Mecklenburg County Families in Recovery to Stay Together Program (FIRST) Process Evaluation Report Prepared by innovation Research & Training, Inc.

Transcription

1 Mecklenburg County Families in Recovery to Stay Together Program (FIRST) Process Evaluation Report 2005 Prepared by innovation Research & Training, Inc. Address: 1415 W NC Highway 54 - Suite 121, Durham NC Voice: Fax:

2 Mecklenburg County Families in Recovery to Stay Together Program (FIRST) Process Evaluation Report Table of Contents I EXECUTIVE SUMMARY...5 II INTRODUCTION...7 III A PURPOSE OF REPORT... 7 B MISSION... 7 C PROGRAM GOALS... 7 Conclusions and Recommendations Regarding Program Goals and Objectives...9 D HISTORY OF MECKLENBURG COUNTY FAMILIES IN RECOVERY TO STAY TOGETHER PROGRAM (FIRST) E HISTORY OF PROGRAM IMPLEMENTATION AND MODIFICATIONS METHODS AND PROCEDURES USED IN THE PROCESS EVALUATION...14 A PLANNING AND ORIENTATION B DATA COLLECTION AND ANALYSIS IV CHARACTERISTICS OF FIRST LEVEL-II PARTICIPANTS...17 Table 1. General Demographic and Basic Characteristics of FIRST Level-II Program Participants Table 2. FIRST Level-II Status by Race Table 3. FIRST Level II Status by Gender Table 4. FIRST Level II Status by Primary Drug of Choice Table 5. FIRST Level II Primary Referral Source Table 6. Primary Referral Source for FIRST Level II Active Participants by Race Table 7. Primary Referral Source for FIRST Level-II Active Participants by Gender Table 8. FIRST Level-II Primary Referral Source by Participant Status Table 9. FIRST Level-II Primary Reason for Discharge due to Termination Table 10. Types of FIRST Level-II Noncompliance Leading to Discharge Table 11. Average Length of Time for FIRST Level-II Program Referral, Interview and Admission Table 12. Compliance with FIRST Level-II Requirements Table 13. FIRST Level-II Drug Test Results Table 14. FIRST Level-II Reasons for Ineligibility A SUMMARY OF MAIN FINDINGS FROM ANALYSIS OF THE DEMOGRAPHICS AND BACKGROUND CHARACTERISTICS DATA V DESCRIPTION OF FIRST LEVEL-II TEAM...26 A COMPOSITION, ROLES, AND RESPONSIBILITIES OF TEAM MEMBERS B BACKGROUND TRAINING AND CONTINUING EDUCATION C STABILITY OF TEAM MEMBERS D DECISION-MAKING PROCESS... 32

3 E RESOURCES AVAILABLE TO AND UTILIZED BY TEAM MEMBERS F GLOBAL IMPRESSIONS ABOUT THE FIRST LEVEL-II PROGRAM REPORTED BY FIRST TEAM MEMBERS G FINDINGS FROM PARTICIPANT INTERVIEWS AND FOCUS GROUPS REGARDING THE FIRST TEAM Conclusions and Recommendations Regarding Team Composition, Stability and Functioning...36 VI DESCRIPTION OF THE FIRST LEVEL-II PROGRAM...38 A PROGRAM OVERVIEW B ADMISSION/INTAKE C CAPACITY AND PROGRAM ENROLLMENT D ELIGIBILITY CRITERIA E FAMILY TREATMENT COURT CONTRACT Conclusions and Recommendations Regarding Program Admissions, Eligibility, and Enrollment Procedures...44 F PHASE SYSTEM Table 15. FIRST LEVEL II PHASE SYSTEM Conclusions and Recommendations Regarding the Phase System...46 G PROGRAM COMPLETION Conclusions and Recommendations Regarding Program Completion...47 H SANCTIONS Table 16. FIRST-LEVEL II SANCTIONS GRID: Conclusions and Recommendations Regarding Sanctions...50 I INCENTIVES Table 17. FIRST Level-II INCENTIVES GRID Conclusions and Recommendations Regarding Incentives...52 J CASE MANAGEMENT AND JUDICIAL SUPERVISION Conclusions and Recommendations Regarding Case Management and Judicial Supervision...55 K TERMINATION Conclusions and Recommendations Regarding Termination...56 L TREATMENT M ANCILLARY SERVICES Conclusions and Recommendations Regarding Treatment and Ancillary Services...62 N AFTERCARE Conclusions and Recommendations Regarding Aftercare...64 O GLOBAL IMPRESSIONS ABOUT THE FIRST LEVEL-II PROGRAM REPORTED BY PAST AND PRESENT PARTICIPANTS Summary of Findings from Focus Groups and Interviews with Former Participants...66 VII CONCLUSIONS AND RECOMMENDATIONS...68 A STRENGTHS OF PROGRAM B RECOMMENDATIONS C CONCLUSIONS VIII REFERENCES...72

