Performance based drug courts: executing the 16 strategies in practice

1. Performance based drug courts:executing the 16 strategies in practice Jacqueline van Wormer, Ph.D. Washington State University NCJFCJ

2. Purpose of Session • To talk about effectiveness of the JDC model • Program Outcomes • Cost Benefit • What is working and not working in the JDC model via review of the 16 Strategies in Practice • Tips and examples of effective programs & techniques

3. Effective Juvenile Justice Principles • Probation/court monitoring, group homes, and correctional facilitates have minimal impact subsequent recidivism. Some studies show negative effects (Lipsey and Cullen, 2007; Petrosinoet al., 2010). • Source: Lipsey, 2010

4. Effective Juvenile Justice Principles • Deterrence-oriented programs that focus on discipline, surveillance, or threat of punitive consequences (e.g., prison visitation Scared Straight–type programs, boot camps, and intensive probation supervision) have no effect on recidivism and may actually increase it (Lipsey, 2009). • Source: Lipsey, 2010

5. Effective Juvenile Justice Principles • “Therapeutic” programs oriented toward facilitating constructive behavior change have shown very positive effects—even for serious offenders (Lipsey, 2009). • Model fidelity to manualized EBP’s is critical! • Source: Lipsey, 2010

6. Juvenile Drug Court Research • Early research: • Small samples and poor designs. • Negative effects found by Hartmann & Rhineberger (2003); • No effects on recidivism found by Wright and Clymer (2001); Anspach et al., (2003) • Positive Findings: • Lutze & Mason (2007); Latessa et al (2002), Rodriguez & Webb (2004), Shaffer et al., (2008) Hickert (2010), Hennegeler (2006, 2012), NPC Research (2006, 2010) • Latessa report (2013) • Meta-Analysis: • Null-findings for both Wilson et al (2006); Shaffer (2006) • Small effect size – Mitchell et al (2012)

7. Cost-Benefit Findings • Findings vary dramatically across courts • More likely to generate greater cost savings with minimal use of detention. • No difference in the rate of re-arrest for juveniles placed in a juvenile institution vs. community. No correlation between length of stay and re-arrest. Long periods of incarceration does not change behavior and is costly to your program!

8. The Cost of Treatment vs. Continued Use SBIRT models popular due to ease of implementation and low cost • $750 per night in Medical Detox • $1,115 per night in hospital • $13,000 per week in intensive • care for premature baby • $27,000 per robbery • $67,000 per assault $70,000/year to keep a child in detention $22,000 / year to incarcerate an adult $30,000/ child-year in foster care Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars

9. New Key Findings • To strengthen outcomes: • Engage families • Attend court & active involvement • Support group method • Engage entire family in services if able • Adopt evidence-based treatment practices • Utilize contingency-management procedures • Evaluate and continually monitor team for adherence to 16 Strategies in Practice. Follow the model!!

10. Not All Drug Courts Are Equally Effective • CSAT, OJJDP and Reclaiming Futures (RF) partnered with a subset of 10 Grantees who put greater emphasis on • Standardized screening to better target youth • Using the GAIN data to drive treatment planning • Developmentally appropriate evidence-based treatment practices implemented with fidelity • Staff training and peer fellowships across site • This Reclaiming Futures Juvenile Treatment Drug Court (RF-JTDC) was compared to a sample from other Juvenile Treatment Drug Courts (JTDC) matched with propensity score weighting on 63 intake variables (see Dennis et al 2013).

11. Change in Days of Substance Use\a RF JTDC Reduce Use more \a Days of abstinence s while living in the community; If coming from detention at intake, based on the days before detention. \b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC \c Amount of change is significantly better for RF-JTDC than JTDC Source: JTDC vs. RF-JTDC (weighted n=1112)

12. Change in Use by JTDC Site All RF Sites average (box) or better (above box) 4 of the 5 best sites are RF 0 of the 4 worst are RF siites 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Across

13. Exploring the 16 Strategies

14. The Importance of Teams • Strategy One: “Engage all stakeholders in creating an interdisciplinary, coordinated, and systemic approach to working with youth and families” • Strategy Two: “Develop and maintain an interdisciplinary, non-adversarial work team” • Strategy Four: “ Schedule frequent judicial reviews and be sensitive to the effect that court proceedings can have on youth and families”

15. Treatment Provider Source: NPC Research

16. Defense Attorney

17. Prosecutor

18. All Team Members

19. Drug Courts That Have Judges Stay Longer Than Two Years Had 3 Times Greater Cost Savings Note: Difference is significant at p<.05

20. Judges Who Spent at Least 3 Minutes Talking to Each Participant in Court Had More Than Twice the Savings Note: Difference is significant at p<.1

21. Target Population & Eligibility Criteria: Assessing true needs and resources • Strategy Three: “ Define a target population and eligibility criteria that are aligned with the program’s goals and objectives” • Strategy Six: “Build partnerships with community organizations to expand the range of opportunities available to youth and their families.”

