FAMILY COURT REVIEW, Vol. 46 No. 1, January 2008 151–162© 2008 Association of Family and Conciliation Courts

Blackwell Publishing IncMalden, USAFCREFamily Court Review1531-2445© Association of Family and Conciliation Courts, 2007XXXOriginal Articles

Bryan AND Havens/KEY LINKAGES BETWEEN CHILD WELFAREFAMILY COURT REVIEW

KEY LINKAGES BETWEEN CHILD WELFARE AND SUBSTANCE ABUSE TREATMENT: SOCIAL FUNCTIONING

IMPROVEMENTS AND CLIENT SATISFACTION IN A FAMILY DRUG TREATMENT COURT*

Valerie Bryan

1

Jennifer Havens

2

This article summarizes early findings regarding social functioning and client satisfaction from a longitudinal studyof women receiving treatment in a family drug treatment court located in the Midwestern United States(

N

= 33). Drug treatment court participants were interviewed at program entry and when they had completed 6months of treatment. Family drug court participants reported significant improvements in employment status andincreases in earned income after 6 months of treatment. Respondents also reported improved social functioningand high overall levels of satisfaction with treatment. Findings and implications for future research are discussed.

Keywords:

family drug court

;

substance abuse treatment

;

family reunification

;

parental substance abuse

;

court-ordered treatment

INTRODUCTION

The problem-solving court model of drug court treatment has evolved over the last dec-ade into a significant trend affecting a wide range of vulnerable groups whose problems inliving involve substance abuse and dependence. Variations on the original criminal court-based adult drug court that first began in 1989 include: juvenile drug courts, driving underthe influence courts, domestic violence courts, and family drug treatment courts (Berman& Feinblatt, 2001; Hora, 2002). Although an accumulation of findings has led to a generalperception that adult drug courts facilitate tangible and beneficial changes in participants’lives, research pertaining to the family drug treatment court model has lagged far behind(Belenko, 2001). Efforts to evaluate the benefits of drug court for those involved with thechild welfare system and family courts because of substance abuse can inform a wide rangeof concerned groups who seek to improve family functioning and long-term child welfareoutcomes. In addition, it may inform potential clients who may become impacted by thesesystems. The findings from this study of family drug court participants’ treatment experi-ences and improvements in functioning are presented in the following summary to illustratethe encouraging possibilities offered by this intervention.

THE TRADITIONAL DRUG COURT MODEL

As a treatment model, drug courts provide a unique approach by combining long-termsubstance abuse treatment and criminal justice supervision, both of which have been shown

Correspondence: vbryan@usouthal.edu; Jennifer.havens@uky.edu

152 FAMILY COURT REVIEW

to have positive effects for increasing retention of drug-involved criminal offenders intreatment and reducing recidivism and drug use among these individuals (Hiller, Knight,Leukefeld, & Simpson, 2002; Leukefeld, Tims, & Farabee, 2002; Nurco, Hanlon, Bateman,& Kinlock, 1995). Since the early 1990s, the number of jurisdictions using a drug courtmodel has grown exponentially. Compared to 1990, when only one drug court was inoperation in Miami (Huddleston, Freeman-Wilson, & Boone, 2004), national data fromNovember 2003 indicated that there were a total of 1,093 drug courts nationwide, comprising696 adult, 294 juvenile, 89 family, and 14 combined drug court programs. Additionally, 235adult, 112 juvenile, 66 family, and 1 combined drug court were in the planning stages(American University, 2003). In 2001, it was estimated that 220,000 adults and 9,000juveniles had received treatment services in drug courts since their inception in 1989(American University, 2001).

The drug court framework is reflected within the Ten Key Components, a set of generalstandards for drug court intervention established by the Drug Courts Program Office in1997 (National Association of Drug Court Professionals, 1997). Briefly described, thesestandards suggest that drug courts should integrate alcohol and other drug treatmentservices with the justice process; intervene early and swiftly; take a multidisciplinary,nonadversarial team approach to case processing and treatment planning; frequently monitorparticipants with drug testing and judicial supervision; develop a coordinated responsestrategy to participant compliance (and noncompliance); forge partnerships and relationshipswith community agencies and networks to enhance service delivery; and seek continuingeducation and evaluate drug court effectiveness to improve the treatment offered in drugcourt programs (National Association of Drug Court Professionals, 1997).

