Effective Treatment Strategies in Juvenile Drug Court

Transcription

1 Effective Treatment Strategies in Juvenile Drug Court Scott W. Henggeler, Ph.D. Professor, Medical University of South Carolina Board Member, NADCP

2 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

3 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

4 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

5 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

6 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

7 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

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

9 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.

10 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.

11 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.

12 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 ). Bethesda, MD: National Institute on Drug Abuse.

13 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

14 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

15 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.

16 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)

17 Juvenile Drug Courts: Show me the money! NADCP Annual Conference 2013 Shannon M. Carey, Ph.D SW Macadam Ave., Ste. 575 Portland, OR Informing policy, improving programs July, 2013

18 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? 2

19 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 3 Majority white (68-90%), Average age at arrest = Marijuana and alcohol primary drugs

20 Are juvenile drug courts effective? 4

21 Are juvenile drug courts effective? Measured effectiveness with reduced recidivism and reduced substance use Recidivism/Rearrests o Juvenile o Adult Substance use o Drug tests o Drug arrests 5

22 Do juvenile drug courts reduce recidivism in Clackamas, OR? 2.5 YES. Juvenile Arrests Average Number of Re-Arrests Over 24 months Average Number of Re-arrests Months All Participants Graduated Comparison 6

23 Do juvenile drug courts reduce recidivism in Harford, MD? YES. Juvenile Arrests (2 yr) Ave # Juvenile Re-Arrests (n=75) Drug Court Sample (n=82) Comparison Group 7

24 Do juvenile drug courts reduce other recidivism in Harford, MD? YES. Juvenile Recidivism (2 yr) Graduates All Drug Court Comparison 0 # of juvenile justice complaints # of adjudication hearings Days in secure detention Days on community detention Days in Shelter Care Days in Group Home 8

25 Do juvenile drug courts reduce recidivism into the adult system? YES. Harford: Adult Recidivism (2 yr) Drug Court Sample (n=75) ComparisonGroup (n=82) Ave # arrests Ave # days in jail Ave #days in prison Ave # days parole/ probation 9

26 Do juvenile drug courts reduce recidivism into the adult system? Clackamas: Adult and Juvenile arrests 2 years from drug court entry Graduates 29% All Participants 44% Comparison 82% 90% reduction in new arrests 10

27 Do juvenile drug courts reduce recidivism into the adult system? YES. Oakland: Juvenile and Adult Arrests (2 yr) 2.5 JDC Participants Years Prior 2 Years Post 11

28 Do juvenile drug court reduce drug use? YES! Baltimore, MD: Percent of Positive UAs in 2 Month Increments Percent of Indivduals with Positive Tests 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Months of Program Participation 12

29 Do juvenile drug court reduce drug use? YES! Clackamas, OR: Percent of Positive UAs in 2 Month Increments 0.3 Percent positive UAs Pre-enhancement Post-enhancement Months 13

30 Do juvenile drug court reduce drug use? Clackamas: Mean Number of Drug Related Re- Arrests in 3-Month Blocks Average # of Drug-Related Rearrests Pre-enhancement Comparison Months 14

31 How much does it cost to run a juvenile drug court program? Varies (services, # of team members, etc.) Cost Analysis Approach: TICA 15

32 Clackamas: Program Transactions (Total Program Cost $23,656/$64 per day) Transaction Transaction Unit Cost Avg. # of Program Related Transactions Avg. Cost per Participant Drug Court Appearances $ $11,047 Case Management $ Days $10,626 Individual Treatment Sessions Group Treatment Sessions $ $438 $ $619 Family Therapy Sessions $ $182 Parent Support Group $ $252 Parent Education Classes $ $42 Drug Tests (UAs) $ $426 Drug Patches $ $24

33 Transaction Harford: Program Transactions (Total Program Cost $11,689/$41 per day) Unit Cost Average # of Transactions Average Cost per Participant Drug Court Appearances $ $3,047 Case Management $ Days $3,271 Individual D&A Treatment Sessions Group D&A Treatment Sessions $ $608 $ $1,413 Drug Tests (UAs) $ $2,027 Mental Health Treatment $ Months $280 Individual Education Sessions Group Job Training Sessions $ Months $521 $ Months $521

34 Program Program cost comparison Cost 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 Cost per day (per participant) *Over $25,000 on Detention Costs 18

35 Harford: Options for High-Risk Youth Placement Options Harford Juvenile Drug Court Program Cost Per Day $41 Detention $296 Residential Treatment $220 Emergency Shelter Care $275 Community Detention $24 19

36 Clackamas: Options for High-Risk Youth Placement Options Options Cost Per Day CCJDC Program $66 Residential Treatment $134 Shelter Care $115 Short-term Detention $187 Long-term Detention $171 Adult Jail $97 20

37 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 21

38 Clackamas: Agency Investment per Participant 22 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

39 Oakland: Agency Investment per Participant 23 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

40 St. Mary s: Agency Investment per Participant Agency 24 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

41 Do juvenile drug courts save taxpayer money? Yes! But not always 25

42 Clackamas: Outcome Cost Findings Transaction Unit Cost All Participants 26 Comparison Group Re-arrests/Referrals $ $171 $406 Formal Hearings $89.80 $40 $61 Probation Violation Hearings $44.90 $34 $53 Felony Cases $ $12 $148 Misdemeanor Cases $ $59 $92 Probation Violation Cases $ $48 $68 Residential Treatment Days $ $4,046 $7,592 Foster Care Days $29.78 $448 $390 Shelter Care Days $ $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, $19,427.00

