effective stategies in juvenile drug court - nadcp in juvenile drug court scott w ... alexander, j....

Effective Treatment Strategies in Juvenile Drug

Court Scott W. Henggeler, Ph.D. Professor, Medical University of South

Carolina Board Member, NADCP

JDC Has Two Primary Components

Judicial – Key features and outcomes described by Dr. Carey Treatment – The specific substance abuse treatment delivered to the youth and family by a therapist working within a provider organization in collaboration with the court

Substance abuse treatment is the focus of this presentation

Treating Substance Abuse in Adolescents

The vast majority of existing services are unproven or iatrogenic Evidence-based treatments (i.e., proven to be effective through rigorous outcome research) have been developed, but they have not been widely transported Evidence-based treatments have key commonalities discussed subsequently

The Best Resources for Identifying Effective Intervention Strategies for Treating Substance Abuse in Adolescents

National Institute on Drug Abuse (e.g., Principles of Drug Abuse Treatment for Adolescents) Blueprints for Healthy Youth Development (University of Colorado) SAMHSA’s National Registry of Evidence-Based Programs and Practices

NIDA Principles of Effective Treatment for Adolescents

Treatment should be individualized to youth’s strengths and context Behavioral therapies are effective Family and community (peers, school) are important aspects of treatment Legal sanctions or family pressure may be necessary Important to monitor drug use during treatment Duration of treatment (e.g., 3+ months) is important Treatment should be comprehensive

Blueprints Blueprints programs meet a set of criteria that

demonstrate their capacity to be adopted and implemented effectively in community settings Treatment and training specification Evaluation quality (e.g., 2 high quality RCTs to qualify for Model program status) Intervention impact – key outcomes sustained for at least 12 months Dissemination readiness – hiring, training, purveyor organization, ongoing quality assurance for supporting program fidelity, outcome tracking

Blueprints Model and Promising Programs

Model Programs for Treating Adolescent Substance Abuse Functional Family Therapy Multisystemic Therapy Multidimensional Treatment Foster Care

FFT, MST, and MTFC are also the best validated for treating youth criminality

Promising Programs – none cited

NREPP Programs

Functional Family Therapy Multisystemic Therapy Multidimensional Treatment Foster Care Brief Strategic Family Therapy Family Behavior Therapy Cognitive Behavioral Therapy Contingency Management

Functional Family Therapy (FFT)

Substance use is viewed as a symptom of dysfunctional family relationships Treatment phases: engagement, motivation, behavior change, generalization 300 programs worldwide fftinc.com Best specification:

Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional family therapy for adolescent behavior problems. Washington, DC: American Psychological Association.

http://www.fftinc.com/�

Multisystemic Therapy (MST)

Addresses multi-determined nature of adolescent substance abuse, addressing individual, family, peer, school, and community variables Home-based delivery of interventions 500+ programs worldwide mstservices.com Best specification:

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford Press.

http://www.mstservices.com/�

Multidimensional Treatment Foster Care (MTFC)

For youth in foster care Multifaceted approach with individual youth, foster family, peers, school, and biological family Behavioral 100 sites in U.S. and Europe mtfc.com Best specification:

Chamberlain, P. (2003). Treating chronic juvenile offenders: Advances made through the Oregon multidimensional treatment foster care model. Washington, DC: American Psychological Association.

http://www.mtfc.com/�

Brief Strategic Family Therapy (BSFT)

Uses family therapy techniques to modify family interactions that are maintaining youth substance use Clinic or home-based treatment delivery 100 sites worldwide bsft.org Best specification:

Szapocznik, J., Hervis, O., & Schwartz, S. (2003). Brief strategic family therapy for adolescent drug abuse. (NIH Publication No. 03-4751). Bethesda, MD: National Institute on Drug Abuse.

http://www.bsft.org/�

Family Behavior Therapy

Uses CBT and contingency management interventions Family based, individualized, and comprehensive Early stages of transport process Best specification:

Donohue, B., & Azrin, N. H. (2012). Treating adolescent substance abuse using family behavior therapy. Hoboken, NJ: Wiley