4 IX APPENDIX A...73 A TABLE 1. CONSUMER SATISFACTION SURVEY: SATISFACTION WITH COMPONENTS OF THE MECKLENBURG COUNTY FIRST LEVEL-II PROGRAM B TABLE 2. CONSUMER SATISFACTION SURVEY: DIFFICULTY WITH REQUIREMENTS OF MECKLENBURG COUNTY FIRST LEVEL-II PROGRAM C TABLE 3. CONSUMER SATISFACTION SURVEY: PROTECTION OF PARTICIPANTS RIGHTS IN MECKLENBURG COUNTY FIRST LEVEL-II PROGRAM D TABLE 4. CONSUMER SATISFACTION SURVEY: DEMOGRAPHICS OF MECKLENBURG COUNTY FIRST LEVEL-II PROGRAM PARTICIPANTS... 76

5 Mecklenburg County Families in Recovery to Stay Together Program (FIRST) Process Evaluation Report Executive Summary Purpose: To describe the operation of the Families In Recovery Staying Together (FIRST) Level-II Program. To compare the implementation of the court with the methods described in program grants, manuals, handbooks, and mandates. To examine the strengths and weaknesses of the current implementation of the court. To make recommendations regarding possible improvements to the current structure and operation of the court. Background: The FIRST Level-II Program was established to identify and provide treatment and rehabilitative services to parents and legal guardians whose children have been adjudicated abused, dependent, and/or neglected, in an attempt to increase the likelihood of reunification with their children. Method: Focus groups were conducted with current court participants. Individual interviews were conducted with court team members, terminated participants, and graduated participants. Pre-court team meetings and court proceedings were observed. Current court participants completed a paper-and-pencil Consumer Satisfaction questionnaire. Demographic characteristics and program compliance information were obtained from court records in the FIRST Program Management Information System (MIS) and the North Carolina Adult MIS. Key Findings: The primary drugs of choice used by FIRST Level II participants are crack, alcohol and marijuana. Higher rates of graduation are seen among participants whose primary drug of choice is either alcohol or crack. The most common reasons for termination from the program are failure to attend treatment, failure to make contacts with the Case Coordinator, and failure to meet other requirements. The FIRST Team is very dedicated and committed to attaining the goals of the program. Team members use innovative methods to overcome barriers and to facilitate family reunification in compliance with the Adoption and Safe Families Act of 1997 (ASFA) guidelines. Standardized screening and enrollment procedures allow the program to reach its target population. IRT,

6 Progression through the program and responses to participant compliance are clearly defined. Lack of adequate funding resources limits the court s ability to provide the recommended amount of treatment services and the variety of treatment services that it would hope to provide to participants. Team members and participants express the need for additional housing options for participants. Currently, there is no formal aftercare or alumni program for participants who successfully complete the program. Conclusions: The results of this process evaluation report suggest that the FIRST Level-II Program is implementing the court in a manner that is consistent, in general, with the originally proposed goals and most participants agree that the treatment court is effectively treating participants. The findings suggest that some ways to improve the functioning of the court include assisting participants with housing issues, creating an alumni or aftercare group, continuing to seek diverse and stable sources of funding for treatment, and increased integration of dependency case information in team meeting discussions and judicial proceedings. IRT,

7 Mecklenburg County Families in Recovery to Stay Together Program (FIRST) Process Evaluation Report Introduction Purpose of Report The primary purpose of this process evaluation report is to provide a description of the structure, organization, and operations of the Mecklenburg County Families in Recovery to Stay Together (FIRST) Level-II Program, as well as to identify the strengths and barriers of the Family Treatment Court. Process evaluations are required by North Carolina s Administrative Office of the Courts and the Bureau of Justice Assistance, and are supported by the North Carolina Governor s Crime Commission. The North Carolina Drug Treatment Court Advisory Committee is "established to develop and recommend to the Director of the AOC guidelines for the DTC and to monitor local courts wherever they are implemented" (N.C. Gen. Stat. 7A-795). A drug court process evaluation documents, describes, and monitors the current operation, strengths, and areas in need of improvement in the functioning of a court. Based on observations, interviews, and analyses of quantitative data, recommendations are made for improvements to the organization, structure, and overall operation of the program. A process evaluation differs from an outcome evaluation in that it does not examine and evaluate the effectiveness of the drug treatment court in terms of its effectiveness in reducing recidivism and substance abuse and addiction. At various points within this report, excerpts from program materials and from interviews are reported verbatim in order to retain the exact language and nuances intended by the court or by the interviewee. This report describes the results of the process evaluation conducted on the functioning of the FIRST Level-II Program. Mission The mission of the FIRST Program, as stated in the 2004 edition of the Operations Manual, is as follows: We will assess all parents and guardians whose children have been adjudicated abused and/or neglected, for substance abuse and other mental health needs, offer treatment, intensive court supervision and frequent urinalysis through a collaborative effort involving the Court, Department of Social Services (DSS) and Area Mental Health (AMH). North Carolina Drug Treatment Court Goals Program Goals The goals of North Carolina s Drug Treatment Courts, as adopted by the State legislature and recorded in the Report on the Status of North Carolina s Pilot Drug Treatment Court Program (1998) are as follows: IRT,

