Wake County Adult Drug Treatment Court

1. Wake CountyAdult Drug Treatment Court Submitted by Valerie Anderson, M.A. Nena Lekwauwa Adam Ross Dr. Janis Kupersmidt innovation Research & Training Process Evaluation Results (919) 493-7700 www.irtinc.us

2. Outline • Background • Team Composition, Roles and Functioning • Program Eligibility, Referral, and Admission • Treatment Services • Sanctions • Incentives • Case Management & Judicial Supervision • Termination & Graduation • Results of Consumer Satisfaction Survey • Challenges to Program Completion • Life Improvements Attributed to Program • Overall Strengths & Barriers • Overall Recommendations • Timeline

3. BackgroundProgram History • NC Drug Treatment Court Act enacted in 1995 • One of five original pilot courts • Original grant application submitted by Carolina Correctional Services • Began operation in 1996 • Originally operated in two courts (Superior and District) • Consolidated into District Court in 2001 • AOC assumes administration of WCADTC on July 1, 2005

4. BackgroundTransition of Court Management • Reasons Provided for Transition: • High operating costs due to administrative overhead • Lack of community networking and partnership with local organizations such as Treatment Alternatives for Safer Communities (TASC) and other relevant community agencies • Goals of Transition: • Seamless and “no harm” provision of treatment services • Increase number of community partnerships • Recommendations Regarding Transition: • Conduct analyses of cost savings with transition to AOC court administration • Formal training and orientation process for new team members • Consider the potential role of TASC in performing case management services or serving as a member of the core court team • Involve Local Management Committee in the planning process

5. Strengths Most team members have attended State and National DTC trainings Team members have had prior relevant educational and professional training in preparation for their current roles Barriers Team members reported greater need for cross-training of team members Treatment Providers are not yet Certified Substance Abuse Counselors, although both are currently working towards this goal Team MembersBackground and Training

6. Team Members’ Background and Training Recommendations • Conduct a needs assessment to determine team members’ specific needs for cross-training, and, if necessary, develop team-based cross-training sessions to meet these needs. • Continue to provide support and structure (e.g., set timelines and expectations) regarding Treatment Providers’ efforts to obtain certification in order for the program to be in compliance with 2005 Guidelines for NC Drug Treatment Courts.

7. Strengths Team composition and roles adhere to Best Practices Guidelines Clearly defined roles and responsibilities, in general Low turnover in Judge, Defense Attorney, and Probation Positions Barriers Rotating schedule for the ADA position, as opposed to one dedicated ADA Previously high turnover among treatment agencies Lack of male treatment providers Lack of understanding (among participants) of the role of the Defense Attorney Although in general, roles and responsibilities are clearly defined, occasionally, some team members perform functions outside out the scope of their prescribed role Team MembersComposition and Roles

8. Team Composition and Roles Recommendations • Request dedicated ADA as team member. • Recruit male treatment staff. • Explain the role of the Defense Attorney to the participants during the admission and orientation process for new participants. • Clarify policies and procedures regarding the criteria and process for excusing participants from court and treatment sessions, and document instances in which these standards are not met.

9. Strengths Orderly and comprehensive processing of individual cases during team meetings Two pre-court staffing meetings provide opportunities for revisiting and resolving cases Consensus-based decision-making about participant cases, in general Barriers Team members hold varying views about Judge’s role as final arbiter Treatment providers could take on more of a leadership role in team meetings Relatively small amount of time spent processing “what works” in team meetings Lack of available time to address broader court issues that arise during pre-court team meetings Team MembersDecision-Making Processes

10. Discuss and decide on Judge’s role as final arbiter of case decisions in which the team cannot reach a consensus. Consider a more active role for Treatment Providers in helping the team to integrate research on substance abuse into decision-making about participant cases. Document unresolved, broader court issues and table them for discussion during Local Management Committee meetings and/or staff retreats. Set aside time, either in team meetings or in a retreat, to process the factors associated with successful program compliance, progress, and completion. Team Decision-Making ProcessesRecommendations

11. Strengths Team members and participants reported that team members maintain professional boundaries Participants reported overall respect for and from the team members and perceive the team as committed, compassionate, and sincere Participants reported especially positive regard for Judge, Treatment Providers, Probation Officer, and Assistant Director of Programs Team members expressed genuine desire for the participants to succeed Barriers Less positive regard was expressed by participants for the Defense Attorney due to feelings of “betrayal” Some participants expressed negative opinions about team members “playing favorites” Some team members reported that participants know which team members can be manipulated into excusing them from meetings and/or court sessions Occasional lapses in professionalism when discussing challenging participant cases in pre court staffing meetings were observed Team MembersInteractions with and about Participants

12. Team Member InteractionsRecommendations • Clarify and clearly communicate to participants the rationale of the “non-adversarial approach,” and its implications for the role and functions of the Defense Attorney. • Use clear language in describing team approaches to differential treatment of participants, and consider how participants may interpret such language. • Adopt and enforce uniform standards and policies for excusing participants from required meetings and sessions. • Maintain professionalism when discussing participants, and agree on appropriate standards for using humor to diffuse difficult or challenging situations.