Cognitive Behavioral Therapy (CBT)

Problem solving skills Drug refusal skills Some variation of CBT is used in most evidence-based treatments of substance abuse as well as for other types of child and adolescent mental health and behavior problems

Contingency Management (CM) Uses CBT strategies Applies positive and negative contingencies based on clear behavioral contract (e.g., rewards abstinence, punishes truancy) Fits well with JDC and diverse provider organizations Not being actively transported Best specification:

Henggeler, S. W., Cunningham, P. B., Rowland, M. D., Schoenwald, S. K., Swenson, C. C., Sheidow, A. J., McCart, M. R, Donohue, B., Navas-Murphy, L. A., & Randall, J. (2012). Contingency management for adolescent substance abuse: A practitioner’s guide. New York: Guilford Press.

Commonalities of Effective Programs

Well specified target population, theory of change (targeting risk and protective factors), interventions, and training Ongoing quality assurance (supporting and tracking treatment adherence and youth outcomes) to sustain treatment and program fidelity Empower caregivers to support favorable outcomes 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)

Informing policy, improving programs

Juvenile Drug Courts: Show me the money!

NADCP Annual Conference 2013 Shannon M. Carey, Ph.D.

5100 SW Macadam Ave., Ste. 575

Portland, OR 97239 503.243.2436

July, 2013

2

What are we talking about today?

• Are juvenile drug courts effective?

• How much does it cost to run a juvenile drug court program?

• How much does each agency invest?

• Do juvenile drug courts save taxpayer money?

• What promising practices are there for juvenile drug courts?

• Do best practices for adults apply?

Outcome and Cost Evaluations: • Examples from six JDC studies - NPC Clackamas, OR N = 53 Oakland, MI N=74 Harford, MD N = 102 St. Mary’s, MD N = 80 Baltimore County, MD N = 156 Anne Arundel, MD N = 154

• Participant demographics Majority white (68-90%), Average age at arrest = 14-17 Marijuana and alcohol primary drugs

3

4

Are juvenile drug courts effective?

5

Are juvenile drug courts effective?

• Recidivism/Rearrests o Juvenile o Adult

• Substance use o Drug tests o Drug arrests

Measured effectiveness with reduced recidivism and reduced substance use

YES. Juvenile Arrests

6

0

0.5

1

1.5

2

2.5

3 6 9 12 15 18 21 24Ave

rag

e N

um

ber

of

Re-

arre

sts

Months

All Participants

Graduated

Comparison

Average Number of Re-Arrests Over 24 months

Do juvenile drug courts reduce recidivism in Clackamas, OR?

7

YES. Juvenile Arrests (2 yr)

Do juvenile drug courts reduce recidivism in Harford, MD?

(n=75) (n=82)

Drug Court Sample Comparison Group

0.6

1 Ave # Juvenile Re-Arrests

YES. Juvenile Recidivism (2 yr)

8

0

2

4

6

8

10

12

14

# of juvenile justice

complaints

# of adjudication

hearings

Days in secure detention

Days on community detention

Days in Shelter Care

Days in Group Home

Graduates

All Drug Court Comparison

Do juvenile drug courts reduce other recidivism in Harford, MD?

9

YES. Harford: Adult Recidivism (2 yr)

0

10

20

30

40

50

60

70

Ave # arrests Ave # days in jail

Ave #days in prison

Ave # days parole/

probation

0.2 3 3

49

0.2 8

11

65

Drug Court Sample (n=75)

ComparisonGroup (n=82)

Do juvenile drug courts reduce recidivism into the adult system?

10

Clackamas: Adult and Juvenile arrests • 2 years from drug court entry Graduates 29% All Participants 44% Comparison 82%

90% reduction in new arrests


11

YES. Oakland: Juvenile and Adult Arrests (2 yr)

0

0.5

1

1.5

2

2.5

2 Years Prior 2 Years Post

2.5

0.27

JDC Participants


Do juvenile drug court reduce drug use?

