New Trends for Treatment and Rehabilitation - Drug Treatment Courts (OAS/CARICOM)

1. New Trends for Treatment and Rehabilitation - Drug Treatment Courts (OAS/CARICOM) Esther Best Manager National Drug Council Trinidad and Tobago

2. Demand Reduction – The Regional Programme • Regional Drug Demand Reduction Strategy • Surveillance, Research and Development • Policy Development and Advocacy • Prevention and Education • Treatment and Rehabilitation • Programme Management and Coordination ( Includes M&E) • CARICOM – Regional Standards of Care – developed in collaboration with CICAD • Considerable work undertaken with the 10th European Development Fund

3. Prevention Initiatives • All countries have prevention activities • Some are more advanced than others • Comprehensive prevention – Including all target groups • Others specialise in target groups – Primarily in school youth • Intervention must start earlier • Trinidad and Tobago, and Grenada have pre-school interventions

4. Treatment and Rehabilitation • All Regional Member States have some form of Treatment services • Hospitals • Health Centres • Out patient • Residential • Support Services – Alcoholics Anonymous; Narcotics Anonymous • Range from specialised treatment services to admission in hospital settings • Treatment modalities include medical, bio-psychosocial model, and religious convention • Services offered by both Government and Civil Society • There are agencies which request fees while others do not

5. Gender Specific Treatment • Traditional treatment opportunities mainly for males • Regionally there was 1 treatment facility for females until 2009 • Located in South Trinidad • There are now 3 treatment facilities for females • Two in Trinidad and Tobago • One in Guyana

6. Treatment for Dually Diagnosed Patients • Usually includes drug addiction co-occurring with mental health issues or HIV/AIDS • Most facilities offer treatment for either one area or the other • This is an area that needs to be addressed as there are increased incidents of mental health issues • The regional discussion on Marijuana also requires that this issue be seriously considered

7. Interventions for Adolescents and Youth • There are youth clinics in some countries – More mental health than drug treatment • Jamaica, and the Bahamas have specific treatment interventions for young people • Need for the development of comprehensive training and services in this area

8. Shift to a Public Health Approach • The cultural acceptance of marijuana use across the region is significant • This is evident from the levels of use noted in successive secondary school surveys • Arrests continue to be high • Recognition that there is a need to increase treatment opportunities • Increasing policies and programmes which recognize addiction as a chronic relapsing disease

9. Harm Reduction Initiatives • Critical component in the public health approach • Harm reduction – Not synonymous with legalization • Successful interventions initiated with the help of DOH International and the EDF • Educating treatment providers and prevention specialist on what is harm reduction and implementing programmes in this area • Establishment of street based interventions in many countries in the region

10. Strengthening The Delivery of Treatment and Rehabilitation Services • Treatment often the domain of Civil Society • Few staff are trained in the area • Deliver services because of the recognition of the need • Committed to the clients • Want to help improve lives • OAS / CICAD is building the capacity of treatment providers through the Caribbean component of the Training and Certification Programme for Drug and Violence Prevention, Treatment and Rehabilitation - PROCCER

11. PROCCER Cont’d • Training of Treatment Providers currently being undertaken in 6 countries in either Prevention or Treatment • All Member States have been trained in both areas • Training to be delivered throughout the region in Treatment and Rehabilitation • Resulting in strengthened capacity of providers - Improved services to clients

12. Drug Treatment Courts – An Alternative to Incarceration • First introduced to the concept in 2005 • An opportunity to observe the Operation of these courts in Miami in 2009 • Launch of the Drug treatment Court in the Americas Programme by CICAD in 2010 • Interest and support from: • CARICOM Secretariat – Collaborated with CICAD to host the first Training opportunity in 2011 • Member states – Bahamas, Barbados, Suriname and Trinidad and Tobago

13. What are Drug Treatment Courts • Solution focused approach to dealing with - drug addicts - criminal behavior driven by drug addiction • Justice in collaboration with treatment will more effectively address drug abuse by criminal offenders • Designed to supervise cases of drug dependent offenders who agree to participate in treatment for their substance abuse • Offenders must take responsibility for their addiction and agree to address same • The DTC combines traditional justice processes with treatment options

14. What Makes DTC’s Different • The Court and Treatment Services • Collaboration of both systems strengthens intervention • Immediate treatment and ongoing judicial supervision • Non Adversarial approach to decisions • A team approach is necessary to address the needs of the participants – Team is usually – Magistrate, Defence Attorney, Prosecution, Probation, Police Officer, Treatment Provider • Decisions reached by consensus • Early identification of eligible offenders • Eligibility based on issues related to public safety and appropriateness for treatment – usually focused on non-violent offenders

15. DTC’s Cont’d • Treatment Services -Treatment should include a range of services -Community resources should be accessed • Urine Testing -This is critical as a participant must have negatives tests to graduate • 6.Incentives and Sanctions - a range of graduated incentives and sanctions are employed - sanctions should be swift and certain but flexible if the circumstances require.

16. DTC’s Cont’d • Ongoing Judicial Supervision - judicial oversight is essential - consistent interaction with each DTC participant is critical - pre court discussions with the judicial officer and the team -Each DTC team member is Vital - the judicial officer is the ultimate decision maker Jurisdiction is not surrendered • Monitoring and Evaluation

17. Activities in the Caribbean • Jamaica’s DTC pilot programme in existence for over 12 years • Training undertaken provided by Justice Kofi Barnes and his team from Canada to the following Member States between 2011 and 2014: • The Bahamas • Barbados • Belize • Grenada • Jamaica • Suriname • Trinidad and Tobago • Opportunities to view DTC’s in operation in Canada and the United States

18. Current Status • Belize - • MOU to be signed • The Bahamas – • CICAD awaits finalization of the MOU • Barbados – • Signed their MOU • DTC launched February 11th 2014

19. Current Status Cont’d • Jamaica – • Currently has 2 courts – • An additional 3 to be opened by 2015 • Trinidad and Tobago - • Launched Pilot Court in San Fernando on 11th September 2012 • Currently 13 participants – 8 applications pending with the DPP • Will start a second court in Tunapuna in May 2014 • Developed a draft policy document for the implementation of a Juvenile DTC • Grenada and Suriname –Still to take action • St. Kitts and Nevis has expressed interest in the programme

20. Caribbean Participation in DTC Conference

21. DTC Activities - 2014 • Training in Monitoring and Evaluation – July 2014 • Workshop on implementing Juvenile Drug Treatment Courts – July 2014 • Development of a Training Manual for juvenile treatment providers • Training for juvenile treatment providers • Launch of a Juvenile DTC in Trinidad and Tobago

22. Our Deepest Appreciation • OAS / CICAD – Ambassadors Adam Blackwell, James Mack, and Paul Simons; Antonio, Joseph, Nischa, Dr. Ryad Insanally and Mr. Francis McBarnette • CARICOM Secretariat - Mrs. Beverly Reynolds • Canadian Team - Justice Barnes • Juvenile DTC Judge - Justice Orlando Prescott • Chief Justices of - • Barbados – Mr. Justice Marston Gibson • Belize – Mr. Justice Kenneth Benjamin • Jamaica – Madame Justice Zaila Mccalla • Trinidad and Tobago – Mr. Justice Ivor Archie • Training Teams - Canada, Jamaica and Trinidad and Tobago

23. Thank you. Questions / Comments