Are Family Treatment Drug Courts Effective? Results from two studies and six sites

1. Are Family Treatment Drug Courts Effective? Results from two studies and six sites October 2008 Scott W.M. Burrus, Ph.D. Shannon Carey, Ph.D. Mike Finigan, Ph.D. Four of the study sites were funded by the Substance Abuse and Mental Health Services Administration, Grant No. 270-02--7107

2. Six Sites With Different FTDC Models • Baltimore City: System-wide reform serving families with at least one child that has never been involved with child welfare • Harford: Single, dedicated treatment provider for the entire program. • San Diego: System-wide reform with FTDC for non-compliant parents • Santa Clara: Mostly traditional FTDC model; some systems changes • Suffolk: Neglect cases only, many children not in out-of-home placements • Washoe: Traditional FTDC model

3. Sample Demographics Samples (treatment vs. comparison) were well-matched, with very few significant differences in demographic, risk, or case characteristics California sites had larger Hispanic populations Suffolk site had no meth users; this was the most common drug at the other 3 national sites

4. Final Study Samples

5. Data Collection Strategies • Administrative record review • Treatment, court, and child welfare records • Parent interviews (National Study only) • A subset of 253 parents across the 4 sites were interviewed up to 4 times during their case • These data not presented here • Qualitative parent and key stakeholder interviews and court observations • Cost data from the State of Maryland and Harford County, MD.

6. Part I: Outcome Analysis Main Question: Do FTDC’s result in better Treatment & Child Welfare outcomes, compared to traditional family court?

7. Treatment Outcome Questions • Compared to parent who did not participate in the program, did parents in FTDC: • Enter treatment more quickly following their child welfare petition? • Spend more time in treatment? • Complete treatment at a higher rate?

8. Days to Treatment Entry * Statistically significant at p<.001.

9. Days Spent in Treatment * Statistically significant at p<.001.

10. Percent Completing at Least One Treatment **Statistically significant at p<.001. *Statistically significant at p<.01.

11. Child Welfare & Court System Outcome Questions Did children of FTDC parents spend less time in out-of-home care? Were children of FTDC parents reunified at a higher rate? Were FTDC parents less likely to become involved with the CWS subsequent to their case?

12. Time in Out-of-Home Placement * Statistically significant at p<.001.

13. Permanency Outcomes

14. Days to Permanent Placement * Statistically significant at p<.05.

15. Percent Reunified * Statistically significant at p<.05. ** Statistically significant at p<.001.

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

17. Outcomes for FTDCs, cont’d FTDC children were more likely to be reunified with their parents at the end of the case

18. Part II: Black Box Analysis (National Study)

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

20. Conceptual Model for Understanding How FTDC Works Child Welfare Outcomes FTDC Treatment Parent Characteristics

21. Key Questions About FTDC • Key FTDC Variables: • Time to enter FTDC • Time spent in FTDC • Number of FTDC hearings • FTDC graduation • Selected Outcomes: • Days in treatment, • Treatment completion • Reunification

22. FTDC Processing Variables A San Diego is significantly different from Santa Clara and Washoe. B Suffolk is significantly higher than all other sites. C San Diego is significantly lower than all other sites.

23. Drug Court Graduation

24. FTDC Experiences and Substance Abuse Treatment Outcomes

25. FTDC Experiences and Reunification

26. Key Questions • Does time to treatment entry relate to outcomes: • Time spent in treatment • Treatment completion • Reunification • Does time spent in treatment relate to: • Treatment completion • Reunification? • Does treatment completion relate to reunification?

27. Treatment Experiences and Treatment Completion

28. Treatment Experiences and Reunification

29. Do Parent Characteristics Influence Outcomes? • 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)

30. Summary: Influences of Parent Characteristics No strong, consistent pattern of differences for different “types” of parents

31. How Do FTDCs Work? Summary of Findings from Quantitative Data Speed of Tx entry Duration of Tx Child Welfare Outcomes FTDC Treatment Parent Characteristics

32. Does FTDC Influence Reunification “Above and Beyond” its Effect on Treatment Completion? Reunification Parent Characteristics FTDC (TX vs Control) .14*** .28*** Treatment Completion

33. What features of drug court most influence parents’ recovery and ability to make progress on the case plan? Part III: Qualitative Parent Interviews

34. Qualitative Parent Interviews Brief, open-ended questions asked of 219 parents, and in-depth qualitative interviews with 30 parents Interviews provide contextual data to facilitate the interpretation of the quantitative data Parents’ perspective of what facilitates the drug court process

35. Emotional Support • Parents talked about how the drug court team, and in particular the judge and the drug court-dedicated 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

36. Accountability and Collaboration • 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.”

37. Accountability and Collaboration, cont’d 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.”

38. Practical Support

39. Sense of Accomplishment 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.”

40. Part IV: Cost Study DO POTENTIAL SOCIETAL COST SAVINGS RESULT FROM FTDC PARTICIPATION?

41. Part IV: Harford Cost Study Results

42. Cost Study Findings

43. Cost Study Findings

44. Harford Cost Study Conclusions 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. The total potential societal cost savings per year of Harford County FRC operation was nearly $317,000, or approximately $12,000 per served family.

45. Baltimore City Cost Study Findings

46. Baltimore City Cost Findings, Cont. After taking into account FRP program costs and State of Maryland alcohol and drug treatment costs: • The total net cost saving of the FRP for 200 cases is $1,004,456 or $5,002 per served family

47. Putting It All Together—What Have We Learned? • FTDC’s work — Families have more positive treatment and child welfare outcomes • 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 • Retention of families in FTDC programs is important to success • FTDC influence on child welfare recidivism needs additional data and research • Reduced time in foster care during and after the child welfare case may result in potential cost savings of FTDC.

48. For More Information: The final report is posted on NPC’s website: www.npcresearch.com E-mail Scott Burrus burrus@npcresearch.com Article on an earlier phase of the FTDC study: Green, Furrer, Worcel, Burrus & Finigan (2007). How Effective Are Family Treatment Drug Courts? Outcomes from a Four-Site National Study, Child Maltreatment 12(1), 43-50.

49. Discussion Questions • What are the ways that you use data as a part of your work in drug court? • Hand out of data used for FDC evaluation • How does this data overlap with what you use regularly? • What are the challenges to collecting data? Which data is most difficult for you to collect? • What are some ideas for overcoming these challenges?