Mecklenburg County Families in Recovery Staying Together Program (FIRST)

1. Mecklenburg County Families in Recovery Staying Together Program (FIRST) Submitted by Eunice Muthengi, MSW Miles Harmon Dr. Janis Kupersmidt innovation Research & Training Process Evaluation Results (919) 493-7700 www.irtinc.us

2. Presentation Overview • Program Structure & Components • Program Admissions • Phase System • Sanctions • Incentives • Treatment • Program Facilitation • Team Members • Case Management & Judicial Supervision • Consumer Satisfaction • Consumer Satisfaction Survey • Summary of Challenges to Program Completion • Life Improvements Attributed to the Program • Summary • Strengths • Areas of Improvement • Testimonials

3. Strengths The court has a standardized screening procedure in place that is conducted by a Qualified Substance Abuse Professional (QSAP). There are multiple avenues for referral in that several people/organizations can refer eligible participants to the program. All parents involved in abuse or neglect cases are screened for eligibility. This ensures that the court reaches its target population. The family court provides accountability by ordering parents into the program and enforcing compliance. A very speedy enrollment procedure. The case manager and respondent’s attorney thoroughly explain program requirements and participant’s rights before they sign the contract. The contract is clear and comprehensive, and is the first step in the process of encouraging participant responsibility. Eligibility criteria are consistent with state and federal guidelines. Barriers Level I case-load impacts work load of program coordinator due to lack of a dedicated case-manager for these participants. Some eligible participants cannot enter the program due to lack of access to treatment resources and financial limitations. I. Program Components Program AdmissionsReferrals, Eligibility & Enrollment Procedures

4. Program AdmissionsReferrals, Eligibility & Enrollment ProceduresRecommendations: • Review and adjust the program capacity for Level I in reference to the program coordinator’s ability to fulfill case manager responsibilities in addition to her own duties. Quality of treatment and case management services should drive program enrollment. Alternatively, seek funding to hire a Level I case manager. • Seek additional substance abuse treatment providers and get training from the Division of Mental Health, Developmental Disabilities and Substance Abuse Services regarding potential funding resources for this population.

5. Phase System Strengths • The phase system and requirements for progression through the program are well-defined and consistent with federal and state guidelines. • Reasons for termination are clearly defined and explained to participants. • Team members agreed that the termination policy is fair and it allows ample opportunity for participants to succeed in the program. • Graduation is an important component of the program that is adequately commemorated during the court session and at the graduation party. Barriers • The FIRST Program does not have an official aftercare program. • Lack of accurate, up-to-date contact information regarding former participants. • Participants reported that they find it difficult to pay the required court fees. Some expressed concern that they would not be able to graduate without paying fees even after fulfilling all other requirements.

6. Phase SystemRecommendations: • Create an FDTC aftercare or alumni program to provide support to participants who graduated from the program and to enhance the likelihood that success will be sustained. • Develop policies and procedures to maintain regular follow-up on discharged participants and record relevant information in a database system. This information will be useful in future evaluation activities such as process and outcome evaluations. • Inform participants of the Judge’s newly implemented policy enabling eligible participants to graduate with a negative balance on payment of court fees, if they sign a contract agreeing to a payment plan.

7. Strengths The sanctions used by the court are reasonable, with a clear progression of severity. Sanctions are clearly defined in the Participant Handbook. Team members reported that sanctions are fair and are used in a consistent manner. Sanctions effectively teach participants that they are responsible for their own actions. Barriers Terminated participants and graduates reported that going to jail was scary and traumatic and it made them “colder to the system.” Sanctions • Recommendation: • To continue seeking additional alternative solutions to jail as a sanction for Level I and Level II offenses.

8. Strengths Team members agreed that incentives are fair and are used consistently across participants with few exceptions. Participants reported that incentives provide positive reinforcement. The A-team honors participants who are compliant in fulfilling all requirements. The FIRST team is committed to facilitating family reunification which, according to participants is the ultimate incentive. Barriers Many team members reported the need for additional incentives. Participants expressed concern that they would be ineligible for the A-team incentive based on their inability to pay program fees. Incentives are not clearly described in the participant handbook. Incentives

9. IncentivesRecommendations: • As suggested by some team members, the court could implement additional incentives that support parental involvement with children such as certificates that parents can use to go to a movie or dinner with their children. • Research has shown that non-material incentives are very effective. Strategic and increased use of praise and encouragement on the part of team members is highly recommended. • The FIRST team could discuss the possibility of using a payment plan contract for participants who are eligible for the A-team but have difficulties in paying fees. • Add the incentives grid to the Participant Handbook to provide additional motivation for change and inform participants of possible rewards for compliance.

