Durham County Family Treatment Court (DFTC)

Durham County Family Treatment Court (DFTC) Submitted by Eunice Muthengi, MSW Miles Harmon Dr. Janis Kupersmidt innovation Research & Training Process Evaluation Results April, 2005 (919) 493-7700 www.irtinc.us

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 Reported by Participants • Life Improvements Attributed to the Program • Summary • Strengths • Areas for Improvement • Testimonials

I. Program Components Program AdmissionsFamily Treatment Court Status of All DFTC Participants

The average age of participants was 32 and the ages ranged from 19 to 50 years. Approximately 95% of participants were female. The program has only served two males since it began in 2002. Most of the participants were African American/Black (78%) while the others were Caucasian/White (23%). The majority of participants were Single/Never Married (62%). About 66% of participants had some middle school or high school education but did not have a high school diploma or GED. Most of the participants were unemployed (66%) and only 16% were employed full-time (35 hours or more per week) at the time of enrollment. The primary drug of choice was crack for more than half of the participants (57%) and the second most common primary drug of choice was alcohol (19%). About half of the participants (49%) had previously received mental health treatment before program admission. Program AdmissionsCharacteristics of all DFTC Program Participants at the Time of Enrollment.

Program AdmissionsAverage Length of Time for Program Referral, Interview and Admission.

Strengths There are multiple avenues for referral in that several people/organizations can refer eligible participants to the program. The dependency court provides accountability by ordering parents into the program. The case manager and respondent’s attorney explain program requirements and participant 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 clear and generally consistent with state and federal guidelines. Barriers Low referral and admission rates--operating at half of program capacity. Lack of support from Parent Attorneys in dependency court. Lack of immediate enforcement of court orders by dependency court leads to large time intervals between referral date and enrollment. Eligibility criteria do not specify screening procedure for substance abuse. Program AdmissionsReferrals, Eligibility & Enrollment Procedures

Program AdmissionsReferrals, Eligibility & Enrollment ProceduresRecommendations: • Continue to promote public awareness of the program and its positive effects to increase support among Parent Attorneys and other sources of referral. • Advocacy and negotiations with the administrators of the dependency court for immediate enforcement of court orders. • Consider revising eligibility criteria to more accurately describe how the court determines whether a candidate has a substance abuse problem.

Phase System Strengths • The phase system and requirements for progression through the program are well-defined and consistent with federal and state guidelines. • Program completion is an important component of the program that is adequately commemorated during the court session and at the graduation party. • Former participants have been reunified with their children prior to program completion, allowing time for DSS to monitor the family and provide support before the parent graduates from the DFTC program. • 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. Barriers • A team member reported that the court’s phase system does not clearly reflect participant progress in treatment. • A team member reported that treatment progress is not addressed in the graduation criteria. • Two team members mentioned that difficulties in obtaining housing and employment are sometimes barriers to program completion. • Lack of accurate, up-to-date contact information regarding former participants. • The DFTC does not have an official aftercare program. However, team members report that they are in the process of developing the program.

Phase SystemRecommendations: • Create a more detailed description of general treatment goals in each phase to emphasize the role of treatment progress in facilitating movement between program phases. For example, provide a better definition of the term “good standing” in treatment, which is one of the requirements for movement to Phase Three or graduation. • Consider reviewing the general treatment objectives for participants and updating the program completion criteria to reflect the level of progress in treatment required prior to program completion. • Continue to find additional resources to assist participants in obtaining employment and housing prior to program completion. • 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. • Researching aftercare programs of other family treatment courts might provide the DFTC with practical examples of evidence-based aftercare programs that have been implemented with this target population.