13. Strengths Eligibility criteria clearly define the target population for the program Team provides multiple opportunities to assure that participants are educated about program requirements Participants begin treatment immediately upon admission Barriers Basis for deviating from stated eligibility criteria are not clearly defined Length of time between probation violation or arrest and eligibility screening is “longer than it should be” In general, the program is a “hard sell” to many offenders and defense attorneys due to length of program and because it is not a deferral program Disagreement among team members regarding who should administer the SASSI (Case Manager or Treatment Provider?) Eligibility, Referral, and Admission Procedures

14. Program Eligibility, Referral, and AdmissionRecommendations • Formalize and document procedures for deciding when to make exceptions to the eligibility criteria. • Document and review the characteristics of cases that take an especially long time to complete the eligibility screening process after the initial probation violation or arrest in order to determine methods for accelerating the admissions process. • Enhance community awareness and education about the purpose and aims of the drug treatment court model. • Adopt SAMHSA’s standards regarding administration of the SASSI and other screening tools: Assure that personnel administering screening tools are adequately trained to properly administer, score, and interpret screening tools.

15. Strengths Team members and participants identify treatment as an essential program component. A wide variety of treatment services are available to participants, including group therapy, individual counseling, and community-based 12-step recovery groups. Participants can be referred to additional treatment services, such as residential treatment and detoxification, and for ancillary services, such as housing, vocational rehabilitation, and transportation. Participants reported that Treatment Providers are helpful and easy to talk to. Treatment Services

16. Strengths Treatment Services are delivered in accordance with a structured phase system, and Phase II participants receive both group and individual counseling. Treatment providers use evidence-based cognitive-behavioral treatment programs for group therapy. Participants find group therapy sessions particularly helpful, and identify peer support as a key component of group therapy. Team members reported that treatment services are applicable for all cultural groups and for both genders. The team has begun to establish more community connections to meet participants’ treatment needs, as evidenced by increasing numbers of referrals from the team to community mental health and substance abuse treatment services. Treatment Services, Cont.

17. Barriers Difficulty securing treatment services for dually diagnosed participants Lack of male treatment providers may be a barrier for some participants Participants did not articulate specific aspects of treatment that were helpful outside of peer support Some participants attributed their recovery to 12-step meetings rather than to court treatment services Treatment providers reported that they do not always adhere to the treatment program guidelines for group therapy sessions due to the need to address pertinent recovery needs of the moment Treatment Services

18. Barriers Team members suspect the treatment court may not be equally as effective across age. One team member felt the lack of male treatment providers may make the treatment services less effective for male participants. Team members believe families should be involved in treatment; there is currently no family component in place. Team members reported that participants often arrive late and depart early from treatment sessions. Treatment Services, Cont.

19. Treatment ServicesRecommendations • Develop strategies to recruit more male treatment staff. • Work with Division of Mental Health and other community partners to identify treatment services for dually diagnosed participants. • Consider the possibility of inviting a member of Wake County Mental Health Services to serve on the Local Management Committee or as a core team member. • Explore the possibility of documenting levels of adherence to treatment manuals, as well as the circumstances (e.g., recovery needs or crises) that necessitate departures from the treatment plan. • Assess the specific skills that participants are acquiring in group therapy sessions. One possibility is to incorporate an assessment of these skills in the exit interview.

20. Treatment ServicesRecommendations • Stricter enforcement of late arrival and early departure policies will maximize the benefit of treatment services. • Evaluate the effectiveness of the court for older participants as compared to younger participants, and for males as compared to females. • Consider the possibility of reviving the family component that was functional in prior years. Conducting a needs assessment to determine participants’ and family members’ need and desire for the program, willingness to participate, and time availability might help to assure better involvement on the part of families. • Continue to identify and forge connections with community partners to enhance community awareness and support for the program, and to increase the diversity of treatment services available for participants.

