Performance based drug courts: executing the 16 strategies in practice

JACQUELINE VAN WORMER, PH.D.WASHINGTON STATE UNIVERSITY

NCJFCJ

PERFORMANCE BASED DRUG COURTS:

EXECUTING THE 16 STRATEGIES IN PRACTICE

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

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; Petrosino et al., 2010).

• SOURCE: LIPSEY, 2010

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

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

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)

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!

The Cost of Treatment vs. Continued Use

Screening & Brief Inter.(1-2 days)Outpatient (18 weeks)

In-prison TC (28 weeks) Intensive Outpatient (12 weeks)Adolescent Outpatient (12 wks)

Treatment Drug Court (46 weeks)Methadone Maintenance (87 wks)

Residential (13 weeks)Therapeutic Community (33 wks)

$0

$10,

000

$20,

000

$30,

000

$40,

000

$50,

000

$60,

000

$70,

000

$407 $1,132 $1,249 $1,384 $1,517 $2,486 $4,277

$10,228 $14,818

Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars

$22,000 / year to incarcerate an adult

$30,000/ child-year in foster care

$70,000/year to keep a child in detention

• $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

SBIRT models popular due to ease of implementation and low cost

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!!

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

\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

090

180270360

Day

s of

Use

Source: JTDC vs. RF-JTDC (weighted n=1112)

RF JTDC Reduce Use more

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24Ac

ross

Change in Use by JTDC Site

All RF Sites average (box) or better (above box)

0 of the 4 worst are RF siites

4 of the 5 best sites are RF

Exploring the 16 Strategies

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”

Treatment Provider Source: NPC Research

YesN=57

NoN=10

0%

5%

10%

15%

20%

25%

30%

35%

40% 38%

19%

A Representative from Treatment Attends Court Hearings

% re

ducti

on in

# o

f rea

rres

ts

Defense Attorney

Prosecutor

All Team Members

Drug Courts That Have Judges Stay Longer Than Two Years Had 3 Times Greater Cost Savings

Note: Difference is significant at p<.05

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

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.”

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)

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.

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”

Quiz!! Hot or Not?

Quiz: Hot or Not?

Quiz: Hot or Not?

Treatment Modalities

ACRAFFTPYP7CBoot camps/wilderness programsMET/CBT5MSTCMIntensive Supervision

What works in Juvenile Justice Programming?

Lipsey (2009): 548 studiesFindings:

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.

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).

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.

Major Predictors of Bigger Effects

1. A strong intervention protocol based on prior evidence

2. Quality assurance to ensure protocol adherence and project implementation

3. Proactive case supervision of individual

4. Triage to focus on the highest severity subgroup

Impact of the numbers of these “Favorable Features” on Recidivism

Source: Lipsey; Muck (2010)

Source: Adapted from Lipsey, 1997, 2005

Average

Practice

The more features, the lower

the recidivis

m

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

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

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”

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)

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)

The Teenage Brain

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

Phase I: setting the stage

Phase II: learning skills

Phase III: maintaining the change

Readiness, stabilization Engagement, involvement

Reflection, enrichment

Focus on compliance Beyond compliance Decrease in drug testing, court appearance

High level of structure Skill development Expanded development activities

Clarifying expectations, building trust

Completing assignments

Enriching community connections

Phase StructureSource: Betty Gurnell

The Four Steps

Behavior to targetCurrent behaviorDesired behaviorSmall, achievable increments

Decision Matrix – Phase I

Phase I Incentives Sanctions

Behavior *Response Response

Attend school at least 18 out of 20 days

• Teacher signs attendance card each day present and acknowledges

•Small prize or coupon for each week with no absences

• After school study hall for each day absent over the limit to make up all missed work

Decision Matrix – Phase II

Phase II Incentives Sanctions

Behavior *Response *Response

Attend regularly

Complete all assignments

•Select a book , notebook, pen after two weeks of success•Praise from teacher, family, court•Grades improve

•After school study hall to complete assignments (with help as needed)

Decision Matrix – Phase III

Phase III Incentives Sanctions

Behavior *Response *Response

Attend regularly

Complete all assignments

Improve grades

•Praise from teacher, family, court for improvement•Certificate of achievement•Select school related gift: tuition, book

•Determine if tutor is needed

•Attend extra class or session for help

•Tighten curfew

Write policy – how, when and by whom will responses be made = better outcomes

Determine range of responsesCommunicate well with each otherTrust each otherEngage the family Be clear about expectationsDevelop reliable system to monitor behavior

JDC team needs to

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)

Incentives and Sanctions, continued

Use contracts as behavior change toolEducate 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

Behavioral Contract Example

Goal Behaviors/Tasks

Incentives Non-compliance

Sanction

Enroll in GED program

•Call or visit GED center by xxxxx date

•Praise•Recognition from Team•Appointment Calendar•XXXXXX

Failure to contact by XXXX

•Increased reporting to PO•Increase in curfew•EM

Contact Information

Jacqueline van Wormer, Ph.D.Washington State UniversitySAC 403ASpokane, WA(509) 628-2663jvanwormer@wsu.edujgvanwormer@gmail.com