inspiring outcomes: lessons learned from family drug ... · inspiring outcomes: lessons learned...
TRANSCRIPT
October 26, 2016| Billings, MT
Montana Drug Court Conference
Inspiring Outcomes: Lessons Learned from
Family Drug CourtsPart II
Phil Breitenbucher, MSWDirector, Family Drug Court Programs
Alexis Balkey, BA, RASProgram Manager, Family Drug Court Program
Important Practices of FDCs
•System of identifying families• Timely access to assessment and treatment services
• Increased management of recovery services and compliance with treatment• Systematic response for participants – contingency management• Increased judicial oversight
Sources: 2002 Process Evaluation and Findings from 2015 CAM Evaluation
• Collaborative non-adversarial approach grounded in efficient communication across service systems and court
• Improved family-centered services and parent-child relationships
Key Family Drug Court Ingredients
Increased management of recovery services and compliance with treatment
• More frequent review hearings• Judicial Oversight• Responses to behavior• Case Staffings• Drug testing
Monitoring Cases
Titles and Models• Recovery Support Specialist• Substance Abuse Specialist• Recovery Coach• Recovery Specialist• Parent Recovery Specialist
• Peer Mentor• Peer Specialist• Peer Providers• Parent Partner
What does our program and community need?YOU NEED TO ASK:
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102
130151
200
0
50
100
150
200
250
No Parent SupportStrategy
Intensive CaseManagement Only
Intensive CaseManagement and
Peer/ Parent Mentors
Intensive CaseManagement andRecovery Coaches
Median in Days
Median Length of Stay in Most Recent Episode of Substance Abuse Treatment after RPG Entry
by Grantee Parent Support Strategy Combinations
46% 46%
56%63%
0%
10%
20%
30%
40%
50%
60%
70%
No ParentSupport Strategy
Intensive CaseManagement
Only
Intensive CaseManagement and
Peer/ ParentMentors
Intensive CaseManagement andRecovery Coaches
Median in Days
Substance Abuse Treatment Completion Rate by Parent
Support Strategies
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 hasreview hearingsevery two weeks
N=14
Drug court hasreview hearings
more or less oftenN=35
46%31%
Perc
ent R
educ
tion
in
Rec
idiv
ism
Drug Courts That Have Judges Stay Longer Than 2 Years Had 3 Times
Greater Cost Savings
Note: Difference is significant at p<.05
0%
10%
20%
30%
Judge is on bench at least 2yearsN=9
Judge is on bench LESS THAN2 years
N=3
25%
8%
Perc
ent i
ncre
ase
in c
ost
savi
ngs
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<.05
0%
10%
20%
30%
40%
50%
Judge spends at least 3 min.per participant
N=23
Judge spends LESS THAN 3min. per participant
N=12
43%
17%
Perc
ent r
educ
tion
in re
cidi
vism
Note 1: Difference is significant at p<.05
Drug Courts Where the Judge Spends an Average of 3 Minutes or Greater per Participant During Court
Hearings had 153% greater reductions in recidivism
Therapeutic Jurisprudence• Engage directly with parents vs. through
attorneys• Create collaborative and respectful
environments• Convene team members and parents
together vs. reinforcing adversarial nature of relationship
• Rely on empathy and support (vs. sanctions and threats) to motivate
Lens, V. Against the Grain: Therapeutic Judging in a Traditional Court. Law & Social Inquiry. American Bar Association. 2015
The Judge Effect
• The judge was the single biggest influence on the outcome, with judicial praise, support and other positive attributes translating into fewer crimes and less use of drugs by participants (Rossman et al, 2011)
• Positive supportive comments by judge were correlated with few failed drug tests, while negative comments led to the opposite (Senjo and Leip, 2001)
• The ritual of appearing before a judge and receiving support and accolades, and “tough love” when warranted and reasonable, helped them stick with court-ordered treatment (Farole and Cissner, 2005, see also Satel 1998)
Note: Difference is significant at p<.10