Strengths The sanctions used by the court are reasonable, with a clear progression of severity. Sanctions are consistently imposed based on the Sanction Grid, but the Team also maintain the flexibility to consider individual circumstances. Team members reported that sanctions are fair and effectively teach participants that they are responsible for their own actions. Current and former DFTC participants reported that the sanctions used by the court were effective deterrents that prevented noncompliance. Barriers Most of the team members reported that the number of occurrences for offenses is sometimes beyond that defined in the Sanction Grid. A team member expressed concern that some team members show favoritism when making decisions regarding sanctions. Disagreement among current and former participants as to the value of jail as a sanction and situations when it should be used. Half of the current participants thought it should only be used in relation to drug testing noncompliance, and not for other types of noncompliance such as missed meetings. Sanctions

SanctionsRecommendations: • Revise the Sanction Grid to make it more applicable to the types and incidences of noncompliant behavior displayed by participants. Team members suggested that the Team retreat might be an ideal opportunity to discuss the use of sanctions. • The combined use of the team approach and the Sanction Grid is designed to prevent the influence of favoritism by allowing each team member to provide input in decision-making, and ensuring consistency in the imposition of sanctions. Concerns about favoritism could be another topic of discussion during the retreat. • Since the DFTC is a civil court, rather than a criminal court, the Team might consider developing additional, alternative sanctions that can be used instead of jail, in some cases.

Strengths Team members agreed that incentives are fair and are used consistently across participants with few exceptions. Participants reported that incentives provide positive reinforcement (especially verbal praise and encouragement from team members). Barriers Many team members reported the need for additional incentives. Incentives

IncentivesRecommendations: • As suggested by one team member, 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. • Participants highlighted the effectiveness of nonmaterial incentives. Strategic and increased use of praise and encouragement on the part of team members is highly recommended.

Treatment Strengths • The treatment provider develops a comprehensive treatment action plan for each participant. • Gender-specific treatment services are available for female participants. • A variety of services are available to participants including individual counseling, group therapy, parenting classes, and residential services. • Participants described counselors as “wonderful” and having the participants “best interests at heart”. • Participants reported that treatment services and parenting classes were helpful and informative. Barriers • The lack of a contract with the treatment provider limits the court’s ability to monitor treatment. • Based on the treatment summary provided by the treatment provider and team member responses, it is unclear whether the treatment services offered to participants are research or evidence-based. • Team members identified the need for additional treatment options for participants. • A current participant mentioned that treatment groups focus more on drug abuse than alcohol abuse. • Half of the team members reported the need for additional mental health services. • Team members identified the need for additional ancillary services such as housing, educational and vocational services, day care services, and public health services.

TreatmentRecommendations: • Even though the court does not have a financial contract with Duke Family Care Program, it is recommended that they establish a Memorandum of Understanding (MOU) with all treatment providers. This would provide clear standards that the court and other evaluators could use to review the performance of the treatment providers as recommended by the AOC best practice guidelines. • To ensure compliance with state guidelines, the DFTC might consider requesting treatment providers to utilize and document the use of evidence-based intervention practices. • Additional treatment options for participants would allow the court to be compliant with federal guidelines. The Drug Court Key Components suggest that participants should be matched with treatment services based on their individual, specific needs. The court might consider contacting the NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (MHDDSAS) regarding alternative substance abuse and mental health treatment options for participants. • Diverse treatment options might also address participant concerns that the substance abuse education groups do not adequately deal with issues that are specifically related to alcohol abuse. Nonetheless, team members could determine the legitimacy of this concern and request the treatment provider to ensure that there is adequate focus placed on the various substances used by participants.

TreatmentRecommendations (Cont.): • Continue to research and network with local service providers to gain increased access to ancillary services for those enrolled in the DFTC. • Publicize service needs throughout the local community. • Network with community colleges and agencies providing educational and vocational services. • Continue efforts to add a housing expert and a public health representative to the Team. The DFTC team could identify representatives from community agencies who would either consult with or become members of the team.