22. Strategy Five: Monitoring & Evaluation • “Establish a system for program monitoring and evaluation to maintain quality of service, assess program impact, and contribute to knowledge in the field” • Research: • Rempel (2005) • Carey & Finigan (2008)

23. Importance of Evaluator Role • General literature shows that programs that have evaluator involved from inception increases program success. Allows for training, quality assurance and data review • In their review of 69 standard drug court practices, NPC Research (Portland, OR) found that: • Courts that review their data and stats, and modify their court operations based on findings have stronger reductions in recidivism and greater cost-savings. • Courts that have program evaluations completed & modifications completed have stronger reductions in recidivism and greater cost-savings.

24. Comprehensive Assessments and Treatment Planning Strategy Seven: “Tailor interventions to the complex and varied needs of youth and their families” Strategy Eight: “ Tailor treatment to the developmental needs of adolescents” Strategy Twelve: “ Recognize and engage the family as a valued partner in all components of the program”

25. Quiz!! Hot or Not?

26. Quiz: Hot or Not?

27. Quiz: Hot or Not?

28. Treatment Modalities ACRA FFT PYP 7C Boot camps/wilderness programs MET/CBT5 MST CM Intensive Supervision

29. What works in Juvenile Justice Programming? • Lipsey (2009): 548 studies • Findings: • Interventions applied to high-risk delinquents, on average, produced larger recidivism reductions than when those interventions were applied to low-risk delinquents. • Favor therapeutic methods over control methods • Both generic and evidence-based programs can be effective if certain principles followed • Amount and quality are key • Must maintain model fidelity in both your treatment programs and your JDC model.

30. Key Elements of D/A Treatment Effectiveness • Screening/Assessment and Treatment Matching • Comprehensive, Integrated Treatment Approach • Family Involvement in Treatment • Developmentally Appropriate Treatment • Engage and Retain Teens in Treatment • Source: Brannigan et al (2004).

31. Key Elements of Effectiveness (cont.) Qualified Staff Gender and Cultural Competence Continuing Care Treatment Outcomes Ongoing Supports and Services: Quality Assurance and Model Fidelity Critical.

32. Major Predictors of Bigger Effects • A strong intervention protocol based on prior evidence • Quality assurance to ensure protocol adherence and project implementation • Proactive case supervision of individual • Triage to focus on the highest severity subgroup

33. Impact of the numbers of these “Favorable Features” on RecidivismSource: Lipsey; Muck (2010) The more features, the lower the recidivism Average Practice Source: Adapted from Lipsey, 1997, 2005

34. Other Common Findings Low structure and ad hoc “treatment as usual” does not do as well as evidenced based practice Wilderness programs have mixed effects Treating adolescents like adults (or with adults), and in boot camp causes harm on average Relapse is still common and there is a need for on-going support, monitoring and when necessary re-intervention

35. Evidence Based Practice Examples Motivational Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT) Motivational Interviewing (MI) Multi Systemic Therapy (MST) Multidimensional Family Therapy (MDFT) Seven Challenges (7C) Adolescent Community Reinforcement Approach (ACRA) Source: Adapted from Lipsey et al 2001, 2010; Waldron et al, 2001, Dennis et al, 2004

36. Focus on Strengths Strategy eleven: “ Maintain a focus on the strengths of youth and their families during program planning and in every interaction between the court and those it serves”

37. Strategy Fourteen: Drug Testing • “ Design drug testing to be frequent, random and observed. Document testing policies and procedures in writing” • Research: • Ives et al (2010) • Carey et al (2006)

38. Goal-Oriented Incentives and Sanctions • Strategy Fifteen: “Respond to compliance and noncompliance with incentives and sanctions that are designed to reinforce or modify the behavior of youth and their families” • Research: • Gendreau (1999) • NPC (2006, 2010) • Henggeler et al., (2006, 2012 (a) (b)) • Salvatore et al., (2010)

39. The Teenage Brain

40. Incentives & Sanctions, Continued Historical CJ responses vs. modification of behavior through a coordinated and thoughtful (research informed) process Punishment for a “wrong” is not the goal – behavior change is the goal The JDC should use a balance of incentives, sanctions and treatment responses

41. Phase Structure Source: Betty Gurnell

42. The Four Steps Behavior to target Current behavior Desired behavior Small, achievable increments

43. Decision Matrix – Phase I

44. Decision Matrix – Phase II

45. Decision Matrix – Phase III

46. JDC team needs to Write policy – how, when and by whom will responses be made = better outcomes Determine range of responses Communicate well with each other Trust each other Engage the family Be clear about expectations Develop reliable system to monitor behavior

47. Incentives and Sanctions, continued • Key components: • Immediate, certain, fair and of appropriate intensity • Do not rely solely on standardized “lists” • Should be proportional and balanced • Punishment alone is least effective way to change behavior • Be comfortable in combining incentives and sanctions • Be cognizant of time • Perceptions of fairness – it all begins with individualization • Make sure youth understand their positive and negative reinforcers • Yeres et al (2008)

48. Incentives and Sanctions, continued Use contracts as behavior change tool Educate youth and family early and often regarding the individualized nature of the program Coordinate treatment and JDC case management plans to alleviate potential incentive/sanction conflicts Exploration of current Incentive & Sanction process, list, and purpose

49. Behavioral Contract Example

50. Contact Information Jacqueline van Wormer, Ph.D. Washington State University SAC 403A Spokane, WA (509) 628-2663 jvanwormer@wsu.edu jgvanwormer@gmail.com