matched
Comparison
Child Indicator Highlights –
Occurrence of maltreatment
96
95.5
95
94.5
94
93.5
93
92.5
92
91.5
91
96
94.9
92.9
6 FDC Sites
Matched
Comparison
Referred
Comparison
Percent of childen who
did not have a
substantiated/indicated
maltreatment within 6months of entry
Child Indicator Highlights –
Occurrence of maltreatment
100
90
80
70
60
50
40
30
20
10
0
20.1
79.9
6 FDC Sites
27.6
72.4
Matched
Comparison
13.6
85.4
Referred
Comparison
Substantiated or indicated
maltreatment
No substantiated or
indicated maltreatment
Child Indicator Highlights –
Average Length of Stay in Days
450
400
350
300
250
200
150
100
50
0
337
6 FDC Sites
350
Matched
Comparison
445
Referred
Comparison
Average length of stay in
foster care - days to
reunification
Child Indicator Highlights –
Reunification Rates
100
80
27.3
47.6
48.6
60
40
Not Reunified
72.7
52.4
20
Reunified
51.4
0
6 FDC Sites
Matched
Comparison
Referred
Comparison
Child Indicator Highlights –
Remained in Home
100
80
60
43
76.3
Remained in home
through closure
40
20
57
23.7
0
6 FDC Sites
Referred
Comparison
Removed from home
prior to case closure
Child Indicator Highlights – ReEntries to Foster Care
86
84
82
80
78
76
74
72
70
83.5
86
75.8
6 FDC Sites
Matched
Comparison
Referred
Comparison
Percentage of children
returned home from
foster care that did not reenter foster care within
12-months of discharge
Child Indicator Highlights – ReEntries to Foster Care
100
90
80
70
60
50
40
30
20
10
0
24.8
30.2
35.2
Re-entered foster care
75.2
6 FDC Sites
69.8
Matched
Comparison
64.8
Referred
Comparison
Did not re-enter foster
care
Child Indicator Highlights –
Timeliness of Reunification
90
80
70
60
50
40
30
20
10
0
77.6
81.4
61.5
6 FDC Sites
Matched
Comparison
Referred
Comparison
Pecentage of children
physically reunified in less
than 12-months from date
of first foster care entry
Child Indicator Highlights –
Timeliness of Reunification
100
90
80
70
60
50
40
30
20
10
0
77.6
22.4
6 FDC Sites
81.4
18.6
Matched
Comparison
61.5
Legally reunified within
12-months
38.5
Referred
Comparison
Legally reunified greater
than 12-months
Child Indicator Highlights –
Timeliness of Permanency
76
74
72
70
75.9
68
74.4
66
64
67.1
62
6 FDC Sites
Matched
Comparison
Referred
Comparison
Percent of children in
foster care, who in less
than 24-months from date
of most recent foster care
placement, achieved
adoption or guardianship
Child Indicator Highlights – Achieving
Permanency within 24-mos.
100
90
80
70
60
50
40
30
20
10
0
24.1
75.9
25.6
34.8
Permanency greater than
24 mos.
74.4
65.2
6 FDC Sites
Matched
Comparison
Referred
Comparison
Permanency within 24mos.
Cost avoidance summary…
• There is a relationship between greater resources
spent on parent substance abuse treatment and
current and future child welfare savings.
• Compared to non-program participants, FTC
participants have:
– Higher costs due to:
• A greater percentage of parents receiving substance abuse
treatment and staying in treatment longer; and
• More children in out of home care at the start of the
program (placement decisions were made prior to
enrollment.
– Cost avoidance due to:
• A higher reunification rate
• More children being able to remain in custody of a parent;
and
• Shorter foster care episode lengths of stay.
Estimated cost avoidance….
Category
Estimated cost/cost avoidance
Substance abuse treatment costs
-$3,206,880.00
Placement at time of enrollment
-$525,533.78
Reunification rate
$7,314,278.26
Children able tot remain with parent
$986,275.72
Median foster care episode length of stay
$895,270.91
ESTIMATED COST AVOIDANCE
$5,463,411.11
Why we do this work…
To Contact Me
Hon. William S. Owens
Associate Juvenile Judge
101 West Fourth Street, Suite 401
641-683-1791
[email protected]
A special thanks to: Doyle Evans, Kathy Thompson
and Gail Barber – Iowa Children’s Justice – for the
Iowa Statistics for Family Treatment Court.
**National statistics courtesy of NADCP