21. Strengths Comprehensive list of sanctions is made available to participants upon admission to program Participants find threat of jail to be a useful deterrent Individualized approach to imposing sanctions is used to meet participants’ recovery needs Consensus-based development of sanctions Team members consider participant’s history of sanctions In general, participants perceive the sanctions used by the court as fair and useful Barriers Some participants perceive inconsistent application of sanctions In retrospect, some former participants reported that team members were too lenient in their use of sanctions (“I needed a sanction.”) Team does not enforce threatened sanctions consistently Sanctions

22. Sanctions Recommendations • Proactively communicate the theory and rationale behind the use of sanctions. • Monitor and evaluate the current level of sanction enforcement. • Explore the adoption of individualized behavior contracts to complement the current contract. • Employ a specific psychological framework or approach (e.g., behavior modification) to develop sanctions that address recovery needs, and evaluate the extent to which sanctions are currently imposed according to the selected framework.

23. Strengths Participants reported that graduation is the greatest reward because it signifies having achieved a new lifestyle (clean and sober) Participants appreciate early release from court and verbal praise from the Judge Participants are generally satisfied with the court’s use of incentives Team members prefer positive reinforcement over punitive methods of trying to bring about behavior change Barriers Variability in standards of progress that merit rewards (i.e., baby steps vs. giant leaps) causes participants to perceive inconsistent application Team members reported that rewards provide instant gratification, but result in minimal lasting impact Lack of sufficient number of tangible incentives Early release is a “mixed blessing” for some due to transportation barriers and conflicts Incentives

24. Incentives Recommendations • Proactively communicate the theory and rationale behind the use of incentives. • Utilize successful program alumni and friends of the program to solicit donations from community businesses. This would also help increase visibility of the program. • Obtain specialized training or network with other drug treatment courts to identify a wider variety of incentives and incentive strategies. • Discuss possibilities for addressing participants’ complaints regarding lengthy travel times only to be dismissed from court early. • Continue to recognize the value of verbal praise and continue to use it frequently.

25. Case Management & Judicial Supervision Barriers • Participants report that in the past, lack of male staff to supervise drug testing has contributed to manipulation of drug screens • Some team members and participants reported instant tests are not always accurate • Noise levels in the rear of the courtroom may prevent some participants from focusing on court proceedings • Phase system does not document or reflect systematic decrease in number of supervision contacts required (Case Management and Probation) Strengths • Participants reported that drug screening is a useful deterrent to drug use • Instant drug screens return results quickly • Participants find status hearings to be an effective deterrent “If I didn’t have court to go to, I wouldn’t be afraid of anything. I could relapse several times.” • Team members reported that the non-adversarial relationship participants form with the Judge is especially helpful

26. Case Management & Judicial SupervisionRecommendations • Male surveillance officer currently administers drug screens at treatment groups and court sessions. The team should evaluate whether this is an appropriate long-term solution. • Document and evaluate instances of inaccurate instant screens to determine whether these instances can be attributed to a particular drug or drugs. • Require participants to sit in the front of the courtroom, and have security personnel circulate to maintain appropriate atmosphere. • Review Phase System, as written, and determine whether more specific requirements regarding the number of Case Management and Probation contacts are necessary.

27. Strengths Consensus-based termination decisions Termination is considered a “last resort” due to team members’ desire to keep participants in treatment Team members all agree the policy is fair Zero-tolerance termination policy for violence Barriers Policy relies heavily on subjective judgments. “Good cause” “Level of participation” “Conduct that is detrimental to the program” Program graduates advocate stricter policies and enforcement as a means of removing participants who reduce morale and make group sessions difficult Participants reported they are unsure about what actions result in termination Lack of consensus regarding the appropriateness of the program for repeat participants Lack of formalized follow-up procedures results in difficulty contacting former participants for evaluation purposes Termination

28. Termination Recommendations • Review the termination policy and decide on more specific language and objective criteria to clarify the “grey areas.” • Consider and discuss the effects that maintaining “difficult” participants may have on other participants. • Evaluate the effectiveness of the program for one-time participants as compared to repeat participants (graduates and terminated). • Consider developing follow-up procedures to monitor outcomes for terminated participants.

29. Strengths Clearly stated and objective criteria for successful program completion Graduation ceremony to publicly honor graduates Successful program graduates are encouraged to maintain contact with program Barriers No formal program in place to retain alumni Some participants are disgruntled about “undeserving” graduates who manage to complete the program simply by avoiding jail Graduation

30. GraduationRecommendations • Investigate and monitor the reported problem of “undeserving” graduates. • Develop a program to retain alumni as treatment and recovery resources and role models.