Strengths The DFTC Core Team is comprised of most of the individuals required by the AOC Best Practices Guidelines. DFTC team members appear to be fulfilling their roles and duties as required. DFTC team members have observed other treatment courts and participated in national and state conferences providing both role specific and general training. Barriers Team members report that DSS has been unable to assign a DSS Attorney due to understaffing. Roles of team members are not comprehensively described in any of the court documents. Lack of an official orientation procedure in place for future team members. Team members expressed the need for additional cross-disciplinary training opportunities. II. Program Facilitation Team MembersComposition, Roles, Background Training & Education

Team MembersComposition, Roles, Background Education & Continuing EducationRecommendations: • Continue negotiations with DSS to include a DSS Attorney as part of the Team. • Develop a comprehensive description of team member roles by combining roles included in the Participant Handbook with additional responsibilities described by team members. This would make the role descriptions more consistent with the Best Practice Guidelines. It is also recommended that the court document these roles in its Policy Manual. • Create an official orientation procedure to facilitate the transition for future team members. • Continue to seek funds and opportunities to provide team members with interdisciplinary training. • As recommended by federal guidelines, the court’s administrators could create official guidelines of continuing education requirements for team members and include these in the Policy Manual.

Team MembersStability and Functioning Strengths • The program is overseen by a Local Management Committee. • The Team has experienced a low rate of turnover (only one position). • Team members are very committed and dedicated to the family drug court model and the needs of participants. • Most of the team members reported that team relationships are good or very good. • Participants described team members as helpful, caring, supportive and professional. • Team members reported that information is generally shared within a timely manner. • The DFTC team utilizes a consensus-based in which all Team members are given equal opportunities to provide input into the decisions made. Barriers • Some Local Management Committee members do not regularly attend meetings. • Team members expressed concern about the efficiency of Team meetings. They mentioned side conversations, meetings exceeding allotted time, and too much time spent discussing some participants. • Inappropriate jokes or comments made about participants during team meeting discussions. • Occasional strained relationships due to personality conflicts as reported by team members. • Team members uncertain about personal and professional boundaries in relationships with participants.

Team MembersStability and FunctioningRecommendations: • Some strategies to improve attendance at Local Management Committee meetings might include contacting members who do not attend to gain an understanding of the reasons for their nonattendance and keeping official minutes of the meetings. These minutes could be distributed to those who were not present at the meeting to keep them informed of the decisions made and the topics of discussion. • Suggestions for making the team meetings more efficient are: • Beginning meetings on time and reducing the amount of time spent on unrelated conversations. • A team member suggested restructuring the order of case review so that noncompliant participants are discussed first. • Consider holding a monthly or bi-monthly meeting to discuss general issues that impact the functioning of the court and to analyze factors that contribute to program completion.

Team MembersStability and FunctioningRecommendations (Cont.): • Discuss and create guidelines regarding the tone of communication about participants. Define the types of comments that might have a negative impact on the Team’s attitude towards participants, its professionalism and its ability to objectively make decisions that are in their best interests of participants. • Address personal or professional conflicts before or after meetings to facilitate the Team’s effectiveness during the meeting time. • Establish court guidelines for team members on the types of pro-social or personal activities that they should engage in with participants. Ensure that these activities do not undermine the professional relationship or participants’ progress in treatment.

Case Management & Judicial SupervisionCompliance with DTC Requirements

Case Management & Judicial SupervisionDrug Test Results These findings describe results from 730 tests for methamphetamines, 773 tests for opiates, 777 tests for marijuana, 862 tests for cocaine, and 701 tests for alcohol.

Case Management & Judicial Supervision Barriers • Noise level and distractions during the court session. • Lack of consensus among team members regarding the level at which dependency case information should be integrated into team meeting and judicial proceedings. • A team member expressed concern about unclear guidelines regarding communication of information between the DFTC and the dependency court. • Need for a standardized, random drug testing system. Strengths • The Case Coordinator meets regularly with participants to monitor participants status and offer support. • Current and former participants described the Judge as caring, encouraging, and supportive. • At least half of the team members identified judicial supervision as the most important program component. • The 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 regularly to provide accountability and monitor abstinence.

