Family Drug Treatment Courts and Juvenile Drug Courts

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 q Harford: Single, dedicated treatment provider for the entire program. q San Diego: System-wide reform, the “Substance Abuse Recovery Maintenance System” (SARMS), with FTDC for non-compliant parents q Santa Clara: Mostly traditional FTDC model; some systems changes q Suffolk: Neglect cases only, many children not in out-of-home placements q Washoe: Traditional FTDC model May 2008 Presented by NPC Research 5

Sample Demographics q Site-level samples (treatment vs. comparison) were well-matched, with very few significant differences in demographic, risk, or case characteristics q California sites had larger Hispanic populations q Suffolk site had no meth users; this was the most common drug at the other 3 national sites May 2008 Presented by NPC Research 6

Data Collection Strategies q. Administrative record review • Treatment, court, and child welfare records q. Qualitative parent and key stakeholder interviews and court observations q. Cost data from the State of Maryland Harford County, MD. May 2008 Presented by NPC Research 7

Treatment Outcome Questions q. 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 Presented by NPC Research 8

Likelihood of Treatment Entry * Statistically significant at p<. 001. May 2008 Presented by NPC Research 9

Days to Treatment Entry * Statistically significant at p<. 001. May 2008 Presented by NPC Research 10

Days Spent in Treatment * Statistically significant at p<. 001. May 2008 Presented by NPC Research 11

Percent Completing at Least One Treatment **Statistically significant at p<. 001. *Statistically significant at p<. 01. May 2008 Presented by NPC Research 12

Child Welfare & Court System Outcome Questions q. Did children of FTDC parents spend less time in out-of-home care? q. Did FTDC cases reach permanency faster? q. Were children of FTDC parents reunified at a higher rate? May 2008 Presented by NPC Research 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 Presented by NPC Research 14

Days to Permanent Placement * Statistically significant at p<. 05. May 2008 Presented by NPC Research 15

Percent Reunified * Statistically significant at p<. 05. ** Statistically significant at p<. 001. May 2008 Presented by NPC Research 16

Summary: Outcomes for FTDCs q Strong treatment outcomes: FTDC parents more likely to enter treatment, spend more time in treatment, and complete treatment q Longer time to permanent placement for FTDC parents could be explained by the longer treatment stays q Less time in Out of Home Placements: FTDC children spent more of this time with their parents May 2008 Presented by NPC Research 17

Outcomes for FTDCs, cont’d q. 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 What factors influence program outcomes? FTDCs work? May 2008 Presented by NPC Research 19

Unpacking the “Black Box” of Family Treatment Drug Court q. Outcome analysis tells us whether FTDCs work q. Analysis of parent characteristics and experiences with services can begin to tell us about how, why, and for whom FTDCs work q. A preliminary look within the FTDC sample May 2008 Presented by NPC Research 20

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 q Key FTDC Variables: • Time to enter FTDC • Time spent in FTDC • Number of FTDC hearings • FTDC graduation q 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 24

Key Questions q Does time to treatment entry relate to outcomes: • Time spent in treatment • Treatment completion • Reunification q Does time spent in treatment relate to: • Treatment completion • Reunification? q Does treatment completion relate to reunification? May 2008 Presented by NPC Research 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 27

Do Parent Characteristics Influence Outcomes? q. 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 28

Summary: Influences of Parent Characteristics No strong, consistent pattern of differences for different “types” of parents May 2008 Presented by NPC Research 29

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 30

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 q 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 33

Accountability and Collaboration q 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 34

Accountability and Collaboration, cont’d q 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 q 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 Presented by NPC Research 38

Part IV: Harford Cost Study Results May 2008 Presented by NPC Research 39

Cost Study Findings May 2008 Presented by NPC Research 40

Cost Study Findings May 2008 Presented by NPC Research 41

Cost Study Conclusions q 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. q 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 Presented by NPC Research 42

Putting It All Together— What Have We Learned? q FTDC’s work — Families have more positive treatment and child welfare outcomes q 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 q Retention of families in FTDC programs is important to success q FTDC influence on child welfare recidivism needs additional data and research q 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 q Fast/expedited entry into drug and alcohol treatment q Intense supervision (court and treatment; frequent drug testing) q Collaboration between treatment, the court, prosecution and defense council q 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 q JDC studies: one in Oregon, one in Maryland q Clackamas N = 53; Harford N = 102 q Similar participant demographics • 85 -90% white • Marijuana primary drug of choice q Outcomes: Re-arrests, substance use, detention/jail, costs/benefits q 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 . 6 Ave # Days Juvenile Probation* 0 61 31 131 May 2008 Presented by NPC Research 48

Harford: JJ Recidivism (2 yr) May 2008 Presented by NPC Research 49

Harford: Adult CJ Recidivism (2 yr) Graduates Discharges (n=37) (n=38) Drug Court Comparison Sample Group (n=75) (n=82) Ave # arrests . 1 . 3 . 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 q. HCJDC participants had 36% fewer juvenile and adult arrests q. HCJDC participants had 59% fewer days on juvenile and adult probation/parole q. HCJDC participants had more days in residential treatment May 2008 Presented by NPC Research 51

Clackamas: JJ Recidivism Average Number of Re-Arrests Over 24 months May 2008 Presented by NPC Research 52

Clackamas: 24 -month recidivism rate q 2 years from drug court entry • Graduates • All Participants • Comparison 29% 44% 82% q 2 nd 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) May 2008 Presented by NPC Research 54

Clackamas Substance Use: Percent of Positive UAs in 2 Month Increments May 2008 Presented by NPC Research 55

Clackamas Mean Number of Drug Related Re-Arrests in 3 -Month Blocks May 2008 Presented by NPC Research 56

Cost Findings q. What is the cost to the taxpayer for a juvenile drug court? q. 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 $23, 656 Transaction Total Drug Court May 2008 Presented by NPC Research 59

Clackamas Detention Costs Averaged per Youth 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 May 2008 Presented by NPC Research 63

Harford: Overview of Cost Findings q. HCJDC participant outcomes cost 60% less per juvenile than the comparison group. q. 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 q 72% in outcome costs savings for Maryland Division of Corrections q. Harford County Sheriff’s Office was shown to experience a 44% savings in outcome costs q 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 q Clackamas County Oregon Juvenile Drug Court • All Drug Court minus Comparison = $961 savings • Graduates minus Comparison = $10, 958 savings q 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 q. Addition of Community Resource Liaison position • Find and create new community resources including community service opportunities • Work to link youth to community resources q. 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: q Added a Family Representative q Oregon Youth Authority q Developed connections with residential treatment programs q Trained community guides q Strong relationships with local agencies and community leaders May 2008 Presented by NPC Research 69

Clackamas: Program Response Community Liaison: (Paradigm Shift) q Arranges for (reserves) community service slots each week and brings to team at client progress meetings q 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 q Attends end of court session to sign kids up May 2008 Presented by NPC Research 70

Data Needed for Outcome/Impact/Cost Studies May 2008 Presented by NPC Research 71

QUESTIONS? Thank you!! May 2008 Presented by NPC Research 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