Family Drug Treatment Courts and Juvenile Drug Courts: Outcomes, Costs and Promising Practices

1. Family Drug Treatment Courts and Juvenile Drug Courts: Outcomes, Costs and Promising Practices NADCP Conference May 2008 Michael W. Finigan, Ph.D. Scott W. M. Burrus, Ph.D. Shannon M. Carey, Ph.D. Juliette R. Mackin, Ph.D. www.npcresearch.com 4380 SW Macadam Ave. Suite 530 Portland, OR 97239

2. Are Family Treatment Drug Courts Effective? Results from two studies and five sites Four of the study sites were funded by the Substance Abuse and Mental Health Services Administration, Grant No. 270-02--7107

3. Study Introduction: The FTDC National Evaluation • Four FTDCs in the study: • Santa Clara, CA; • San Diego, CA; • Washoe, NV; • Suffolk, NY. A federally funded national evaluation funded by the Center for Substance Abuse Treatment, SAMHSA A study conducted by NPC Research

4. Study Introduction: The Harford County, MD Evaluation

5. Five Sites With Different FTDC Models • Harford: Single, dedicated treatment provider for the entire program. • San Diego: System-wide reform, the “Substance Abuse Recovery Maintenance System” (SARMS), 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

6. Sample Demographics Site-level 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

7. Data Collection Strategies • Administrative record review • Treatment, court, and child welfare records • Qualitative parent and key stakeholder interviews and court observations • Cost data from the State of Maryland and Harford County, MD.

8. Treatment Outcome Questions • Compared to Control Parents, Did Parents in FTDC: • Enter treatment at a higher rate? • Enter treatment more quickly following their child welfare petition? • Spend more time in treatment? • Complete treatment at a higher rate?

9. Likelihood of Treatment Entry * Statistically significant at p<.001.

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

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

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

13. Child Welfare & Court System Outcome Questions Did children of FTDC parents spend less time in out-of-home care? Did FTDC cases reach permanency faster? Were children of FTDC parents reunified at a higher rate?

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

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

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

17. 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

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

19. Black Box Analysis (National Study)

20. 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

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

22. 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

23. FTDC Experiences and Substance Abuse Treatment Outcomes

24. FTDC Experiences and Reunification

25. 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?

26. Treatment Experiences and Treatment Completion

27. Treatment Experiences and Reunification

28. 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)

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

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

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

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

33. 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

34. 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.”

35. 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.”

36. Practical Support

37. 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.”

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

39. Part IV: Harford Cost Study Results

40. Cost Study Findings

41. Cost Study Findings

42. 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.

43. 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.

44. Are Juvenile Drug Courts Effective? Results from two studies

45. Typical Characteristics Fast/expedited entry into drug and alcohol treatment Intense supervision (court and treatment; frequent drug testing) Collaboration between treatment, the court, prosecution and defense council Use the principals of behavior modification such as rewards and punishment (including jail as a sanction)

46. Outcome and Cost Evaluations:Clackamas County Juvenile Drug Court and the Harford County Juvenile Drug Court • JDC studies: one in Oregon, one in Maryland • Clackamas N = 53; Harford N = 102 • Similar participant demographics • 85-90% white • Marijuana primary drug of choice • Outcomes: Re-arrests, substance use, detention/jail, costs/benefits • Costs: Investment and Outcome costs to taxpayer

47. Juvenile Drug Court Outcomes

48. Harford: JJ Recidivism (2 yr)

49. Harford: JJ Recidivism (2 yr)

50. Harford: Adult CJ Recidivism (2 yr)