Drug Courts Where Treatment Communicates withthe Court via Email had
119% greater reductions in recidivism
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
YesN=31
NoN=14
0.46
0.21
% re
duct
ion
in #
of r
earr
ests
Treatment communicates with court via email
0%
10%
20%
30%
40%
Program usespaper files
N=8
Program haselectronic database
N=3
20%
33%
Perc
ent i
ncre
ase
in c
ost s
avin
gs
Drug Courts That Used Paper Files Rather Than Electronic
Databases Had 65% LESS Savings
Note: Difference is significant at p<.05
Drug Courts That Required All Team Members to Attend Staffings
Had 50% Greater Reductions in Recidivism and 20% Greater Savings
0%
10%
20%
30%
40%
50%
All team members attend staffingsN=31
All team does NOT attend staffingsN=28
42%28%
Perc
ent r
educ
tion
in
reci
divi
sm
Note 1: Difference is significant at p<.05Note 2: “Team Members” = Judge, Both Attorneys, Treatment Provider, Coordinator
Note: Difference is significant at p<.15 (Trend)
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 atleast 2X per week
N=53
Participants tested LESS oftenthan 2X per week
N=12
29%18%
Perc
ent i
ncre
ase
in c
ost
savi
ngs
Note: Difference is significant at p<.05
0%
10%
20%
30%
40%
Drug tests are back within48 hours
N=21
Drug testsare back in
LONGER THAN48 hours…
32%19%
Perc
ent i
ncre
ase
in c
ost
savi
ngs
Drug Courts Where Drug Test Results are Back in 48 Hours or Less had
68% Higher Cost Savings
Improved family-centered services and parent-child relationshipsKey Family Drug Court Ingredients
Addiction affects the
whole family
Developmental impact
Psycho-social impact
Impact on parenting
Generational impact
FDC Practice Improvements
Approaches to child well-being in FDCs need to change
Child-focused assessments and
services
In the context of parent’s recovery
Family-centered Treatmentincludes parent-child dyad
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 classesN=44
Program does NOT provide parentingclassesN=17
38%
23%
% R
educ
tion
in R
ecid
ivis
m
Drug Courts That Offer Family Counseling Had 65% Greater
Reductions in Recidivism
Offered Family CounselingN = 35
No Family CounselingN = 15
38%
23%
% R
educ
tion
in R
ecid
ivis
m
Sacramento County Family Drug Court Programming
Parent-child parenting intervention
FDC
CIF
Connections to community supports
Improved outcomes
•Dependency Drug Court (DDC)• Post-File
•Early Intervention Family Drug Court (EIFDC)
• Pre-FileDDC has served over 4,200 parents & 6,300 childrenEIFDC has served over 1,140 parents & 2,042 children CIF has served over 540 parents and 860 children
54.1%61.5%
40.1%46.6%
35.5%
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%
DDC Only DDC + CIF EIFDC Only EIFDC + CIF SacramentoCounty
DDC and EIFDC: p < 0.05
Treatment completion rates were higher for parents in DDC and EIFDC than the overall County rate. Parents provided CIF Enhancement were significantly more likely to successfully complete treatment.
Recovery Treatment Completion RatesNote: All treatment episodes represented here
EIFDC: n.s. p > 0.05
Almost all children in EIFDC were able to stay in their parents care. Families provided the CIF Enhancement were on average more likely to have children stay home.
Remain at Home Percent of Children Remaining at Home
82.6% 84.3%
50.0%
60.0%
70.0%
80.0%
90.0%
EIFDC Only EIFDC + CIF
Re-occurrence of Maltreatment at 12 Months
4.4% 2.8% 4.3% 3.8%
14.3%
0.0%
5.0%
10.0%
15.0%
20.0%
DDC Only DDC + CIF EIFDC Only EIFDC + CIF SacramentoCounty
DDC and EIFDC: n.s. p > 0.05
Families in DDC or EIFDC were less likely than the larger Sacrament County population to experience reoccurrence of child abuse and/or neglect.
Re-occurrence
DDC : n.s. p > 0.05
11.4% 10.3%
17.5%
0.0%
5.0%
10.0%
15.0%
20.0%
DDC Only DDC + CIF Sacramento County
Re-Entry Re-Entry into Foster Care 12 Months after Reunification
Families in DDC were less likely than the larger Sacramento County population to experience removals of children following reunification.
