Best Practices Standards Vol. I: An Overview

1. Best Practices Standards Vol. I: An Overview

2. OBJECTIVES • Define Best Practices Standards • Identify the need for Best Practices Standards • Briefly examine each of the Best Practices Standards in Volume One • Discuss the impact of Best Practices Standards on Drug/DWI Court’s operation

3. Best Practice Standards • Set benchmarks for new and existing programs • Focus on practices supported by reliable and convincing evidence • Are both aspirational and directive

4. Best Practices Standards • Target Population • Historically Disadvantaged Groups • Roles and Responsibilities of the Judge • Incentives, Sanctions, and Therapeutic Adjustments • Substance Abuse Treatment

5. I. Target Population Objective Eligibility & Exclusion Criteria • Specified in writing • Communicated to team

6. I. Target Population High-Risk and High Need Participants • Substantial risk for reoffending, community supervision failure, and/or treatment failure. • Addicted

7. Validated Eligibility Assessments I. Target Population Validated risk-assessment tool Valid Clinical-assessment tool

8. I. Target Population Offenders charged with drug dealing or those with violence histories are not excluded automatically Criminal History Disqualifications

9. I. Target Population Clinical Disqualifications • Co-occurring mental health diagnosis • Medical Condition • Legally prescribed psychotropic or addiction medication Candidates are not disqualified automatically due to:

10. II. Historically Disadvantaged Groups

11. II. Historically Disadvantaged Groups • Nondiscriminatory in intent and impact • Valid assessment tools for members of group Equivalent Access

12. II. Historically Disadvantaged Groups Monitors completion rates for group, if lower • Investigate reasons for disparity • Develop remedial action plan • Reevaluate Equivalent retention

13. II. Historically Disadvantaged Groups Equivalent Treatment Equivalent incentives & Sanctions Equivalent Dispositions Evidence- based treatment for cultural group -Monitor -Remedial action if needed -Disparate Dispositions? -More frequent terminations? -Harsher sentences?

14. II. Historically Disadvantaged Groups Team Training Develop culturally sensitive attitudes Develop concrete strategies to correct and remediate disparities in services and outcomes

15. III. Roles & Responsibilities of the Judge

16. III. Roles & Responsibilities of the Judge Professional Training • Constitutional • Ethics • Evidence-based substance abuse • Mental Health treatment • Behavior modification • Community Supervision

17. III. Roles & Responsibilities of the Judge • Length of Term • No less than two consecutive years • Consistent Dockets • Participate in Pre-court Staff Meetings

18. III. Roles & Responsibilities of the Judge • Frequency of Status Hearings • At least every two weeks during first phase • No less than once per month in later phases • Length of Interaction with participant • At least three minutes

19. III. Roles & Responsibilities of the Judge Judicial Demeanor Respectful Fair Attentive Enthusiastic Consistent Caring

20. III. Roles & Responsibilities of the Judge Judicial Decision Making Seek and value team input Responsible for weighing facts Don’t decide by majority vote

21. IV. Incentives, Sanctions, andTherapeutic Adjustments

22. III. Roles & Responsibilities of the Judge • Advance Notice • Written policies and procedures • Opportunity to Be Heard • Explanation – by participant, by judge • Equivalent Consequences

23. IV. Incentives, Sanctions, andTherapeutic Adjustments • Progressive sanctions • Intermediate range • Proximal Behaviors • Distal Behaviors

24. IV. Incentives, Sanctions, andTherapeutic Adjustments Licit addictive or intoxicating substances • Continued use is contrary to evidence-based practices except when medically necessary • Authorized use only: • Competent medical evidence indicates medically indicated, and effective alternative treatments are not reasonably available

25. IV. Incentives, Sanctions, andTherapeutic Adjustments Therapeutic Adjustments • Early phase: Maintaining abstinence may be extremely difficult • Adjust treatment based on expertise of trained clinicians • Later phase: After treatment and stabilization sanctions can escalate for illicit drug or alcohol use.

26. IV. Incentives, Sanctions, andTherapeutic Adjustments • Incentivizing Productivity • Improved outcomes when court uses higher levels of praise and positive incentives • Phase Promotion • Clearly defined phase structure • Clearly defined behavior requirements • Rewards participant and sets expectations

27. IV. Incentives, Sanctions, andTherapeutic Adjustments Use jail sanctions sparingly • Increased recidivism after six day on average

28. IV. Incentives, Sanctions, andTherapeutic Adjustments • Those who automatically Terminate participants for new drug or alcohol use or drug possession offenses have: • 50% higher recidivism • 48% loser cost savings

29. IV. Incentives, Sanctions, andTherapeutic Adjustments • Consequences of graduation and termination • Favorable criminal justice outcomes should result from graduation • More restrictive or more stringent criminal justice outcomes should result from unsuccessful termination or withdrawal

30. V. Substance Abuse Treatment

31. V. Substance Abuse Treatment • Continuum of Care • Standardized patient placement criteria governs level of care provided. • Incarceration • Is not used to achieve clinical or social service objectives (e.g., for detox) • Treatment • Is not used to accomplish non-clinical goals (e.g., for housing or for those who need jail)

32. V. Substance Abuse Treatment Clinically trained representative from one or two treatment agencies are core members of team and attend staffing and hearings

33. V. Substance Abuse Treatment • Treatment Dosage and Duration • 9 to 12 months; 200 hours of counseling • Treatment Modalities • One individual per week in Phase 1 • Group membership is guided by evidence-based selection criteria • Evidence-Based Treatments • Medications

34. V. Substance Abuse Treatment Medication Assisted Treatment • Effective with and necessary for some participants when combined with psychosocial treatment • Programs avoid blanket prohibitions • Best when prescribed by a physician specializing in addiction medicine • Judge exercises discretion to prohibit MAT only when determined to not be medically necessary by a physician advising the court

35. V. Substance Abuse Treatment Provider Training and Credentials • Licensed or certified • Experience working with criminal justice populations • Clinically supervised

36. V. Substance Abuse Treatment • Peer Support Groups • Structured model or curriculum • 12-Step and secular alternatives • Continuing Care • Continue with pro-social activities and remain connected with a peer support group after Drug Court

37. Best Practices Standards Vol. I: An Overview