43 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

44 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 28

45 What promising practices are there for juvenile drug courts? Do best practices for adults apply? 29

46 Taking a closer look Re-Arrests Pre and Post Enhancement 0.5 Average # of re-arrests Comparison Months 30

47 Taking a closer look Re-Arrests Pre and Post Enhancement 0.5 Pre-enhancement Average # of re-arrests Comparison Months 31

48 Taking a closer look Re-Arrests Pre and Post Enhancement Average # of re-arrests Pre-enhancement Post-enhancement Comparison Months 32

49 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

50 Clackamas Enhancements 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 34

51 Clackamas Enhancements 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

52 Taking a Closer Look CC BC HC SMC AA Savings $9,070 $8,762 $5,702 $2,

53 Taking a Closer Look CC BC HC SMC AA Savings $9,070 $8,762 $5,702 $2, Court Sessions 357/29 407/26 283/12 341/13 315/40 2 weeks 2 weeks 3 weeks 4 weeks 1 week

54 Drug Courts That Held Status Hearings Every 2 Weeks During Phase 1 Had 50% Greater Reductions in Recidivism 46% Percent Reduction in Recidivism 50% 40% 30% 20% 10% 0% Drug court has review hearings every two weeks N=14 31% Drug court has review hearings more or less often N=35 Adult Note: Difference is significant at p<.1

55 Taking a Closer Look CC BC HC SMC AA Savings $9,070 $8,762 $5,702 $2, Court Sessions Drug Tests 357/29 407/26 283/12 341/13 315/40 2 weeks 2 weeks 3 weeks 4 weeks 1 week /week 3/mo 2/week 3/mo Self pay

56 Drug Courts Where Drug Tests are Collected at Least Two Times per Week In the First Phase had a 61% Higher Cost Savings Percent increase in cost savings 40% 30% 20% 10% 0% 29% Participants drug tested at least 2X per week N=53 18% Participants tested LESS often than 2X per week N=12 Adult

57 Taking a Closer Look CC BC HC SMC AA Savings $9,070 $8,762 $5,702 $2, Court Sessions 357/29 407/26 283/12 341/13 315/40 2 weeks 2 weeks 3 weeks 4 weeks 1 week Drug Tests Self pay Family Counseling Yes Yes No No Self pay Parenting Yes No No No No

58 Drug courts that offer parenting classes had 68% greater reductions in recidivism and 52% greater cost savings 38% % Reduction in Recidivism 23% Program provides parenting classes N=44 Program does NOT provide parenting classes N=17 True in adult, family, juvenile

59 Taking a Closer Look CC BC HC SMC AA Savings $9,070 $8,762 $5,702 $2, Court Sessions 357/29 407/26 283/12 341/13 315/40 2 weeks 2 weeks 3 weeks 4 weeks weekly Drug Tests 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

60 Drug courts that offer mental health treatment had 80% greater reductions in recidivism % Reduction in Recidivism 40% 35% 30% 25% 20% 15% 10% 5% 0% 36% MH Tx Provided N=52 20% MH Tx NOT Provided N=10 Adult

61 A closer look at the use of detention Detention costs were very high in most of the juvenile programs 45

62 A closer look at the use of detention Clackamas Detention Costs Averaged per Youth $12,000 $10,000 Detention Costs $8,000 $6,000 $4,000 $2,000 $0 Graduated Terminated Comparison Year 1 $747 $9,785 $2,598 Year 2 $393 $2,876 $1,791 Year 1 Year 2 46

63 A closer look at the use of detention Detention Costs per Youth Across Programs $12, Terminated Graduated $10, $8, $6, $4, $2, $- Baltimore Harford AA Clackamas 47

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

65 Drug Courts where sanctions were imposed in advance of a regularly scheduled court hearing had double the cost savings 28% % Increase in Cost Savings Adult Sanctions Imposed Swiftly N=36 14% Sanctions NOT Imposed Swiftly N=17 Note: Difference is significant at p<.05

66 5. Drug Courts Where in Order to Graduate Participants Must Have a Job or be in School had 83% Higher Cost Savings Note: Difference is significant at p<.05

67 4. Drug Courts Where the Defense Attorney Attends Drug Court Team Meetings (Staffings) had 93% Higher Cost Savings Note: Difference is significant at p<.05

68 6. Drug Courts Where a Representative from Treatment Attends Court Sessions had 81% Higher Cost Savings Note: Difference is significant at p<.10

69 7. Drug Courts Where Team Members are Given a Copy of the Guidelines for Sanctions had 72% Higher Cost Savings Note: Difference is significant at p<.15 (Trend)

70 9. Drug Courts where Law Enforcement is a member of the drug court team had 88% greater reductions in recidivism Law Enforcement is a Member of Drug Court Team 0.45 % reduction in # of rearrests Yes N=20 No N=29 Note: Difference is significant at p<.05

71 1. Drug Courts Where Review of The Data and Stats Has Led to Modifications in Drug Court Operations had 131% Higher Cost Savings Note: Difference is significant at p<.05

72 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

73 Questions? 57

74 Contact Information Shannon Carey, Ph.D. 58