12

Baltimore, MD: Percent of Positive UAs in 2 Month Increments

YES!

0%5%

10%15%20%25%30%35%40%45%

2 4 6 8 10 12

Pe

rce

nt

of

Ind

ivd

ua

ls w

ith

P

osi

tiv

e T

est

s

Months of Program Participation


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Clackamas, OR: Percent of Positive UAs in 2 Month Increments

0

0.05

0.1

0.15

0.2

0.25

0.3

2 4 6 8 10 12

Perc

ent p

ositi

ve U

As

Months

Pre-enhancement

Post-enhancement

YES!

00.020.040.060.080.1

0.120.140.16

3 6 9 12 15 18

Ave

rage

# o

f Dru

g-R

elat

ed R

e-ar

rest

s

Months

Pre-enhancement

Comparison

14

Clackamas: Mean Number of Drug Related Re-Arrests in 3-Month Blocks


15

How much does it cost to run a juvenile drug court program?

Cost Analysis Approach: TICA

Varies (services, # of team members, etc.)

Clackamas: Program Transactions

Transaction Transaction Unit Cost

Avg. # of Program Related

Transactions

Avg. Cost per Participant

Drug Court Appearances $373.83 29.55 $11,047

Case Management $29.78 356.82 Days $10,626 Individual Treatment Sessions $52.48 8.35 $438

Group Treatment Sessions $16.33 37.88 $619

Family Therapy Sessions $19.99 9.12 $182

Parent Support Group $9.54 26.41 $252

Parent Education Classes $9.33 4.47 $42

Drug Tests (UAs) $6.00 70.96 $426 Drug Patches $20.00 1.19 $24

(Total Program Cost $23,656/$64 per day)

Harford: Program Transactions

(Total Program Cost $11,689/$41 per day)

Transaction Unit Cost Average # of Transactions

Average Cost per Participant

Drug Court Appearances $249.96 12.19 $3,047

Case Management $11.56 283 Days $3,271 Individual D&A Treatment Sessions $62.83 9.68 $608 Group D&A Treatment Sessions $42.01 33.63 $1,413

Drug Tests (UAs) $36.85 55 $2,027

Mental Health Treatment $29.73 9.43 Months $280 Individual Education Sessions $55.21 9.43 Months $521 Group Job Training Sessions $55.21 9.43 Months $521

Program cost comparison

*Over $25,000 on Detention Costs 18

Program Cost per participant

Cost per day (per participant)

Harford $11,689 $41

Clackamas $23,656 $64

Anne Arundel $27,234 $86

Baltimore County* $56,631 $139

St. Mary’s $33,768 $99

Oakland $22,564 $64

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Harford: Options for High-Risk Youth

Placement Options Cost Per Day

Harford Juvenile Drug Court Program $41

Detention $296

Residential Treatment $220

Emergency Shelter Care $275

Community Detention $24

20

Placement Options

Placement Options Cost Per Day

CCJDC Program

$66

Residential Treatment

$134

Shelter Care

$115

Short-term Detention

$187

Long-term Detention

$171

Adult Jail

$97

Clackamas: Options for High-Risk Youth

21

How much does each agency invest?

Varies widely: JDC’s are implemented in a variety of ways

No standard model

Some don’t follow the 10KC or 16 Juvenile Strategies

22

Clackamas: Agency Investment per Participant

Agency Average Agency Cost per Participant

Circuit Court $1,413

District Attorney $1,234

Defense Attorney $600

Juvenile Department $12,974 Clackamas County Mental Health (Treatment + Testing) $6,299

Oregon Youth Authority $855

C-TEC Youth Services $281

Total $23,656

23

Oakland: Agency Investment per Participant

Agency Average Agency Cost

per participant

Circuit Court $11,675

Prosecutor $287

Defense Advisor $196

Oakland Family Services $3,314

JAMS (Drug Testing) $309

Easter Seals $102 Health and Human Services Department (Treatment) $5,929

Treatment $753

Total $22,565

24

St. Mary’s: Agency Investment per Participant

Agency Average Agency Cost

per Participant

St. Mary’s County Circuit Court $2,177 St. Mary’s County State’s Attorney’s Office $785 Maryland Office of the Public Defender $905 MD Department of Juvenile Services $19,111 Maryland Alcohol and Drug Abuse Administration (Treatment) $3,266

St. Mary’s County Sheriff ’s Office $4,249 St. Mary’s County Public Schools $1,000 Mental Health Authority $142 Walden Sierra $1,703 Maryland Office of Problem Solving Courts $428

Total $33,766

25

Do juvenile drug courts save taxpayer money?