8 All North Carolina Drug Courts were funded and implemented under the authorization of the Administrative Office of the Courts (AOC) based on legislation mandated in 1995 by the North Carolina General Assembly. The legislation states that the goals of the North Carolina Drug Treatment Court (DTC) are as follows: 1. To reduce alcoholism and other drug dependencies among adult and juvenile offenders and defendants and among respondents in juvenile petitions for abuse, neglect, or both; 2. To reduce criminal and delinquent recidivism and the incidence of child abuse and neglect; 3. To reduce the alcohol-related and other drug-related court workload; 4. To increase the personal, familial and societal accountability of adult and juvenile offenders and defendants and respondents in juvenile petitions for abuse, neglect, or both; and 5. To promote effective interaction and use of resources among criminal and juvenile justice personnel, child protective services personnel, and community agencies. North Carolina Family Drug Treatment Court Goals The goals of Family Drug Treatment Courts in North Carolina, as adopted by the State legislature and recorded in the Report on the Status of North Carolina s Pilot Drug Treatment Court Program (1998) are as follows: 1. To provide parent(s)/guardians(s) with an opportunity to be clean and sober; 2. To provide constructive support to aid them in resisting further criminal activity; 3. To provide skills that will aid them in leading productive, substance-free and crime-free lives; 4. To help the parent to become emotionally, financially, and personally self-sufficient; and 5. To develop adequate parenting and coping skills to be able to serve as an effective parents on a day-to-day basis. Local Program Goals and Objectives The goals of the FIRST Program, as stated in the 2001 grant proposal to the Governor s Crime Commission (GCC), are: 1. To ensure compliance with the statutory mandate of the Adoption and Safe Families Act; 2. To enhance the likelihood of family reunification; and 3. To increase personal, familial, and system accountability. The objectives of the FIRST Program, as stated in the 2001 grant proposal to the GCC, are as follows: 1. To provide increased assessment information on all parents adjudicated abusive and/ or neglectful; IRT,

9 2. To provide immediate access to substance abuse treatment to all parents who have been adjudicated abusive and/or neglectful; 3. To provide increased treatment participation for all parents adjudicated abusive and/or neglectful; 4. To provide monthly status reports on compliance with court orders pertaining to substance abuse issues of all parents adjudicated abusive and/or neglectful; 5. To provide increased court supervision of all adjudicated parent s participation in substance abuse and mental health services; 6. To reduce the time from identification to service delivery for all parents adjudicated abusive and/or neglectful; 7. To decrease use of illegal substances by drug court participating parents; 8. To provide more substantive information concerning a parent s chance for recovery and reunification earlier in the process; 9. To provide more rapid decision-making processes for reunification or termination of rights; 10. To increase family reunifications; 11. To increase life skills, parenting skills and knowledge of developmental norms; and 12. To provide increased opportunities for safe and stable housing. Conclusions and Recommendations Regarding Program Goals and Objectives As a whole, the stated mission, goals, and objectives of the FIRST Program are in line with the State s goals for Family Drug Treatment Courts. The mission statement clearly states the program s method for achieving its goals. However, it does not identify the purpose of the program, or the values that guide the organization toward achieving its. Clarifying the purpose and values of the treatment court might strengthen and complete the mission statement. The local program goals do not address substance abuse and addiction issues, which are outlined in the legislation for Family Drug Treatment Courts in North Carolina. This is also inconsistent with the focus placed on substance abuse in the FIRST Program mission statement and program objectives. The court might consider expanding its individual goals to better reflect the goals outlined by the state and to better match its own objectives. Most of the local program objectives are clearly stated, measurable, and appear to be achievable. The eighth objective may need to be clarified with regard to the definition of phrases such as substantive information, and earlier in the process, to be a more measurable goal. It would also be helpful to identify the recipient of this information. Since the goals and objectives of a program guide its operation and evaluation, the court might consider adding its goals and objectives to the FIRST Program Operations Manual. IRT,

10 History of Mecklenburg County Families in Recovery to Stay Together Program (FIRST) The Mecklenburg County FIRST Program began operations on December 1, 1999, with a Governor s Crime Commission (GCC) grant in the amount of $105,187 for the first year and $106,312 in the second. In July of 2001, the GCC extended the funding for a year while the FIRST Program wrote a new grant proposal and looked for alternative funding sources. In 2002, a continuation of the GCC grant was awarded for the sums of $261,489 for the first year and $322,500 for the second. These grant funds allowed for the creation of a two-part Family Treatment Court Program, Level I and Level II, in order to provide more appropriate services to program participants. Level I was a less intensive program that did not include bi-weekly judicial monitoring, while Level II provided participants with more intensive substance abuse treatment services and other components that characterize Family Treatment Court programs. Since the GCC grant period ended in June 2004, Mecklenburg County currently provides funds to support the positions of the FIRST Program Coordinator and the Case Coordinator. The position of the FIRST Program Qualified Substance Abuse Professional (QSAP) is funded by the Mecklenburg County Area Mental Health Authority (AMHA). The AMHA also funds the majority of the treatment services provided through the FIRST Program. This includes $250,000 for substance abuse treatment services for female participants, and $200,000 for 10 residential beds available to female participants and their children. The original members, who proposed and oversaw the creation of the Mecklenburg County FIRST Program, were Judges Fulton and Evans, Deannette Smith from Youth and Family Services, and Grayce Crockett from Mecklenburg County AMHA. History of Program Implementation and Modifications The existence of the FIRST program was the result of collaboration between the Mecklenburg County Drug Treatment Court Program, the Mecklenburg County Department of Social Services (DSS), and the Mecklenburg County AMHA. The court was created in response to a social problem outlined in the original 1999 Governor s Crime Commission (GCC) grant proposal. In 1998, substance abuse was named by 32 states as one of the top two problems associated with child abuse and neglect. The Department of Social Services in Mecklenburg County reported that up to 80% of its cases involved substance abuse in one or both of the parents. In light of the Adoption and Safe Families Act (ASFA), which was passed by the General Assembly in 1997, treatment of substance abuse to facilitate timely family reunification became a vital need. Family Dependency/Drug Treatment Court (FDTC) became a viable intervention strategy to provide parents with substance abuse treatment, support services and monitoring to increase their likelihood of recovering from their addiction, and regaining custody of their children. Several key individuals who recognized the need for this type of court were initially involved in planning for the court and seeking funding. Judge Yvonne Evans, who later became the court s first Judge, was a Judge in the family court who strongly believed in the need for a FDTC in Mecklenburg County. She worked with Karen Simon who, at the time, was the Director of IRT,

