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Juvenile Drug Courts (Part II): Incentives and Sanctions

Sandra J. Altshuler, Ph.D., L.I.C.S.W.Spokane County Behavioral Health Therapeutic Courts

With thanks toJacqueline van Wormer, Ph.D.Washington State University

andNATIONAL COUNCIL OF JUVENILE AND FAMILY COURT JUDGES

Learning Objectives

Participants will review briefly the need for diversion programs for juveniles and the research on Juvenile Drug Courts (JDCs).

Participants will review and discuss proper phase structures in JDCs.

Participants will learn about JDC Incentives and Sanctions that DO and DO NOT work to promote positive behavior change in youth.

Participants will learn about contingency management (CM) and its use in JDCs for adolescent’s substance abuse and use.

Participants will learn how to develop behavior and activity contracts.

Can We Strengthen Our Court Sessions to Bring About Stronger Behavior Change?

What is the purpose of using sanctions in your JDC?

What is the purpose of using incentives?

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)

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

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

Contingency Management

What is Contingency Management (CM)?

And

How do we strengthen the use of CM in our treatment settings, and utilize the same methods

within our Juvenile Drug Courts?

Contingency Management

“Contingency management or systematic use of reinforcement is a type of treatment used in the mental health or substance abuse fields. Patients' behaviors are rewarded (or, less often, punished); generally, adherence to or failure to adhere to program rules and regulations or their treatment plan.” (Wikipedia)

Reasons Why JDCs Should Implement CM

Theories are based on cognitive behavioral therapy, which has been proven to work with adolescents, and is vastly used in outpatient settings

It can be easily adapted within the JDC

In their study of six juvenile drug courts, Henggeler et al (2006) found stronger outcomes for those youth who received MST AND CM then standard process

Point & Level “Reward” Systems

Behavior Contract Most Valued Privilege Checkbook System Reward Menu

Behavior Contracts

“Rewards for Responsible Behavior in Other Domains” (Henggeler et al, p. 131) How to target specific behaviors (i.e., school attendance) How to add a step-by-step process for the youth to follow How to get youth working towards “things” they are

interested in How to engage families/guardians in the process How to increase communication between the youth and

judge And…how to implement these components in your

program

The Four Steps in Addressing Problem

Behaviors

Identify (define) the targeted behavior

Identify (define) the current behavior

Identify (define) the desired behavior

Use small, achievable increments

Decision Matrix – Phase I

Phase I Incentives Sanctions

Behavior *Response Response

Attend school at least ?? 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

Behavior Incentives Sanctions

*Expectation *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

Behavior Incentives Sanctions

*Expectation *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

Behavioral Contract Example

Goal BehaviorsSteps needed (Expectations)

Responses if steps done

Responses if steps not done

Support Services

Enroll in GED program

•Call or visit GED center by xxxxx date

•Praise•Recognition from Team•Appointment Calendar•XXXXXX

•Increased reporting to PO•Increase in curfew•EM

•Find GED center phone number•Bus pass and route

Youth’s Signature of Agreement:

Caregiver(s) Signature of Agreement:

Case Manager’s Signature of Agreement:

Behavior Contract: School

Work with your partner to develop

a fictional behavior contract

Example of a “behavioral contract”

Goal Behaviors/Tasks Incentives Non-compliance Sanction Support Services

Improve school grades

- Attend school daily- Keep a planner or homework log- Organize books/school supplies- Complete all assignments

PraiseRecognitionAdd 3 points for each day youth attends school*Recognition from teachers/team/family *Grades improve

Failure to attend school/classes Failure to get a planner Failure to complete assignments

Limit free time After school study hallLimit TV time/video game time *Failing/poor grade

Transportation assistanceTutoringAlarm clockHealth assessmentEye exam

Youth’s Signature of Agreement:

Caregiver(s) Signature of Agreement:

Case Manager’s Signature of Agreement:

Most Valued Privilege

This is a privilege that the youth values and will work hard to earn

Work with the youth and family to determine what the MVP is, preferably a family-based reward (i.e., video games, cell phone use, time w/ friends)

The MVP is given or taken away with each drug screen IMPORTANT – youth does not earn points if

there is a positive drug screen but points that have already been earned are not taken away

(Henggeler et al, p. 107-108)

Make it Transparent MVP

Sally – Use of cell phoneJohn – Curfew extension on Saturday nightMary – Allowed to use Mom’s car on Friday afternoonJack – Ride to school, rather than walk

Checkbook System

Basic checkbook set up – date; transaction description; debit/credit; and balance

Basic personal checks that the youth can draft and use to purchase items on the reward menu Make this very visual and tangible for the youth Consider working with a local bank to provide life

skills training on how to keep a checking account and write checks or to provide free checkbooks and/or personalized checks

(Henggeler et al, p. 126-127)

Recommended Reading

Contingency Management for Adolescent Substance Abuse: A Practitioner’s Guide, by: Scott W. Henggeler, Phillippe B. Cunningham, Melisa D. Rowland, Sonja K. Schoenwald and Associates

Contingency Management in Addiction Treatment. by: Nancy L. Petry. Psychiatric Times: http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0

Making Sense of Incentives and Sanctions in working with the Substance-Abusing Youth: Answers to Frequently Asked Questions (Juvenile & Family Justice TODAY. 2012, Volume 21, Number 2)

Enhancing the Effectiveness of Juvenile Drug Courts by Integrating Evidence-Based Practices (Journal of Consulting and Clinical Psychology. 2012, Vol. 80, No. 2, 264-275)

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Part IIIThemes of Effective

Programs

Themes of Effective Programs

Team Approach – Good communication

Well specified target population, theory of change (targeting risk and protective factors), interventions, and training

Ongoing quality assurance (fidelity checks)

Empower caregivers to support favorable outcomes (involve the family)

Themes of Effective Programs

Individualized to youth/family strengths and weaknesses (not one size fits all)

Comprehensive services (individual, family, peer, school, community) provided

Use of behavioral tracking and intervention techniques such as CBT (problem solving skills, drug refusal skills) and implementation of reward/punishment contingencies

Treatment delivered in natural environment (not in out-of-home placements)

Contact Information

Sandra J. Altshuler, Ph.D., L.I.C.S.W.Spokane County Superior Court1116 W. BroadwaySpokane WA 99203(509) 477 6355saltshuler@spokanecounty.org sandyaltshuler@gmail.com

Ncjfcj.org