Are Family Treatment Drug Courts Effective? Results from a Four Site National Study

1. Are Family Treatment Drug Courts Effective? Results from a Four Site National Study National Association of Drug Court Professionals Meeting June 12-15 Washington, D.C. This study was funded by the Substance Abuse and Mental Health Services Administration, Grant No. 270-02-7107 www.npcresearch.com

2. NPC Project Team • Beth Green, Ph.D., Principal Investigator • Michael Finigan, Ph.D., Co-Principal Investigator • Sonia Worcel, M.S., M.A., Project Director • Carrie Furrer, Ph.D., Research Analyst • Scott Burrus, M. A., Research Coordinator • Jennifer Aborn, Data Specialist • Becky Jones, Data Specialist NPC Research

3. Acknowledgements • NPC Site Research Coordinators and Data Collection Staff • FTDC judges, coordinators, and other team members at all four sites • FTDC parents • State and county child welfare and treatment agencies in California, Nevada, and New York NPC Research

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

5. Primary Research Questions • I. Outcome Analysis How do treatment, child welfare, and court outcomes differ for families processed through FTDCs as compared to traditional child welfare case processing? • II. Black Box Analysis How do FTDCs work? What factors influence program outcomes? • III. Qualitative Analysis What features of drug court most influence parents’ recovery and ability to make progress on the case plan? NPC Research

6. General Conceptual Model for FTDC Effects Intermediate Parent Outcomes Mediating Treatment & Other Outcomes FTDC Experience Intermediate Service Outcomes Child Outcomes NPC Research – 1/26/07 6

7. Four Sites With Different FTDC Models • San Diego: system-wide reform, the “Substance Abuse Recovery Maintenance System” (SARMS), with FTDC for non-compliant parents • Santa Clara: started as traditional FTDC model; Made some systems changes later in the study • Suffolk: neglect cases only, many children not in out-of-home placements • Washoe: traditional FTDC model NPC Research

8. Study Samples • Complex design based on FTDC models and availability of comparison groups • Suffolk and Washoe relied on within-county comparison groups of unserved eligible clients • San Diego relied on comparison county comparison group, matched at the individual level • Santa Clara relied on a combination of within-county and comparison county comparison groups NPC Research

9. Final Study Samples NPC Research

10. Data Collection Strategies • Administrative record review • Treatment, court, and child welfare records • Data were collected on both parents in two-parent families, but data presented today are for mothers only • Parent interviews • A subset of 253 parents across the 4 sites were interviewed up to 4 times during their case • These data not presented here • Qualitative parent and key stakeholder interviews and court observations NPC Research

11. Administrative Data Tool • Extensive data extraction tool captured the following information: • Family Background (e.g., number/ages of children, marital status) • Child Welfare Case (e.g., hearing dates, out-of-home placements) • FTDC Services (e.g., appearances, sanctions) • Treatment Services (e.g., number & type of tx.) • Permanency Outcomes (permanency decisions & custody arrangements) • Child Welfare Recidivism (e.g., new referrals, petitions) NPC Research

12. Sample Demographics • Samples 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 sites NPC Research

13. Sample Demographics, cont’d • 75% of parents were unemployed • 60% of families were headed by single mothers • 25-50% had less than high school education • Families had an average of 2 children and half had an infant NPC Research

14. Mother Risk Factors • Collected information on the following maternal risk factors identified in administrative data sources: • Mental illness • Learning/developmental disorder • Medical disability/condition • History of domestic violence • Computed 0-4 risk index (one point for each risk factor present) NPC Research

15. Average Number of Mother Risk Factors * Statistically significant at p<.001. NPC Research

16. Child Risk Factors • Collected information on the following child risk factors: • Developmental/educational issues • Behavioral/emotional issues • Child alcohol and drug issues • Prenatal substance exposure • Child sexually acting out • Child was sexually abused • Computed 0-6 risk index (received one point for each risk factor) NPC Research

17. Average Number of Child Risk Factors NPC Research * Statistically significant at p<.05.

18. Summary: Sample Characteristics • Overall, samples were well-matched, with very few significant differences in demographic, risk, or case characteristics • Some site differences in terms of race/ethnicity, drug of choice, treatment history & prior CPS involvement NPC Research

19. Part I: Outcome Analysis How do treatment, child welfare, and court outcomes differ for families processed through FTDCs as compared to traditional child welfare case processing? NPC Research

20. Outcomes: Analytic Approach • Propensity scoring is a method for reducing bias in effect estimates associated with selection bias in non-randomized designs (Rosenbaum & Rubin, 1983). • Propensity scores were modeled for each site using the following characteristics: – Race – Previous CPS involvement– Marital status – # mother risk factors – Education – # child risk factors – Employment status – # children on case – Type of abuse allegation – Infant involved in case – Mother’s age – Frequency of drug use – Age 1st drug use – Previous TPR NPC Research

21. Outcomes: Analytic Approach • Outcomes were analyzed using weighted least squares (WLS) regression • Propensity scores were used as site-specific weights • Data presented are adjusted means • Treatment effects were estimated within each site, and then pooled for an overall study effect size estimate • Effects of treatment group reflect FTDC vs. comparison group except San Diego, where FTDC and SARMS are combined and weighted, creating a “FTDC system” treatment group NPC Research

22. 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? NPC Research

23. Likelihood of Treatment Entry * Statistically significant at p<.001. NPC Research

24. Days to Treatment Entry * Statistically significant at p<.001. NPC Research

25. Days Spent in Treatment * Statistically significant at p<.001. NPC Research

26. Percent Completing at Least One Treatment NPC Research * Statistically significant at p<.01. ** Statistically significant at p<.001.