Yes!

But not always…

26

Clackamas: Outcome Cost Findings

Transaction Unit Cost All Participants Comparison

Group Re-arrests/Referrals $200.72 $171 $406 Formal Hearings $89.80 $40 $61 Probation Violation Hearings $44.90 $34 $53 Felony Cases $390.00 $12 $148 Misdemeanor Cases $280.00 $59 $92 Probation Violation Cases $150.00 $48 $68 Residential Treatment Days $134.19 $4,046 $7,592 Foster Care Days $29.78 $448 $390 Shelter Care Days $115.57 $7 $529 Juvenile Probation Days $1.70 $256 $363 Jail Bookings (Adult) $20.59 $13 $4 Jail Bed Days (Adult) $96.77 $102 $19 Total $10,357.00 $19,427.00

Savings Across Programs

Savings Per JDC Participant over 2 years

• Clackamas County Oregon = $9,070

• Baltimore County Maryland = $8,762

• Harford County Maryland = $5,702

• St. Mary’s County Maryland = $2,962

• Anne Arundel Maryland = -$172

• Oakland County Michigan = NA

28

Which Agencies Save the Most?

• Harford: 72% in outcome costs savings for Maryland Division of Corrections

• Baltimore: 85% Department of Juvenile Services

• Clackamas: 78% Oregon Youth Authority

*Due to reduced detention and jail costs

29

What promising practices are there for juvenile drug courts?

Do best practices for adults apply?

Taking a closer look

30

Re-Arrests Pre and Post Enhancement

0

0.1

0.2

0.3

0.4

0.5

3 6 9 12 15 18

Aver

age

# of

re-a

rres

ts

Months

Comparison


31


0

0.1

0.2

0.3

0.4

0.5

3 6 9 12 15 18

Aver

age

# of

re-a

rres

ts

Months

Pre-enhancement

Comparison


32


0

0.1

0.2

0.3

0.4

0.5

3 6 9 12 15 18

Aver

age

# of

re-a

rres

ts

Months

Pre-enhancement

Post-enhancement

Comparison

Clackamas Enhancements

• Addition of Community Resource Liaison position Find and create new community resources

including community service opportunities Work to link youth to community resources

• Family Therapist almost at full-time Already required family therapy More home visits Required parenting class instituted

33

34

Community Resource Liaison: • Added a Family Representative

• Oregon Youth Authority

• Developed connections with residential treatment programs

• Trained community guides

• Strong relationships with local agencies and community leaders


Community Liaison: (Paradigm Shift) • Arranges for (reserves) community service

slots each week and brings to team at client progress meetings

• Increased the variety of community service options Youth can choose a service that is meaningful to

them Youth that don’t do well together can be sent to

different service options

• Attends end of court session to sign kids up

35


Taking a Closer Look

CC BC HC SMC AA

Savings $9,070 $8,762 $5,702 $2,962 -172


CC BC HC SMC AA

Savings $9,070 $8,762 $5,702 $2,962 -172

Court Sessions 357/29 407/26 283/12 341/13 315/40

2 weeks 2 weeks 3 weeks 4 weeks 1 week

Drug Courts That Held Status Hearings Every 2 Weeks During Phase 1 Had 50% Greater Reductions in