TRANSFORMATION OF THE MODEL FOR CHILD WELFARE INTERVENTION

While interest in and awareness of the drug court treatment model continues to grow anddevelop across the nation, an understanding of the unique model of family drug treatmentcourt remains largely unexamined. As noted above, far fewer family drug treatment courtprograms have been implemented compared with adult and juvenile drug courts. Althoughfamily drug treatment courts share the common missions of its adult and juvenile predecessors,important goals and objectives are pursued in family drug treatment court to intervene inchild welfare, improve family functioning, and foster the development of home environ-ments that permit reunification of drug-abusing parents and their children. Unique to thefamily drug court model, not only are substance abuse treatments and court systems com-bined in efforts to support individual recovery, but also the perspective and representationof the public child welfare system is integrated into the drug court team. This centers thedirection of drug court treatment on strengthening families and promoting child health(Family court comes of age, 2001).

Substance abuse research has long identified associations between substance abuse andpoor parenting practices (Gregoire & Schultz, 2001; Semidei, Radel, & Nolan, 2001). Datafrom several national studies suggest that 40% to 80% of child abuse and maltreatmentcases involve substance abuse (Wingfield, Klempner, & Pizzigati, 2000). Child welfareclients who abuse substances have been found to have greater levels of mental illness,domestic violence, economic and housing instability, and more frequently reside in dangerousliving environments. Research in this area suggests that child welfare agencies must domore than make standard substance abuse assessment referrals in these cases (Semideiet al., 2001) and strategies that show promise include a shift in focus from the substance

Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 153

abusing parent to the whole family and family environment (Gregoire & Schultz, 2001).However, in order to comply with the Adoption and Safe Families Act of 1997 (ASFA)guidelines requiring termination of parental rights to be pursued when a child has beenin foster care for 15 of the prior 22 months, substance abuse interventions for childwelfare clients must be swift, intensive, and effective (Karoll & Poertner, 2002; Semideiet al., 2001).

Family drug treatment court programs are interventions which emphasize this holisticfocus upon strengthening families by offering extensive and comprehensive wraparoundservices that are individualized to the needs of the substance-abusing parent and affectedchildren, as well as relatives and partners. The model encourages the development ofcohesive linkages among stakeholders in the child welfare, substance abuse treatment, andjudicial systems. Because child welfare is an active and central focus of the family drugtreatment court team, the ability to accommodate and adhere to the demands of the ASFAtimeline may also be substantially improved.

In order to help participants regain control of their lives, an intensive component of thisholistic approach involves addressing employment problems and assisting participants withacquiring and maintaining employment; in fact, diligent efforts to find employment andremain employed are requirements for retention in many drug court programs (Leukefeld,McDonald, Staton, & Mateyoke-Scrivner, 2004). Research shows that rates of substanceabuse are highest among those who are unemployed (Townsend, Lane, Dewa, Brittingham,& Pergamit, 1999; Wilkinson, Leigh, Cordingley, Martin, & Lei, 1987). Furthermore,treatment retention and long-term recovery outcomes have also been found to be positivelyassociated with employment status in drug court and other treatment programs (Butzin,Saum, & Scarpitti, 2002; Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004; McLellanet al., 1994; Miller & Shutt, 2001; Peters, Haas, & Hunt, 2001; Truitt et al., 2002). Therefore,it appears important to examine the capabilities of treatment programs to facilitate occupa-tional improvements.

Within the treatment framework utilized in family drug treatment court programs,social functioning improvements are another set of intended program outcomes worthwhileto evaluate (Huddleston et al., 2004). Additionally, as client satisfaction with treatmenthas been shown in recent substance abuse research to be associated with improved long-term recovery outcomes (Dearing, Barrick, Dermen, & Walitzer, 2005), it may be usefulto examine client levels of satisfaction with treatment received in family drug treatmentcourt. Prior studies of the traditional drug court model have reported problems with clientengagement in this form of treatment (Peyton & Gossweiler, 2001), and measures ofclient satisfaction have been identified as a correlate of treatment engagement (Dearinget al., 2005).