27. Cross-site Effects on Substance Abuse Treatment • Strong cross-site treatment effects • Compared to comparison parents, drug court parents: • Were more likely to enter treatment • Entered treatment more quickly than comparison parents • Stayed in treatment longer than comparison parents • Completed treatment more often than comparison parents NPC Research

28. Child Welfare & Court System Outcome Questions • Did children of FTDC parents: • Receive more ancillary services? • Have fewer placement changes? • Spend less time in out-of-home care? • Have more kinship placements? • Were children of FTDC parents reunified at a higher rate? • Were FTDC parents less likely to become involved with the CWS subsequent to their case? • Were court cases shorter and less often contested? NPC Research

29. P2 P1 C1 C2 C1 C2 C3 Child Welfare: Levels of Analysis • Analysis of child welfare outcomes is complicated by the fact that multiple children may have outcomes for each parent • Two levels of analysis: children “nested” within parents NPC Research

30. Child Welfare: Levels of Analysis • Outcomes for children within a family are likely to be similar • Analyzing each child’s outcome can result in bias in significance testing • SPSS linear mixed models used to adjust the error terms to reduce possible bias caused by the “nesting” of children within families NPC Research

31. Children’s Experiences During the Case • Number of services for children (medical, early intervention, mental health, education, substance abuse, and “other” services) • Children’s living situations during case • # of living situation changes • Days & % of case in parental care • Days & % of case in out of home placements • Days & % of case in kinship care NPC Research

32. Number of Services for Children * Statistically significant at p<.05. NPC Research

33. Number of Living Situations During CW Case * Statistically significant at p<.001., controlling for length of case NPC Research

34. Time in Parental Care NPC Research * Statistically significant at p<.05. ** Statistically significant at p<.001.

35. Time in Out-of-Home Placements NPC Research * Statistically significant at p<.001.

36. Time in Kinship Care NPC Research

37. Cross-site Children’s Experiences Effects • No significant difference between groups in number of services children received • Drug court children had significantly more living situation changes than comparison children • Drug court children spent significantly less time in out-of-home placements and more time with parents than comparison children, especially in Santa Clara and Washoe sites NPC Research

38. Permanency Outcomes • Time to permanent placement • Permanency decisions: • % reunification • % terminations of parental rights • % another permanency outcome • About one-fourth (24%) of children had not yet reached permanency at the end of the 2-year window: • San Diego: 20% • Santa Clara: 12% • Suffolk: 57% • Washoe: 13% NPC Research

39. Days to Permanent Placement * Statistically significant at p<.05. NPC Research

40. San Diego Permanency Decisions * Statistically significant at p<.05. ** Statistically significant at p<.001. NPC Research

41. Santa Clara Permanency Decisions * Statistically significant at p<.001. NPC Research

42. Suffolk Permanency Decisions NPC Research

43. Washoe Permanency Decisions * Statistically significant at p<.01. ** Statistically significant at p<.001. NPC Research

44. Cross-site Permanency Effects • Drug court cases took significantly longer than comparison cases to reach permanent placement • Drug court children were significantly more likely to be reunified and less likely to have TPRs than comparison children, in all sites except for Suffolk NPC Research

45. Parents’ Subsequent Involvement with Child Welfare • % With second petition on original case • % With a new CPS referral • % With a new CPS petition (new case) • % With subsequent out-of-home placements • % With subsequent TPR • % With a new drug-exposed baby NPC Research

46. Cross-site Effects • When we pooled results across sites, there were no significant differences between drug court and comparison families on any of the child welfare recidivism outcomes • Time frame is likely too short to adequately assess subsequent involvement with child welfare NPC Research

47. Court Outcomes • Contested hearings • Indication of noncompliance with case plan • Time to case closure NPC Research

48. Cross-site Court Effects • No significant differences in number of contested hearings between FTDC and comparison cases • FTDC parents had significantly fewer incidents of noncompliance with court orders than comparison parents • FTDC cases took significantly longer to reach case closure than comparison cases NPC Research

49. 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 and case closure for FTDC parents could be explained by the longer treatment stays • Cases took longer to reach permanency and closure, but FTDC children spent more of this time with their parents NPC Research

50. Outcomes for FTDCs, cont’d • FTDC children were more likely to be reunified with their parents at the end of the case • No differences in child welfare recidivism, but follow-up period was short NPC Research