Recidivism

Note: Difference is significant at p<.1

0%

10%

20%

30%

40%

50%

Drug court has review hearings every two weeks

N=14

Drug court has review hearings

more or less often N=35

46%

31%

Perc

ent R

educ

tion

in R

ecid

ivis

m

Adult


CC BC HC SMC AA

Savings $9,070 $8,762 $5,702 $2,962 -172

Court Sessions 357/29 407/26 283/12 341/13 315/40


Drug Tests 71 37 55 34

Self pay 2/week 3/mo 2/week 3/mo

Drug Courts Where Drug Tests are Collected at Least Two Times per Week In the First Phase had

a 61% Higher Cost Savings

0%

10%

20%

30%

40%

Participants drug tested at least 2X per week

N=53

Participants tested LESS often than 2X per week

N=12

29%

18%

Perc

ent i

ncre

ase

in c

ost s

avin

gs

Adult


CC BC HC SMC AA

Savings $9,070 $8,762 $5,702 $2,962 -172

Court Sessions 357/29 407/26 283/12 341/13 315/40


Drug Tests 71 37 55 34 Self pay

Family Counseling Yes Yes No No Self pay

Parenting Yes No No No No

True in adult, family, juvenile

Drug courts that offer parenting classes had 68% greater reductions in recidivism and 52% greater cost savings

Program provides parenting classes

N=44

Program does NOT provide parenting classes

N=17

38%

23%

% R

educ

tion

in

Rec

idiv

ism


CC BC HC SMC AA

Savings $9,070 $8,762 $5,702 $2,962 -172

Court Sessions 357/29 407/26 283/12 341/13 315/40

2 weeks 2 weeks 3 weeks 4 weeks weekly

Drug Tests 71 37 55 34 Self pay

Family Counseling Yes Yes No No Self pay

Parenting Yes No No No No

Treatment Youth and parent

Youth Gender Specific + MH

Youth + MH Youth Self pay

Drug courts that offer mental health treatment had 80% greater reductions in recidivism

0% 5%

10% 15% 20% 25% 30% 35% 40%

MH Tx Provided N=52

MH Tx NOT Provided N=10

36%

20%

% R

educ

tion

in R

ecid

ivis

m

Adult

45

A closer look at the use of detention

Detention costs were very high in most of the juvenile programs

46

Clackamas Detention Costs Averaged per Youth

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000D

eten

tio

n C

ost

s

Year 1Year 2

Year 1 $747 $9,785 $2,598

Year 2 $393 $2,876 $1,791

Graduated Terminated Comparison


47

Detention Costs per Youth Across Programs

$-

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

Baltimore Harford AA Clackamas

Terminated

Graduated


Courts that use jail greater than 6 days have worse (higher) recidivism

Adult

Drug Courts where sanctions were imposed in advance of a regularly scheduled court hearing

had double the cost savings

Sanctions Imposed Swiftly

N=36

Sanctions NOT Imposed Swiftly

N=17

28%

14%

% In

crea

se in

Cos

t Sav

ings

Note: Difference is significant at p<.05 Adult


5. Drug Courts Where in Order to Graduate Participants Must Have a Job or be in School had

83% Higher Cost Savings


4. Drug Courts Where the Defense Attorney Attends Drug Court Team Meetings (Staffings) had



6. Drug Courts Where a Representative from Treatment Attends Court Sessions had


Note: Difference is significant at p<.15 (Trend)

7. Drug Courts Where Team Members are Given a Copy of the Guidelines for Sanctions had



9. Drug Courts where Law Enforcement is a member of the drug court team had

88% greater reductions in recidivism

0.45

0.24

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

0.50

Yes N=20

No N=29

% re

duct

ion

in #

of r

earr

ests

Law Enforcement is a Member of Drug Court Team


1. Drug Courts Where Review of The Data and Stats Has Led to Modifications in Drug Court Operations had


Conclusions

In spite of mixed results from other juvenile drug court studies – juvenile

drug courts can be effective

Juvenile drug courts need more quality studies, especially in best practices, so the model can be implemented more

consistently

56

Questions?

57

Contact Information

Shannon Carey, Ph.D. [email protected]

www.npcresearch.com

58

effective stategies in juvenile drug court - nadcp in juvenile drug court scott w ... alexander, j....

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