Case Management & Judicial SupervisionRecommendations: • To maintain the engagement of those in the court room, the court might consider asking a bailiff to make a statement at beginning of court session demanding complete silence and requesting that people only exit the courtroom if it is extremely necessary. • 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. • Establish clear guidelines regarding the type of information that should be communicated between the DFTC and the dependency court while safeguarding participant confidentiality. • As suggested by one team member, the court would benefit from the addition of a random drug testing system to make testing more standardized.

III. Consumer SatisfactionConsumer Satisfaction Questionnaire Description of the Sample • A total of 8 current participants completed a consumer satisfaction survey regarding their experience with the DFTC. • All of the participants were female. • Their ages ranged between 29 and 50 years. • Most of the participants reported their race as Black (6 participants) while the others were White (2 participants). • Three participants reported their living status as “living independently,” while four said they were residing in community housing. • The primary drug of choice was reported as alcohol for two participants, cocaine for one participant and crack for five participants. • Half (4) of the participants reported that they had received substance abuse treatment in the past, five reported past mental health treatment, and only two said they had participated in family therapy in the past. • Three-quarters of the participants reported that they had previously been to court for another crime before entering the DFTC, but this was their first time in a family drug treatment court program.

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

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 transportation services. • Participants were most satisfied, on average, with their interactions with the judge, interactions with the drug court team, substance abuse treatment services, individual treatment sessions, and their positive activities and/or hobbies.

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

Consumer Satisfaction Questionnaire Client Reports of Level of Difficulty in Fulfilling Program Requirements. Summary of Results • On average, participants reported that all but one of the requirements were easy to complete. • As you can see by the mean values, the most difficult requirement to complete was paying court fees. • On average, the easiest requirements to complete were going to the location of the drug testing and cooperating with drug testing.

Summary of Challenges Reported by ParticipantsFindings from Interviews and Focus Groups • Difficulties in maintaining employment and fulfilling program requirements. • Treatment sessions were focused on drug abuse and did not include much content on alcohol abuse. • Lack of adequate housing options that are conducive to sobriety. • Health problems. • Use of jail as a sanction.

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 DFTC program. These include: • Helping them to focus on recovery and refrain from using. • Providing needed services. • Better relationships with children, family, and friends. • Increasing their chances of regaining custody. • Helping them feel better about themselves. • It taught them responsibility. • Enabled a participant to have a baby free of the influence of drugs or alcohol. • Helped them to become better parents. • Improvements in employment and financial status. • Assistance in finding housing.

IV. Summary Strengths There are many strengths associated with the DFTC program including: • The dedication and commitment of team members. • Promotes personal, familial, and system accountability through provision of services and monitoring of participant progress. • Gender-specific and culturally competent treatment services available to female participants. • Collaboration between the DFTC and DSS to reunify parents with their children, ensuring adequate time for DSS to monitor families before graduation. • Effective use of sanctions and incentives in response to participant compliance. • Team members and participants speak highly of the Judge and identify judicial supervision as one of the most important program components . • Promotes significant improvements in the lives of participants.

Areas for Improvement Some important areas for further development and improvement are: • Creation of an alumni or aftercare program. • Addition of pertinent information to the Policy Manual so that there is a comprehensive record of the courts operational procedures and policies. • Increased integration of dependency case information in team meeting discussions and judicial proceedings. • Continued efforts to collaborate with referral sources so as to increase the referral and admission rates. • Establish an MOU with treatment providers. • Seek alternative treatment options for participants. • Seek additional housing options for participants. • Implement additional incentives that promote parental involvement. • Restructure the team meetings and address personal or professional conflicts before or after meetings to ensure efficient use of time.

Testimonials • “I would probably not be living today if it were not for this program.” • “Drug court helped me…to be the mother that I want to be and to realize I am someone.” -Focus Group Participants. • “I am now very thankful for getting in the program,” • “It’s a great program.” -Graduates • “It helps you a lot if you really want to be clean.” -Terminated Participant.

Durham County Family Treatment Court (DFTC)