11 Mecklenburg County Drug Treatment Courts, Deannette Smith from DSS Youth and Family Services Division (YFS); Chuck Porter, a friend of Judge Evans and a local attorney; and Grayce Crockett from Area Mental Health Authority (AMHA) to develop the FIRST program. The FDTC that resulted is based on the parallel or separate model. In contrast to a fully integrated FDTC model, where the same Judge presides over the abuse or neglect and the parent s treatment case plan, a parallel model is characterized by the separation of these two proceedings. In the FIRST Program, the drug court Judge presides over some but not all of the abuse or neglect or dependency cases. The original 1999 grant proposal was funded by the GCC effective July 1, 1999 and was extended in 2000 and The court s first Case Coordinator began in the position in October of 1999 and the first court session of the Family Treatment Court (FTC) was held in December The FTC developed written materials and MOU s with DSS and the Justice System, and facilitated Strategic Planning Meetings with personnel from both of these systems, as well as treatment providers, parenting education providers, and community organizations. Court administrators applied to the GCC for funding again in 2001 and proposed additional changes in the implementation of the court. This grant was funded effective July 1, st 2002, for one year with the possibility of extension for two additional years. In September of the same year, the Mecklenburg county FTC was named the Families in Recovery to Stay Together Program (FIRST) and expanded to include two tracks, Level I and Level II. Systemwide implementation began in December of 2002 on a continuation of the original 1999 GCC grant and involved the collaborative efforts of the Court, Mecklenburg County DSS Youth and Family Services Division, and the Mecklenburg County AMHA. The two levels of participation offered by the FIRST program, differed in severity of treatment and level of contractual commitment. Level I was a less intensive program while Level II provided more intensive substance abuse services, bi-weekly meetings with the Case Coordinator and bi-weekly appearances before the Family Treatment Court Judge. Two other major changes in the functioning of the court were put into effect during this period of time. In 2001, seeing a need to adapt the screening process and expand the program, Judge Evans met with DSS and AMHA representatives to discuss the possibility of screening all parents and legal guardians whose children have been adjudicated abused and/or neglected for domestic violence, substance abuse, and mental health problems. This process was successfully implemented in September of 2002; however, services were only available for substance abuse treatment with limited services for mental health and no immediate access to services for domestic violence. Referrals were made for domestic violence services as needed and court administrators continued to search for additional opportunities to increase availability to mental health services. In cases where screening results indicated a need for substance abuse treatment, the court could now officially order parents to comply with Level I treatment through the FIRST program and write this into the court order. Level I participants who did not comply with SA Treatment would either be held in contempt or ordered into Level 2 to receive more intensive treatment. This process was based on the ideology that substance abuse treatment would lead to more timely compliance with ASFA guidelines. IRT,