Although a growing body of research indicates that adult drug court participants areretained longer in treatment, are more likely to complete treatment, and are less likely tocriminally recidivate than those in traditional treatment programs (Belenko, 2001; Peters &Murrin, 2000; Roman, Townsend, & Bhati, 2003), the development of empirical knowledgeabout the effectiveness of family treatment drug court programs remains in its infancy(Belenko, 2001). At the time of this study, no findings pertaining to family treatment drugcourt outcomes of any kind could be located within the substance abuse and drug courtliterature. Therefore, the purpose of this analysis was to explore and describe earlytreatment experiences among participants from an urban family drug treatment courtlocated in the Midwestern United States in order to begin to address the gap in the literatureabout this unique treatment model.

154 FAMILY COURT REVIEW

DESCRIPTION OF THE FAMILY DRUG TREATMENT COURT PROGRAM

The intervention under study is a family drug treatment court which enrolls participantswho had been referred from the family court division of civil court due to an identifiablesubstance misuse problem, which the court believes to have contributed to child dependency,abuse, or neglect. Upon referral to the program, the potential participant is assessed bysocial work clinicians with certification in substance abuse counseling for program eligibility.The program is voluntary, and clients who do not choose to participate continue familycourt case proceedings in the family court which initiated the referral.

The program is based on a 12-month minimum treatment timeline; however, many whohave successfully completed this program have required up to 18 months or more of treat-ment. This drug court follows the model presented in the Ten Key Components and theguidelines set forth by traditional drug court programs by using a phase system, whichtreats the participant most intensively in the first phase. All participants meet with cliniciansand case managers to develop a treatment plan, which contains both standard expectationsfor all clients and goals identified for each individual’s particular circumstances. Substanceabuse treatment is provided through mandatory individual and group counseling sessionsand mandatory attendance at support groups, which is gradually stepped down as partici-pants successfully complete phases one, two, and three. Participants are regularly drug testedthroughout the program with urine screens, though the frequency of testing is also reducedaccording to the phase of treatment. Regular drug court sessions before the family drug courtjudge are also required, when case progress is reviewed and participants are encouragedfor achieving successes and sanctioned for noncompliance with their program plan.When participants are not compliant with their treatment plan, which may include missingscheduled appointments with drug court staff or linked resources (such as a mental healthscreening or job interview), missing drug tests, or failing to show for drug court, they receivesanctions that are graduated in severity. The list of possible sanctions is made clear to parti-cipants before they agree to participate. Sanctions the court has used include 48 hours to 7 daysin jail, increased support group attendance, fines, and demotions to a lower phase of treatment.

As the intensity of substance abuse treatment lessens, increased attention is directedtoward strengthening social supports, social and occupational functioning, and identifyingneeded linkages to community resources applicable to the participants’ situations. Drugcourt case managers work with clients to seek sources of financial support, includingpursuing and obtaining child support; finishing high school or enrolling in higher educationalprograms; and enrolling in prevocational workshops, job training courses, obtaining employ-ment, or pursuing a preferred career path. Participants also complete a 16-week parentingcourse offered on-site once they have achieved early recovery, which is usually recognizedas completing the first phase. Emphasis is also placed upon the need to improve physicalhealth and to tend to any medical or mental health concerns that may have been overlookedor ignored while participants were in an active phase of addiction. Consequently, as the indi-vidual succeeds in early recovery, more responsibility is placed upon them to achieve anoverall improved level of life functioning and autonomy.

The program’s treatment philosophy is to provide a standard, wraparound set of supportiveand therapeutic services, while identifying and addressing unique issues of each participant. Theintended goal for participants is that, by the completion of the third phase, program graduateswill have experienced a prolonged period of recovery from substance abuse or dependence andwill have achieved a level of physical, psychological, and behavioral functioning that fosters thedevelopment of healthy relationships with their children and reduces the likelihood of system

Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 155

reentry. As a participant approaches program completion, drug court staff, including the drugcourt judge, work closely with the referring family court to advocate for family reunificationif desired by the client, often providing written or verbal testimony on the client’s behalf.

STUDY DESCRIPTION

The data presented in this report were collected by researchers from August 2003 throughJune 2005 during a larger, ongoing process/outcome evaluation of the family drug treat-ment court program. Data collection procedures were approved through both the drug courtsite and the affiliated university’s Institutional Review Board. To protect the drug courtparticipants’ privacy, researchers requested and received a Certificate of Confidentiality fromthe U.S. Department of Health and Human Services in October 2003.