10. Treatment Strengths • The court’s case manager creates treatment plans tailored to each individual. • A wide variety of services are available to participants including individual counseling, group therapy, parenting classes and residential services. • Team members refer participants to other agencies that provide ancillary services such as educational and vocational services, domestic violence, housing, food, clothing and health care services. • Participants described counselors as “excellent, helpful, and caring.” They also reported that treatment services were helpful and informative. Barriers • The lack of stable and adequate funding sources for treatment. • Team members reported the need for additional services such as housing, educational and vocational services, residential treatment, domestic violence, mental health. • Current funding provides substance abuse services for mothers, however, these services are not available for fathers. • Due to limited treatment options, the length of treatment, in some cases, is significantly less the length recommended for producing better treatment outcomes. • Treatment agencies are not always accountable in communicating information regarding participants in a timely manner.

11. TreatmentRecommendations: • The court’s administrators could continue to seek ways of attaining diverse, stable sources of funding for treatment. This could include looking at other family drug courts and examining their funding strategies. • Continue to research and network with local service providers to gain access to services for fathers enrolled in the FDTC. • Publicize service needs throughout the community. • Connect with local domestic violence agencies that provide services for both batterers and victims. • Network with community colleges and agencies providing educational and vocational services. • Develop a contingency plan for accessing dual diagnosis services after the S.A.I.L. grant ends in July, 2005. Seek training opportunities for team members regarding comorbidity of substance abuse and mental health. Discuss the court’s ability to serve participants with dual diagnoses.

12. TreatmentRecommendations (Cont.): • Set more stringent requirements for eligible treatment providers based on quality and length of their treatment programs. Inadequate services may lead to negative rather than positive outcomes. • Consider revising the graduation criteria to reflect the ideal length of time in treatment recommended by the court (1 year), state and federal guidelines, and findings from research. • Participants suggested the addition of a housing expert to the drug court team. The FIRST team could identify a representative from a community housing agency who would either consult with or become a member of the team. • To improve timely communication of treatment information, it is recommended that the court discuss the possibility of adding the CASCADE case manager to the drug court team. It is also suggested that this individual enter relevant information into the court’s MIS system on a regular basis.

13. Strengths Team members are very committed and dedicated to the family drug court model and the needs of participants. The FIRST team members are well trained and qualified for their positions. Their roles are complementary and clearly defined. There is a sense of mutual respect for one another and information is generally shared within a timely manner. The FIRST team utilizes a democratic decision-making process. Team members reported that they are given equal opportunities to provide input into all decisions made. Team members have demonstrated excellent problem solving skills and the ability to find creating solutions to problems and barriers. Barriers The lack of a Level I case manger has forced other team members to take on additional responsibilities. The Team has experienced some turnover, especially in the program coordinator and case manager positions. There is no standardized orientation procedure for new team members. Team members expressed the need for additional job-related training opportunities. II. Program Facilitation Team MembersComposition, Stability & Functioning

14. Team MembersComposition, Stability and FunctioningRecommendations: • It is recommended that the court continue to seek necessary funding to hire a case manager for Level I. • The court’s Operations Committee could discuss ways to ensure stability in the program coordinator and case manager positions. • Develop a standardized orientation procedure including a packet of information such as a description of one’s role in the court, copies of procedural handbooks, and other pertinent information. • The court’s administrators could create official guidelines of training requirements for team members and include this in the Operations Manual.

15. Case Management & Judicial Supervision Strengths • Participants reported that regular meetings with the case manager provided motivation and a strong sense of support. • Judge’s monitoring in the Bi-Weekly Court Sessions provides structure, motivation, and embodiment of the law. • Judge uses the court session as an opportunity to educate others about the benefits of compliance and the consequences of noncompliance. • Drug testing is administered randomly and at scheduled intervals to provide accountability and monitor abstinence. Barriers • Lack of consensus among team members regarding the level at which dependency case information should be integrated into judicial proceedings. • Participants find it difficult to maintain employment and fulfill all drug court requirements. • Transportation to court, treatment and work. Level II participants were all in agreement that bus schedules were unreliable, the drug court van was often late, and participants living in a residential facility setting are not allowed access to their own car. • Some current participants mentioned that there are too many drug tests required by various agencies.

16. Case Management & Judicial SupervisionRecommendations: • Increased integration of dependency case information into team meeting discussions and judicial proceedings is recommended by NC state officials. To facilitate this, the court’s administrators and team members could review the FDTC model and discuss the implications of this policy in reference to the court’s goals and objectives. • The court could consider reducing the frequency of court sessions, and drug tests for those Phase III to enable compliant participants to maintain employment. The court should also continue negotiations with CASCADE to provide both a morning and evening track for treatment services. • Investigate participant concerns regarding the drug court van and discuss other transportation options. • Drug testing is an essential component of each agency that participants are involved in, including FDTC, treatment and residential facilities.