Other Service Enhancements
• Therapeutic-based parent-child interventions
• Trauma-focused interventions
• Developmental and behavioral interventions
• Quality visitation and family time
• Family functioning assessment tools – N. Carolina Family Assessment Scale (NCFAS)
Clark County: NCFAS Scores Improved Significantly from Entry to Exit
-3.0
-2.0
-1.0
0.0
1.0
2.0
-0.1
-1.1
-0.5-0.8
0.2
-0.2
-1.9
0.5
-0.2
-0.8
1.41.3
1.0
1.7
1.31.1
0.0
1.6 1.61.9
Entry Exit
DISCUSSION
RECOMMENDATION 6-7: ADDRESS THE NEEDS OF PARENTS
ADDRESS THE NEEDS OF CHILDREN
5-10 MINUTES
Once served, how do we know we are making an impact?
The importance of monitoring cases and outcomes
1999 2016
Body of KnowledgeWe know a lot more now
FDC Movement
Key Family Drug Court Ingredients
Collaborative non-adversarial approach grounded in efficient communication across service systems and court
Administrative Level (macro)• Baselines and Dashboards• Outcomes• Sustainability
Front-line Level (micro)Front-line Level (micro)
• Case management• Reporting• Tracking
Two Levels of Information Sharing
Client Program
Who collects data, where is it stored, who uses it, who “owns” the data,
levels of access
Assess effectiveness of system in achieving its desired results or
outcomes
Monitoring Outcomes
“Feel Good” ProgramFamily Drug Courts as a
How do you know….. How will you…..
• How are families doing?• Doing good vs. harm?• What’s needed for families?
• Monitor and improve performance?• Demonstrate effectiveness?• Secure needed resources?
The importance of
Data Dashboard• What needles are you trying move?• What outcomes are the most important?• Is there shared accountability for “moving the needle” in a
measurable way, in FDC and larger systems?• Who are we comparing to?
Note: Difference is significant at p<.05
Program reviews their own statsN=20
Program does NOT review statsN=15
37%
16%
Perc
ent i
ncre
ase
in c
ost s
avin
gsDrug Courts Where Review of The Data and
Stats Has Led to Modifications in Drug Court Operations had a 131% Increase in
Cost Savings
Note: Difference is significant at p<.05
0%
10%
20%
30%
40%
50%
Used evaluation to makemodifications to program
N=18
Did NOT use evaluation to makemodifications
N=13
36%
18%
Perc
ent i
ncre
ase
in co
st sa
ving
sDrug Courts Where the Results of Program Evaluations Have Led to
Modifications in Drug Court Operations Had a 100% Increase in Cost Savings
Data-Driven & Problem-Focused: Identifying Opportunities for Change
Identify specific need,
concern or issue
Collect and examine data
Share data and
information to clarify problem
statement
Use data for discussion
and identify opportunities
for change
Monitor outcomes and
changesScenario:
Reunification & Re-Entry
ScenarioWhat happens to children who are reunified through participation in FDC?
85% of children in substantiated abuse and neglect cases either stay home or go home
Identifying the Issue
One of the outcomes our FTC focused a lot of time and resources on was increasing our rate of reunification. As a
result of our hard work, our FTC program is doing a great job of reunifying kids with their parents.