31. Consumer Satisfaction SurveyDemographic Characteristics of Respondents

32. Consumer Satisfaction SurveyDemographics

33. Consumer Satisfaction SurveyDemographics

34. Consumer Satisfaction SurveySatisfaction with Program Components How satisfied are you with the various parts of your Drug Treatment Court? (1 = very unsatisfied  4 = very satisfied)

35. Consumer Satisfaction SurveySatisfaction with Program Components

36. Consumer Satisfaction SurveyProtection of Rights How well do you feel that your legal rights were protected? (1 = not at all  4 = completely)

37. Consumer Satisfaction SurveyDifficulty of Program Requirements How easy or difficult is it for you to complete the following program requirements? ( 1 = very difficult  5 = very easy)

38. Consumer Satisfaction SurveyDifficulty of Program Requirements

39. Consumer Satisfaction SurveyDifficulty of Program Requirements

40. Challenges to Program Compliance and Completion as Reported by Participants • Frequency of required meetings and court sessions • Participants question why those who are doing well and on the verge of completion have to attend court. • Participants feel that number of weekly NA/AA meetings should diminish over time. • “Court ALWAYS starts late!” • Many active participants reported that drug court status hearings frequently begin late • This is particularly inconvenient for participants who rely on others for rides to and from court • Active participants reported that required meetings conflict with job requirements • Employers are not always understanding of their obligations • Lost wages due to requirement to attend court • Transportation difficulties were reported to be a barrier to full participation by active and former participants • Many participants have their licenses revoked and are reliant on others for transportation • Long travel distances for a few participants who do not live in Raleigh • Lack of child care options was reported as a barrier by three active female participants • Difficulty fulfilling community service and court fee requirements

41. Life Improvements Attributed to the Program • Participants’ comments • Gainful employment • Improved finances due to elimination of drug purchases • Improved relationships with and attitudes toward family members and friends • Increased understanding about addiction • Increased honesty with self and others • Decreased (or eliminated) drug use • Team members’ comments • “Participants change in every way” • Improved physical appearance • Improved attitude, self-esteem • Better employment situation • Better understanding of the legal system • Gain a sense of community

42. Team composition, roles and functions adhere to Best Practices Guidelines Positive interactions between team members and participants Orderly and comprehensive processing of individual cases Treatment services are delivered according to a structured phase system, and are guided by evidence-based treatment programs for recovery and relapse prevention Overall Strengths

43. Consensus-based decision-making is used to arrive at the best course of action for participants Individualized approach to the delivery of sanctions is designed to meet participants’ recovery needs Both team members and participants attribute positive life changes to the drug treatment court program Overall Strengths

44. Lack of consensus among team members regarding Judge’s role as final arbiter. Lack of time spent processing “what works.” Justice system team members do not have as much time as they would like to devote to the program due to other caseloads and responsibilities. Participants are unclear about the role of the Defense Attorney. Reasons for making exceptions to the stated eligibility criteria are not clearly defined. Overall Barriers

45. The program is a “hard sell” for many offenders and defense attorneys Lack of treatment services for dually diagnosed participants Some participants perceive inconsistent use of sanctions and rewards Termination policy is largely based on subjective judgments and criteria that are not clearly defined Lack of consensus among team members regarding appropriateness of the program for repeat participants Lack of follow-up procedures for discharged participants Overall Barriers

46. Overall Recommendations • Consider recruiting male treatment providers. • Clarify the role of the Defense Attorney for participants. • Discuss and gain consensus regarding Judge’s role as final arbiter. • Plan for opportunities to discuss broader court issues. • Identify the factors that contribute to longer processing time (eligibility screening) for some referred cases. • Work with community partners to identify treatment services for dually diagnosed participants, and consider inviting a mental health professional to be a core team member or Local Management Committee member

47. Overall Recommendations • Explore the possibility of implementing individualized behavior contracts. • Monitor possible instances of inaccurate drug screens. • Review, and perhaps revise, termination policy. • Evaluate the effectiveness of the program for one-time vs. repeat participants and gain consensus regarding the suitability of the program for repeat participants. • Explore the possibility of re-establishing a family program.

48. Timeline Draft of Report to WCADTC: April 25, 2005 Feedback from WCADTC: April 28, 2005 Final Draft Delivered: April 30, 2005