12 The second change involved the capacity of the court to provide residential services for participants who lacked a stable living environment in which they could recover and live with their children once they regain custody. With some of the funding attained through the 2001 GCC grant, the FTC purchased 17 beds at Hope Haven, a licensed residential halfway house for women, and implemented a new residential program in collaboration with Courage and Support for Changing Attitudes, Dependencies, and Environments (CASCADE), to serve women and their children. On July 1, 2003, the program gained access to 10 additional residential beds through CASCADE. One year later, in June 2004, the FIRST Program lost access to the residential services provided at Hope Haven, due to funding constraints. CASCADE is currently the primary treatment provider for the FIRST Program. Funding allocated to CASCADE by the Mecklenburg County AMHA allows the Family Treatment Court to maintain the 10 residential beds and to provide gender-specific, substance abuse treatment for female participants. The modifications that the court implemented within its first few years all had a positive impact on the functioning of the court and allowed it to better meet the needs of its participants. The program became a model FTC and received visitors from around the country who were planning to implement similar courts. In 2003, the FIRST program received the 2003 Pioneer Award from the Chemical Dependency Center and was recognized as a Program of Excellence by the North Carolina Council of Community MH/DD/SA Programs. Other recognitions include the inclusion of the FIRST program in the Bureau of Justice Assistance s (BJA) annual report to the US Congress as an exemplary model of a FTC and the identification of the FIRST program as a National Drug Court Institute (NDCI) host training site. In addition, Judge Avril Sisk, Erica Oxendine-Hall, the Case Manger, Tyrone Wade, the DSS Youth and Family Services (YFS) attorney,and Charles Porter, parent s attorney were asked to assist the NDCI at their Family Drug Treatment Court Operations Training sessions. The FIRST program has conducted annual evaluations entitled SCOT ( Strengths, Challenges, Opportunities and Threats ) analyses. SCOT analyses for Fiscal Year and Fiscal Year are reviewed below. These documents have highlighted the challenges faced by the administrators and team in implementing the program as well as options for minimizing or overcoming these barriers. Most of the internal challenges that were identified in the and the SCOT analyses have either been sufficiently addressed or are currently being dealt with. The first challenge was the need for integrated case planning. Social workers were previously unable to attend the integrated staffing meetings in which the team discusses participant progress in attaining program goals and fulfilling requirements. The team addressed this issue by communicating with social workers and attendance has greatly improved over the past six months. Second, the team stated that there was a need for further education across collaborative agencies. The FIRST Program provided six training sessions in 2003 that were aimed at educating members of collaborating agencies on various aspects of client services, such as strength-based assessments and treatment planning. All of the collaborative agencies participated in these trainings. A third challenge documented both years was the full participation of all team IRT,

13 members in the implementation of the program, including legal counsel. The Judge addressed this during pre-court and monthly meetings by emphasizing the important role played by each member of the Team and reinforcing their level of dedication to the FIRST Program. This challenge was successfully overcome and the entire team is currently committed to the program and the participants that they serve. Fourth, both analyses included the need for a comprehensive database system to measure outcomes. The North Carolina Administrative Office of the Courts (AOC) is currently in the process of developing a comprehensive database system for use by all FDTC s in the state. Finally, another challenge reported in both SCOT analyses was scheduling and documentation from the Clerk s office. In the past, the program had a difficult time receiving court orders from the Juvenile Review hearings regarding parents ordered into the FIRST program. Several steps were taken to deal with this challenge, including discussions during monthly team meetings, discussions with the Juvenile Clerk s office, s sent to DSS attorneys, a stronger judicial role in requesting prompt receipt of information, and changes within the court order form to make it more user-friendly and easier to designate parents ordered to the program. The attorneys and the clerk's office have since worked diligently to ensure that this information is relayed in a timely manner and the number of missed referrals has been greatly reduced. A few other barriers persist despite measures taken to minimize or overcome their effects on the functioning of the court. These include the need for more staff due to the large volume of referrals, refinement of policies and procedures for the residential provider, limited number of substance abuse treatment slots, and financial support. Due to lack of funding to hire a Case Coordinator for Level I participants, these responsibilities are currently performed by the Program Coordinator with assistance from the FIRST QSAP. Team members report that a Level I Case Coordinator is much needed to oversee the large caseload of clients. According to a team member, statewide mental health reform has also had an impact on the FIRST program. Due to divestiture of local mental health services, effective February 1, 2005, the FIRST Program reported that it no longer has a contract with the main substance abuse treatment provider for FTC participants. This change has reduced the ability of the FIRST program to monitor treatment services and has reduced communication between the FTC and the treatment provider. Team members reported that the court s loss of GCC funding in June 2004, limited its financial resources and its ability to provide program-funded treatment services. The GCC funding was time-limited and aimed at facilitating the initial implementation of the drug court. The court anticipated that the 2001 GCC grant would be renewed for an additional three years, but were unexpectedly informed that they would not receive funds for the State Fiscal Year of FIRST Program team members reported that this loss of funding reduces the treatment options available for participants who do not have access to private insurance or Medicaid. The majority of the treatment services that are currently available to participants are paid for by the AMHA, while the Program Coordinator and Case Coordinator positions are funded by Mecklenburg County. Court administrators and team members continue to seek innovative ways of obtaining funding to sustain the court. The FIRST Program recently established a non-profit foundation to allow IRT,