88.2% 85.4%
34.9%
70.3%63.0%
Grantee A Grantee B Grantee C Grantee D Cross Grantee
N = 165
Reunification
Re-Entry into Foster Care
26.7%
2.4%0.0%
11.5%7.7%
Grantee A Grantee B Grantee C Grantee D Cross Grantee
N = 104 reunifications
Implications for Case and Outcome Monitoring
• Monitor Cases – to focus on transitions and outcomes of treatment and CWS case plans
• Conduct Systems Walk-Through – to assess effectiveness of system in achieving its desired results or outcomes
• Conduct parent focus groups – to identify client experience and needs
• Conduct rapid change cycle – to test out Reunification Groups or use of Resource Specialist
System Walk-Through Data and Info Walk-Through
Who collects data, where is it stored, who uses it, who “owns” the data,
levels of access
Assess effectiveness of system in achieving its desired results or
outcomes
Tools for Monitoring Outcomes
Drop-Off Points
Total number of cases that resulted in investigation and those with a screening
Number and percentage of parents referred for assessment
Number and percentage who received an assessment
Number and percentage referred to treatment and FDC
Number and percentage admitted (attended at least one session) to
treatment and to FDCNumber and
percentage in treatment for at least 90 days
Number and percentage completing treatment
Payoff – Number and percentage Reunified / Remained at home
Systems Walk-Through
Referral
Monitoring
Screening
Assessment
Importance of Leadership
• Leadership does not “just happen”• Needed at every level• Capable of systems thinking and has effective relations in larger system• Data-driven and problem-focused• Sees barriers as goals and targets for change• Opportunity to shape a policy environment to move towards expansion and institutionalization
Oversight/ExecutiveCommittee
Director Level
Quarterly
Ensure long-term sustainability and final
approval of practice, and policy changes
Steering Committee
Management Level
Monthly or Bi-Weekly
Remove barriers to ensure program success and achieve project’s
goals
FDC Team
Front-line staff
Weekly
Staff cases; ensuring client
success
Membership
Meets
Primary Functions
The Collaborative Structure for Leading Change
Information flow
Information flow
Note: Difference is significant at p<.05
Drug Courts That Provided Formal Training for ALL New Team Members
Had 54% Greater Reductions in Recidivism
0%
10%
20%
30%
40%
50%
All new teammembers have formal training
N=30
All team membersNOT formally trained
N=17
40%
26%
Note: Difference is significant at p<.05
Drug Courts That Received Training Prior to Implementation Had Almost
3.5 Times Higher Cost Savings
0%
10%
20%
30%
40%
Team trained BEFORE implementationN=12
Team members NOT trained beforeimplementation
N=5
27%
8%
Perc
ent i
ncre
ase
in c
ost s
avin
gs
Q&A and Discussion
Training and Technical Assistance Needs of FDCs
1999 2016
Body of KnowledgeWe know a lot more now
FDC Movement
FDC Guidelines
http://www.cffutures.org/files/publications/FDC-Guidelines.pdf
To download a copy today visit our website:
FDC Learning Academy
For more information please visit: http://www.cffutures.org/projects/family-drug-court-learning-academy
• Webinar Recordings• FDC Podcasts • FDC Resources• FDC Video features• Webinar registration
information
FDC Learning Academy Blog
www.familydrugcourts.blogspot.com
Family Drug Court Online Tutorial
FDC 101 – will cover basic knowledge of the FDC model and operations
FAMILY DRUG COURTPEER LEARNING COURT PROGRAM
King County, WA
Baltimore City, MD
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Miami-Dade, FL
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CONTACT US FOR MORE INFORMATION: [email protected]
FDC Discipline Specific Orientation Materials
Child Welfare | AOD Treatment | Judges | Attorneys
Please visit: www.cffutures.org/fdc/
Resources
1. Understanding Substance Abuse and Facilitating Recovery: A Guide for Child Welfare Workers
2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals
3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals
Please visit: http://www.ncsacw.samhsa.gov/
NCSACW Online Tutorials
Resources
2015 Special Issue
Includes four Family Drug Court specific articles presenting findings on:
• Findings from the Children Affected by Methamphetamine (CAM) FDC grant program
• FDC program compliance and child welfare outcomes
• Changes in adult, child, and family functioning amongst FDC participants
• Issues pertaining to rural FDCs
www.cwla.org
Research and Evaluation
Need help with your evaluation?CFF's Research and Evaluation Division has worked with child and family serving organizations in more than 30 Tribes and Tribal organizations and nearly 100 counties across the United States.
CFF’s Research and Evaluation staff offer comprehensive methodological expertise in applied research and evaluation including qualitative and quantitative design, data collection, analysis and reporting.
Our diverse content expertise includes work with: Family, adult, and juvenile drug courts Veterans programs and courts Child and family welfare Public health and substance use treatment programs Youth development programs
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Expertise
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Contact Information
Phil Breitenbucher, MSWDirector, Family Drug Court ProgramsChildren and Family Futures(714) [email protected] Balkey, BA, RASProgram Manager, Family Drug Court ProgramChildren and Family Futures(714) [email protected]