INSTRUMENTATION

The data described in the current report were collected during subject interviews usingthe Center for Substance Abuse Treatment/Government Performance and Results ActClient Outcome Measures for Discretionary Programs (CSAT-GPRA), the Behavior andSymptom Identification Scale (BASIS-32), and the Mental Health Statistics ImprovementProgram Consumer Survey (MHSIP). Administration of the CSAT-GPRA was completedin order to meet grantee reporting requirements to the Center for Substance Abuse Treatment.Demographic data, employment, and income findings reported were derived from informationcollected from this instrument.

The BASIS-32 is a self-report survey which has been shown to be valid and reliableacross inpatient and outpatient settings, measuring perceived levels of social, behavioral,and psychological functioning (Chun-Chung Chow, Snowden, & McConnell, 2001; Eisen,Wilcox, Leff, Schaefer, & Culhane, 1999). Researchers who tested the psychometricproperties of the survey using confirmatory factor analysis found it to be moderately reliableand valid across Caucasian, African American, Asian American, and Latino respondents(Chun-Chung Chow et al., 2001). This instrument is a 32-item scale which assesses therespondent’s functioning levels through questions which ask the client to indicate the level ofdifficulty s/he is experiencing in particular areas (e.g., daily life activities, work, school,household responsibilities, etc.) using a 5-point Likert-scale format from 0 to 4, with 0 indi-cating

no difficulty

and 4 indicating

extreme difficulty

. Reliability analysis of the BASIS-32for this sample produced a lower internal consistency coefficient than previous research wouldpredict (.67), though within the acceptable range for an exploratory study such as this.

The MHSIP collects self-report data on client satisfaction with treatment received. A 2000research workgroup on the development of the MHSIP found four domains of satisfactionpresent in the survey, identified as: general satisfaction, access, appropriateness/quality, andoutcome (MHSIP Policy Group, 2000). This instrument has also been found to bemeasurement invariant across Caucasian, African American, Asian/Pacific Islander, andLatino respondents (Arneill-Py, 2004). A 14-item measure using MHSIP survey questionsderived from the instrument’s original 28 questions was used in the study to ease the reportingburden placed upon volunteer respondents who were interviewed using multiple scales andquestionnaires. Cronbach’s alpha for the study’s sample on the adapted MHSIP was .90,indicating high reliability. Factor analysis of this sample’s responses confirmed that thefour-domain structure of the instrument was retained in its adapted form.

156 FAMILY COURT REVIEW

PROCEDURES

Family drug treatment court participants were identified to interviewers when they wereaccepted into the program, following an orientation phase of approximately 1 month. Femaleparticipants were recruited, as the original drug treatment program only accepted child welfare–referred mothers. Interviewers met with the participants in a private room at the drug courtoffice, explained the purpose of the study, and invited the participant to enroll in the study.It was explained to the potential research subject that she would be contacted 6 and 12 monthsafter the date of the initial interview to be interviewed again. CSAT-GPRA reportingrequirements at the time of this study involved interviewing participants within 2 weeksof the date of program entry, 6 months after program entry, and 12 months after programentry. After informed consent was given, participants were interviewed using the previouslydescribed survey instruments, which typically lasted 1 hour. The MHSIP was administeredduring follow-up interviews but not during the baseline session, because it was not expectedthat participants would have developed an informed opinion of treatment received indrug court within only a month of program orientation. Subjects interviewed at follow-upwere reimbursed for their time and effort with $20 in the form of a check issued by theresearchers’ university.

SAMPLE DESCRIPTION

Because participants in the study were volunteers, not all clients of the family drugtreatment court were enrolled. Also, several participants were fully active in the programbefore the project began and therefore were not interviewed at baseline. The participation rateof available baseline interviewees was 88%. At the time of this report, 77 program particip-ants had been interviewed at program entry and, of these, 33 participants had been interviewedat 6 months. The reasons for the substantial attrition from the study were because manyparticipants were terminated from the program for noncompliance before they had completed6 months of treatment and could not be located (

n

= 23, 53.5% of nonrespondents); severalparticipants had not been enrolled for 6 months at the time of this study (

n

= 15, 34.9% ofnonrespondents); and five (11.6%) were located but refused the interview invitation. Oneprogram participant was hospitalized during the time her 6-month interview would haveoccurred and therefore was only interviewed at baseline and 12 months. It was determinedthat her results were likely incomparable and should not be included with other particip-ants’ 6-month observations. Only data from participants who were interviewed at bothbaseline and 6 months were included in the analysis, in order to examine changes in par-ticipants’ lives after a period of program involvement. By following the required protocolof CSAT-GPRA, participants also were sought and invited to be interviewed at 12 monthsafter program entry, but only five respondents were successfully interviewed at the 12-monthwindow by the time of this report’s development; therefore, the third observation window isnot reported upon at this time. The administration of the BASIS-32 and the MHSIP werenot initiated until after GPRA data collection had begun with respondents, so the availablesample size on these measures is smaller. Twenty-eight participants were surveyed with theMHSIP at 6 months, and 24 participants completed the BASIS-32 at both baseline and6 months to examine changes in social/behavioral functioning over time.