17. III. Consumer SatisfactionConsumer Satisfaction Questionnaire Description of the Sample • A total of 10 current participants completed a consumer satisfaction survey regarding their experience with the FIRST Program. • All of the participants were female. • Their ages ranged between 22 and 39 (N=7). • Most of the participants reported their race as Black (7 participants) while the others were White (1 participant), Native American (1 participant) or Other (1 participant). • Two participants reported their living status as “living independently,” while four said they were residing in community housing. • Participants were asked to select the primary drug that they used most often. Of the seven participants who responded to this question, two reported their primary drug as alcohol, two other participants reported marijuana and three participants reported crack. • Seven participants responded to questions about their criminal and treatment history. They all reported that they had previously been to court for another crime before entering the FIRST Program, but this was their first time in a family drug treatment court program.

18. Consumer Satisfaction Questionnaire Client Reports of Level of Satisfaction with Program Components Response Scale: 1=Very Unsatisfied, 2=Unsatisfied, 3=Satisfied, 4=Very Satisfied

19. Consumer Satisfaction Questionnaire Client Reports of Level of Satisfaction with Program Components Summary of Results • On average, participants were “satisfied” with all ten of the drug court components. • As you can see by the mean values, participants were least satisfied with the frequency of court appearances. This would imply that they thought the court appearances were too frequent. • Participants were most satisfied, on average, with other services they received, the interactions with the judge, and drug testing. Some of the “other” ancillary services provided by the court are educational and vocational training, food and clothing vouchers, transportation services, domestic violence services and housing services.

20. Consumer Satisfaction Questionnaire: Client Reports of Level of Difficulty in Fulfilling Program Requirements. Response Scale: 1=Very Difficult, 2=Difficult, 3=Somewhat Hard, 4=Easy, 5=Very Easy

21. Consumer Satisfaction Questionnaire Client Reports of Level of Difficulty in Fulfilling Program Requirements. Summary of Results • On average, participants reported that all but three of the requirements were easy to complete. • As you can see by the mean values, the most difficult requirements to complete were attending AA/NA meetings, paying court fees, and paying fines. These findings are consistent with focus group reports of problems with paying fees and maintaining full-time employment. • On average, the easiest requirements to complete were “staying clean and sober” and attending regularly scheduled meetings with the case manager.

22. Summary of Challenges to Successful Completion of the ProgramFindings from Interviews and Focus Groups • Lack of adequate housing options that are conducive to sobriety. • Lack of transportation. • Difficulties in maintaining employment and fulfilling program requirements. • Paying program fees. • Some residential staff members need further education about addiction.

23. Life Improvements Attributed to the ProgramFindings from Interviews and Focus Groups Current and former participants reported many positive changes in their lives that resulted from their participation in the FIRST program. These include: • Better relationships with children, family, and friends. • Improved communications skills. • Respect for themselves and from their families. • Ability to achieve and maintain sobriety. • Becoming a “productive member of society.” • Skills classes taught them how to budget and to better manage their finances. • Learned useful information about substance abuse and how to recognize and avoid risky situations.

24. IV. Summary Strengths There are many strengths associated with the FIRST program including: • The dedication and commitment of team members. • Standardized screening of all candidates and compliance enforced by court for eligible participants. • Clearly defined policies and procedures regarding progression through the Phase system and the use of sanctions and incentives. • Promotes personal, familial, and system accountability. • Effective monitoring of participants. • The FIRST Program has been awarded several honors including the 2003 Pioneer Award from the Chemical Dependency Center and recognition as a Program of Excellence by the North Carolina Council of Community MH/DD/SA Programs. The program was also identified as an exemplary model of an FDTC by the BJA.

25. Areas for Improvement Some important areas for further development and improvement are: • Continuing education and training opportunities for team members. • Creation of an alumni or aftercare program. • Attainment of diverse and stable funding sources for treatment. • More stringent requirements regarding length of treatment programs. • Increased integration of dependency case information in team meeting discussions and judicial proceedings. • Seek housing expert to consult with the Team. • Continue to network with community agencies. • Implement additional incentives that promote parental involvement.

26. Testimonials • “It is a valuable program that saved my life. Myself and others are a wonderful testament to the program.” -Graduate • “Thank you for the program.” • “I would tell them that they are doing a good job.” • “Thank you for making this program.” -Level I and Level II Focus Group Participants