14 for additional funding options such as donations from the community. Administrators also participated in AOC sustainability meetings and are working to get the drug court institutionalized so that it can be supported by the legislature. In addition, the court has recently begun to implement a policy change that would allow participants to have physical custody of their children while DSS maintains legal custody. Since Medicaid funding is only available to parents who have custody of their children, this would enable additional participants to receive treatment services that the service provider can bill to Medicaid. Despite these steps, funding remains a major barrier for this program. Methods and Procedures Used in the Process Evaluation Planning and Orientation In order to introduce and orient all relevant staff and team members to the process evaluation, an initial orientation meeting was held before the beginning the evaluation. Present at this initial orientation meeting were Dr. Janis Kupersmidt, President of Innovation Research and Training (IRT) and Project Director for the Process Evaluation; Dr. Jacqueline Hansen, AOC Evaluation Specialist / Research Coordinator; Cristel Orrand, AOC Research Assistant; Dr. Tiki Gwynne and Dr. Elizabeth Jackson, IRT Team Leaders; Eunice Muthengi, IRT Team Leader for the Mecklenburg FIRST Program Process Evaluation; and Directors of the Orange Mental Health Treatment Court and the Person / Caswell County Adult Drug Treatment Court. Eunice Muthengi later scheduled a conference call with the Program Coordinator of the Mecklenburg County FIRST Program, during which they reviewed each of the topics discussed at this meeting. The agenda for the orientation meeting included a welcome and discussion of the need for the process evaluation; an introduction of IRT team leaders; a description of the respective roles of each organization (e.g., AOC, IRT, and treatment court team members) involved in the process evaluation; the research plan and methods to be used in conducting the evaluation; and the tasks and timelines for completing the evaluation. Treatment Court Administrators were informed of the importance of providing all needed information in accordance with the timelines due to the brief period of time between data collection and report completion. Due to the stringent nature of the timeline, any materials that were not received from the courts by the deadline were not included in the final report. Data Collection and Analysis There were four types of data and methods used to collect and analyze data for this process evaluation report: quantitative data, qualitative data, review of historical documents, and observational data. The collection and analysis of each of theses forms of data is discussed in detail below. Quantitative data. Quantitative data and methods were used to describe the Level II population that has been served by Mecklenburg County FIRST Program from its inception to December 31, 2004, and to begin to describe the characteristics of drug court participants who were current participants, terminated participants or successful graduates of the drug court program (see IRT,

15 Section IV). The data for these quantitative analyses were obtained from the current AOC Evaluation Specialist / Research Coordinator. The quantitative data regarding Level-II participants were collected from the NC Adult MIS and a Microsoft Access database used by the FIRST Program, and included demographic characteristics of both the ineligible and the eligible populations, information regarding the primary drug of choice for each client, and information regarding the client s history and involvement in the Drug Treatment Court. The original datasets were stripped of identifying information such as names and identification numbers in order to ensure anonymity. A unique but non-identifying identification number was assigned to each participant, and questionnaire data were combined into a single database using this number. Analyses were conducted to describe the demographic and background characteristics of clients, such as age, race / ethnicity, educational and employment status, primary drug of choice of drug court participants, and trends related to program capacity and compliance. In addition, quantitative data methods were used to describe participants level of satisfaction with their treatment court experience. Current participants completed a Customer Satisfaction Questionnaire at the close of a court session. The Customer Satisfaction Survey asked participants to provide information regarding their demographic and background characteristics such as gender, race, ethnicity, employment status, marital status, and family composition. In addition, the survey asked participants to report on different aspects of their treatment court experience, such as length of time spent in court, primary drug of choice, charges that led to involvement in Family Treatment Court, and criminal and treatment history. Participants were then asked to rate their level of satisfaction with various aspects of the drug court program, including treatment services, sanctions and incentives, drug testing, community service activities, and court sessions. Finally, participants were asked to rate the level of difficulty of complying with various program requirements, including making it to scheduled appointments, cooperating with treatment programs and services, cooperating with drug testing, paying court fines and fees, and staying clean, sober and drug-free. Analyses were conducted to describe mean- level differences and similarities between participants in terms of age, race, ethnicity, gender and primary drug of choice. Qualitative data. Qualitative data were also collected based upon four different types of openended interviews. First, two hour focus groups were conducted with eight current Level II participants and two current Level I participants. The Moderator s Guide used in conducting the focus groups covered topics such as the most and least helpful aspects of the FIRST Program program, barriers to full program participation, feedback about sanctions and incentives, and the impact of the drug court on participants lives. Focus group interviews were conducted at the FIRST Program office and at the office of the treatment provider and were conducted by trained project staff members from IRT. Before beginning each focus group, the moderator reviewed the informed consent forms with focus group members and answered questions. Then, the moderators followed the protocol outlined in the Moderator s Guide. Additionally, a random sample of nine FIRST Level-I graduates, nine FIRST Level-II graduates nine terminated FIRST Level-I participants, and nine FIRST Level-II participants, stratified by drug of choice, race and gender, were selected for interviews using a semi-structured questionnaire. Despite efforts to reach these graduates and terminated participants as well as an equal number of alternates, only two graduated and two terminated participants completed IRT,