Study participants ranged in age from 22 to 43 years, with an average age of 32. Thestudy population of those who completed both the baseline and 6-month interviews was

Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 157

52% (

n

= 17) African American and 48% (

n

= 16) Caucasian. All were residents of the drugcourt’s jurisdiction. The drugs of choice among participants included cocaine or crack cocaine(52%), sedatives/barbiturates (16%), marijuana (16%), alcohol (12%), and opiates/heroin (4%).At the time of this report, 7 study participants had successfully completed treatment, 6 wereterminated before completion, and 20 were still enrolled in the program.

DATA ANALYSIS

Since data were examined over time among the same participants, paired-sample

t

testswere utilized to identify significant changes in income. Similarly, in order to examine changesin employment status, which was measured as a dichotomous variable (employed or not),the McNemar’s chi-square test for paired sample proportions was conducted. Due to thenon-normal distribution of the BASIS-32 data, nonparametric tests were employed toexamine changes in scores over time. Specifically, the Wilcoxon signed-rank test was usedto examine changes in perceived functioning from program entry through 6 months oftreatment, which accounts for differences in ordinal ranks (such as the 0–4 scale used)without inappropriately treating the ranks as interval variables. Both McNemar’s chi-squaretest used here to examine employment and Wilcoxon signed-rank test are recommendedprocedures for small samples (Agresti & Finlay, 1997). All analyses were performedusing SPSS.

FINDINGS ON OCCUPATIONAL AND SOCIAL FUNCTIONING AND CLIENT SATISFACTION INCOME

Participants (

n

= 33) reported on average $99.00 from earned wages in the month priorto family drug court entry. By 6 months, the average income from earned wages rose to anaverage of $572.00, an increase of $473.00 (

t

=

−

4.915,

df

= 32,

p

< .001). Notably, adecrease was observed in the amount of public assistance payments reported by respondentsafter 6 months of treatment from an average of $146.00 at baseline to $84.00 at 6months, which may indicate a trend toward increased self-reliance, but this result was notsignificant at the

p

< .05 level (

t

= 1.916,

df

= 32,

p

= .064).

EMPLOYMENT

Data were available on employment status (0 = unemployed, 1 = employed) for allparticipants at baseline and at 6 months (

n

= 33). Employment status was found to besignificantly improved after 6 months of program involvement (

p

< .001)

3

, with 17unemployed respondents at baseline gaining employment by 6 months and 12 employedparticipants at baseline maintaining employment. Only one of the employed participants atbaseline was unemployed at 6 months, while three respondents reported no change inunemployed status. It is important to note that the one previously employed participant whowas unemployed at 6 months was enrolled full-time in an educational program at follow-up.

BASIS-32 FINDINGS

Life functioning in all areas measured showed improvements through decreased levelsof perceived difficulty on all 32 items after 6 months in the drug court program, and

158 FAMILY COURT REVIEW

several functioning improvements were statistically significant (

n

= 24). Results from thisanalysis indicated that the largest positive changes in perceived levels of functioning werereported in a reduction of feelings of isolation and loneliness (

z

=

−

2.827,

p

< .002); lessfear, anxiety, and panic (

z

=

−

1.835,

p

< .035); less uncontrollable, compulsive behavior(

z

=

−

2.157,

p

< .024); and less dissatisfaction with one’s life (

z

=

−

2.351,

p

< .008).

CLIENT SATISFACTION

Descriptive measures of participants’ satisfaction with the treatment provided in familydrug treatment court were obtained from answers to the adapted MHSIP Consumer Surveyadministered at 6 months after program entry from 28 participants. Responses wereoverwhelmingly positive to the treatment experience. Ninety-two percent of participantssurveyed agreed to the statement, “I liked the services I received,” with 15 of these respondentsstrongly agreeing with the statement. Seventy-five percent of participants indicated thatthey would choose to receive services from this agency even if they had other options; thisis notable given the forced-choice nature of the drug treatment court option in this jurisdiction,with the likelihood of parental rights termination greatly increased when one refusestreatment. Eighty-two percent of participants reported that they would recommend theservice to a friend or family member. Ninety-six percent of participants said that drug courtstaff saw them as often as was necessary, and 89% of respondents said that staff returnedtheir calls within 24 hours. Sixty-eight percent of participants agreed that the location ofservices was convenient, while 86% of participants stated that the time was convenient fortheir schedules. Eighty-nine percent believed they got the services they needed, and 96%of participants said that staff believed they could “grow, change, and recover.” Eighty-sixpercent of participants felt free to complain, and 96% of participants reported that staff toldthem what side effects to expect from substance abuse recovery. Eighty-six percent ofrespondents stated that staff respected their cultural/ethnic background, 89% of participantsinterviewed believed that drug court staff effectively managed confidentiality requirements,and 96% of respondents said that they received the information necessary to manage therecovery process associated with their addiction.

DISCUSSION AND CONCLUSION

STUDY LIMITATIONS

Reports on substance abuse relapse are notably not included, as this drug court’spre-enrollment orientation process includes intensive crisis intervention and a typicalresidential treatment stay. This essentially results in no relapses in the prior 30 days reportedat the baseline interview, and therefore, improvements were not seen at 6 months; however,relapses at 6 months were not found among the sample, either. Child welfare outcomesalso were not evaluated in this study because these data were not captured through participantinterviews, and final outcomes of child welfare case dispositions are not known until drugtreatment court participants complete treatment.

The results from the current study could have been substantially strengthened by theinclusion of and comparison to a control group who did not receive drug court treatment.Although researchers intended to identify a control group sample from a population of familycourt–referred individuals who refused to participate in drug court treatment, permission

Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 159

from and cooperation by the state child welfare agency responsible for the oversight ofthese cases could not be obtained due to workers’ caseload constraints and agency concernsregarding case confidentiality. Also, this drug court program did not have an availablewaitlist from which to alternatively recruit a control sample. Random assignment toa no-treatment condition under these circumstances was not an option, as in the majorityof drug court evaluations, because the referring family court’s policy was to offer the sameopportunity for treatment to all individuals who were willing and eligible to participate(Belenko, 2002).

Attrition from the study was an expected obstacle and clearly limits generalizability ofany findings due to the small treatment sample. Because the study was linked to participationin drug court treatment by being the primary location for interviewing and maintaining currentcontact information for participants, arranging interviews with drug court clients who leftthe program before completing treatment became extremely difficult. A substantial numberof participants also continued in treatment when the study took place, but were essentiallycensored from participating because they had not been enrolled for 6 months and were notdue for their CSAT-GPRA follow-up interview (

n

= 15, 34.9% of nonrespondents). Particip-ants who were interviewed at baseline and 6 months were compared to those who werenot on several background characteristics including age, ethnicity, and drug of choice,and on the outcomes of interest at baseline, including employment status, income, andBASIS-32 responses.

Significant differences identified between these groups included age of participants andseveral life functioning items on the BASIS-32 instrument. The average age for those whocompleted both interviews was 32 years, while the average age for baseline-only intervieweeswas 28 years. Those interviewed only at program entry reported at baseline (in response toBASIS-32 items) greater difficulties with managing day-to-day life (

z

=

−

2.198,

p

< .029),work (

z

=

−

2.143,

p

< .033), school (

z

=

−

2.512,

p

< .013), developing independence(

z

=

−

2.308,

p

< .022), goals and directions in life (

z

=

−

2.719,

p

< .008), using/misusingdrugs (

z

=

−

2.025,

p

< .044), and impulsive, illegal, and reckless behavior (

z

=

−

2.001,

p

< .046). These notable differences in functioning problems at program entry may haveincreased the likelihood of program failure and therefore study attrition for those who leftdrug court (n = 23, 53.5% of nonrespondents). These findings suggest that family drugcourt treatment may have been a more manageable program for those participants whoentered the program with better social and behavioral functioning abilities.