16 interviews. Others were unreachable due to incorrect or outdated contact information. Trained project staff members from IRT conducted the interviews over the telephone. The interview covered such topics as the most and least helpful aspects of the FIRST Program, barriers to participation in the Family Treatment Court feedback about sanctions and incentives, and how the drug court has influenced the lives of the participants. Before beginning the interview, the interviewer reviewed the informed consent form with the participant and answered any questions. The interviewer then followed the protocol outlined in the interview guide to complete the interview. Finally, individual interviews lasting approximately one hour were conducted with all nine FIRST Program team members as well as the Director of all Mecklenburg Treatment Courts and a former FIRST Program Judge. The main topics discussed in each individual semi-structured interview included questions about program history, the most and least helpful aspects of the FIRST Program, the respective roles of team members, barriers to implementing the FIRST Program, feedback about sanctions and incentives, and how the FIRST Program has impacted participants lives. Individual interviews were conducted in team members offices or other rooms at the FIRST Program offices and were led by trained project staff members from IRT. Before beginning the interview, the interviewer reviewed the informed consent form with the staff member being interviewed and answered any questions. Then, the interviewer followed the protocol outlined in the interview guide to complete the interview. Responses to each question were recorded into a database so that answers could be compared across current participants, team members, and former participants. If there was agreement across all respondents on an item, then it was reported as such. Cases in which there was disagreement across respondents were also noted and described in the text. Observational data. Observational methods were used to gather information regarding the processes used in pre-court staff meetings and in court sessions. For the pre-court staff meetings, trained IRT staff observed and noted such factors as the types of issues discussed and the amount of time spent on each issue, the decision-making process, the interaction among team members, and the respective roles of each of the team members. For the court sessions, trained IRT staff observed and noted such factors as the overall atmosphere within the court, the interaction among team members, and interactions between the Judge and the participants for the pre-court staffing and court session observation forms. Historical Documents. Documents pertaining to the history, implementation, modification, and funding of the court were also analyzed for this process evaluation. Documents reviewed included original grant proposals submitted for the implementation of the court, award letters for grants received, the program operation manual, participant contracts and handbooks, SCOT analyses, Operations Committee Meeting minutes, Monthly Team Meeting Minutes, and Monthly Statistical Reports. Trained IRT staff members collected, reviewed, and incorporated information from these documents into the process evaluation report, where appropriate. IRT,

17 Characteristics of FIRST Level-II Participants Demographic and background characteristics data were collected from three groups of FIRST Program Level-II participants including current participants, successful graduates of the program, and participants who were terminated from the program due to rule infractions or changes in the goal of the DSS case. These data were taken from the Mecklenburg County FIRST Program database and the NC Adult MIS database, which the FIRST Program uses for tracking Level II participants. Demographic and background characteristics of the entire sample are shown first; then, the demographic and drug use characteristics are examined as risk factors in the prediction of each type of outcome (e.g., successful program completion, unsuccessful termination). Other variables examined are the sources of referral, reasons for termination and ineligibility, average length of time from intake to admission, compliance with FTC requirements and drug testing results. All reported results are based on results of descriptive statistics. The demographic and background characteristics of the total number of drug court participants can be seen below in Table 1. A total of 76 complete records were available for use in these analyses. This included 17 active participants as of December 31, 2004, and 59 former participants. Only two-fifths of the former participants successfully completed the program (37%), while the others were discharged unsuccessfully (67%). A large majority of these participants were female (80%) and over two-thirds (71%) were African American. Half of these participants were single (54%) and almost two-thirds (63%) did not graduate from high school. The most common primary drug of choice was crack, (36%) followed by alcohol (27%) and marijuana (20%). IRT,

18 Table 1. General Demographic and Basic Characteristics of FIRST Level-II Program Participants Characteristics Of FIRST Level-II Participants (As of 12/31/2004) Total Number Frequency (Percent) Total Number of Participants % Total Active (Current) Participants 17 22% Total Former Participants 59 78% Status of Former Participants Graduated 22 37% Terminated 37 63% Age of Participants Average Age 35 Range (22-53) Gender Percent Female 68 89% Percent Male 8 11% Race / Ethnicity African / African American 54 71% Caucasian / White 19 25% Native American 1 1% Other 2 3% Marital Status Married 6 8% Divorced 12 17% Living with someone as married (but not legally married) 0 0% Separated 13 18% Single/Never married 39 54% Widowed 2 3% IRT,

19 Table 1. (Cont.) Characteristics Of FIRST Level-II Participants (As of 12/31/2004) Total Number Frequency (Percent) Educational Attainment (Years of School Completed) Grade school (K-5) Middle school (6-8) 8 15% High school (NO diploma) 25 48% High school diploma / GED 11 21% Some college or technical college 3 6% Two-year college / Associate degree 4 8% Four-year college degree 0 0% Graduate work / No degree 1 2% * Frequency of missing data = 24 Employment Status* Unemployed (Available for and/or actively seeking work) 31 54% Full-time (35 hours or more per week) 9 16% Part-time (Under 35 hours per week) 2 4% Not in labor force and not available for work 13 23% Disabled 0 0% Other 2 4% * Frequency of missing data = 19 County of Residence Mecklenburg % Primary Drug of Choice Alcohol 20 27% Cocaine (powder) 13 17% Crack 27 36% Heroin 0 0% Marijuana 15 20% Other 0 0% The following three tables (Tables 2 to 4) show Family Treatment Court outcomes as a function of participants race, gender and primary drug of choice. Table 2 indicates that the rates for graduation from the FIRST program are slightly higher for African Americans (41%) than for Caucasians (33%). Conclusions about the effectiveness of the program in serving people of varying racial backgrounds cannot be drawn from these findings without further analyses, which is beyond the scope of this report. IRT,