These methodological limitations all indicate that the promising findings reported heremay not be generalizable to other family drug court treatment programs or to individualparticipants in such programs. However, the study provides an interesting and worthwhileglimpse at this unique and contemporary form of treatment that is increasingly offered asan alternative to family court processing in cases involving parental substance abuse. Itshould be emphasized that the main purpose of this study is to explore and describe thisparticular group’s drug court experience and to identify how this program’s wraparoundservice delivery and holistic focus works to facilitate improvements in overall life functioning.

RESEARCH IMPLICATIONS

These preliminary findings reported from family drug treatment court participants areconsistent with previous findings from substance abuse research indicating that drug courtsand similarly structured interagency collaborative programs can improve social, behavioral,and occupational functioning (Freeman, 2003; McLellan et al., 2003). Substance abuse

160 FAMILY COURT REVIEW

treatment and drug court studies which have related social stability and socioeconomic statusfactors to treatment retention, completion, and postprogram recovery suggest that theseparticipants may experience better long-term substance abuse recovery outcomes. If drugcourt treatment was the key factor in improving these participants’ functioning levelsduring program involvement, the drug court may have increased the likelihood of theirrecovery from substance abuse and dependence (Butzin et al., 2002; Miller & Shutt, 2001;Peters et al., 2001; Peters, Haas, & Murrin, 1999; Truitt et al., 2002). More rigorous studydesigns for the purpose of identifying causal relationships between program factors andoutcomes are needed to establish if in fact the program model can explain functionalimprovements such as those observed here.

While the increases in employment found in this study are notable, employment is arequirement of the program for those considered capable of working, and therefore thesechanges may merely reflect participants’ compliance with the program. However, incomehas been shown to be a critical barrier in the success of child welfare clients’ attempts toreunify with their children, so this improvement in income, likely achieved through theobserved employment gains, is a promising finding for the purpose of this intervention(Wells & Shafran, 2005).

The high levels of satisfaction reported are also a positive indicator of potentially betterlong-term recovery outcomes for these participants. As found by other recent treatmentresearch, satisfaction with treatment is related to program retention (Dearing et al., 2005),and longer stays in treatment programs have been found to improve the likelihood oflong-term recovery (Zhang, Friedmann, & Gerstein, 2003).

These preliminary findings certainly suggest a need for increased attention to thispromising treatment model. Tangible improvements in income and employment status wereobserved, as well as significant improvements in perceived difficulties in social and behavioralfunctioning. Enrolled participants also appeared engaged with the treatment provided indrug court across a variety of characteristic dimensions, showing strong receptivity to theprogram’s intervention and implementation plans through high levels of satisfaction.

The implications for future research are evident, as this model of drug court treatmenthas not been extensively explored or studied. More research on family drug treatment courtis necessary to investigate this treatment model’s capability to successfully treat the targetpopulation and to address its complex and challenging child welfare and family preservationgoals. Studies with larger treatment samples, comparison groups, and the cooperation ofagencies to allow random assignment would all inform the beginning knowledge baseregarding this form of treatment. Studies that can further address the multiple intendedoutcomes of family drug court, like long-term recovery, family stability, and family preserva-tion, would provide important practical information to family courts, child welfare agencies,treatment providers, and families needing a structured intervention. Additionally, theseproblem-solving, treatment courts should carefully track their own therapeutic processes,successes, and failures in order to inform concerned stakeholders and practitioners aboutwhat constitutes best practice in this innovative and comprehensive treatment framework.

NOTES

* This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)and the Center for Substance Abuse Treatment (CSAT). Points of view in this document are those of the authorsand do not necessarily represent the official position or policies of SAMHSA or CSAT.

Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 161

1. Direct correspondence to: Valerie Bryan, University of South Alabama, Department of Sociology,Anthropology, and Social Work, 34 Humanities Bldg, Mobile, Alabama 36688.

2. University of Kentucky, Center on Drug and Alcohol Research, 915-B S. Limestone St., Lexington KY40536.

3. McNemar chi-square test of paired proportions does not report a chi-square test statistic.

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Valerie Bryan, MSW, Ph.D., is an assistant professor in the University of South Alabama Department ofSociology, Anthropology, and Social Work. Her current research interests include advances in program eval-uation methodology and the study of contextual effects upon community-based programs.

Jennifer Havens, MPH, Ph.D., is an assistant professor in the University of Kentucky Departmentof Behavioral Science with an appointment in the Center on Drug and Alcohol Research. Her researchinterests include the epidemiology of prescription and illicit opiate use, comorbid psychopathology amongsubstance users, and HIV and other infectious complications of drug use.