20 Table 2. FIRST Level-II Status by Race Court Status Race Graduated Terminated Total African/African American 41% 59% 39 Caucasian/White 33% 67% 18 Native American 0% 100% 1 Other 0% 100% 1 Although the majority of participants served by the FIRST Program are females, graduation rates do not seem to differ considerably by gender. As seen in Table 3, below, slightly more than one third (38%) of the female participants graduated compared to almost a third of the males (29%). Table 3. FIRST Level II Status by Gender Court Status Gender Graduated Terminated Total Female 38% 62% 52 Male 29% 71% 7 Table 4 indicates that the rates of program completion are highest for participants whose primary drugs of choice were alcohol (56%) or crack (40%). Program completion rates were lowest for participants whose primary drugs of choice were cocaine (13%) or marijuana (17%). Table 4. FIRST Level II Status by Primary Drug of Choice Court Status Primary Drug of Choice Graduated Terminated Total Alcohol 56% 44% 18 Cocaine (powder) 13% 88% 8 Crack 40% 60% 20 Heroin 0% 0% 0 Marijuana 17% 83% 12 The next four tables (Tables 5 to 8) examine the sources that initially referred participants to the FIRST program. Table 5 shows the referral sources for 73 of the current and former FIRST Level-II participants. Most of the referrals for FIRST Level II participants were made by the Judge (60%) or by other individuals (33%). IRT,

21 Table 5. FIRST Level II Primary Referral Source Primary Referral Source Number Percentage Public Defender 4 5% Judge 44 60% Other 24 33% Offender 0 0% Private Defense Attorney 1 1% Total 73 99% As seen in Table 6, African-American active participants were either referred to the FIRST program by Other sources (60%) or by the Judge (40%). Referrals for the other two participants were also made by the Judge. Table 6. Primary Referral Source for FIRST Level II Active Participants by Race Primary Referral Source African American (N=15) Caucasian/ White (N=1) Race Native American (N=0) Other (N=1) Total Public Defender 0% 0% 0% 0% 0 Judge 40% 100% 0% 100% 8 Other 60% 0% 0% 0% 9 Offender 0% 0% 0% 0% 0 Private Defense Attorney 0% 0% 0% 0% 0 Table 7 shows a similar distribution of the referral source by gender. Over half of the females (56%) were referred by Other sources and the others were referred by the Judge (44%). Table 7. Primary Referral Source for FIRST Level-II Active Participants by Gender Gender Primary Referral Source Female (N=16) Male (N=1) Total Public Defender 0% 0% 0 Judge 44% 100% 8 Other 56% 0% 9 Offender 0% 0% 0 Private Defense Attorney 0% 0% 0 IRT,

22 The primary referral source was also examined by participant status for former participants. As seen in Table 8, below, half of the participants who graduated from the program were referred by the Judge and a third were referred by Other sources. Almost three-fourths of the terminated participants were also referred by the Judge. Table 8. FIRST Level-II Primary Referral Source by Participant Status Court Status Graduated Terminated Total Primary Referral Source (N=20) (N=36) Public Defender 15% 3% 4 Judge 50% 72% 44 Other 35% 22% 24 Offender 0% 0% 0 Private Defense Attorney 0% 3% 1 FIRST Level-II Program participants can be discharged for a variety of reasons. Table 9 shows the primary reasons for discharge due to termination for 33 former participants. While a few participants were terminated because of a change in the goal of the DSS case, most (82%) of the participants were terminated because of noncompliance with the FIRST Program rules (DTC noncompliance). Table 9. FIRST Level-II Primary Reason for Discharge due to Termination Primary Reason for Discharge Number Percentage DTC noncompliance 27 82% Plan changed to Termination of Parental Rights 3 9% Plan changed to reunification w/other parent 1 3% Plan changed from reunification 2 6% Other 0 0% Total % Participants can have more than one type of noncompliance. These reasons for noncompliance are further described in Table 10. The most common types of noncompliance for these former participants were failure to meet other requirements (25%), failure to attend treatment (23%), and failure to make case manager [case coordinator] contacts (22%). IRT,

23 Table 10. Types of FIRST Level-II Noncompliance Leading to Discharge Type of Noncompliance * Number Percentage Failure to attend treatment 18 23% Failure to attend court 9 12% Failure to make case manager 1 contacts 17 22% Failure to make probation contacts 3 4% Failure to meet other requirements 19 25% Other 11 14% *Note: Participants may have more than one recorded type of FIRST Level-II noncompliance. The term case manager has recently been changed to case coordinator. Table 11 indicates that an average of 13 days elapsed between the day that Level II participants were referred to the FIRST Level II Program and the day an interview was conducted to determine eligibility for the program. The average length of time from the referral date to the admission date was 24 days, while the average length of time from the admission date to the intake interview was another 23 days. Table 11. Average Length of Time for FIRST Level-II Program Referral, Interview and Admission Time Interval Number Mean Average number of days from Referral to Interview Average number of days from Admission to Intake Interview Average number of days from Referral to Admission FIRST Level II-Program participants demonstrated high levels of compliance with attendance of case management appointments and required AA/NA meetings. Table 12 indicates that, on average, participants attended 87% of their case management meetings and 93% of the required AA/NA meetings. IRT,

24 Table 12. Compliance with FIRST Level-II Requirements Compliance Issue Proportion of case management appointments made to appointments required. Proportion of AA / NA appointments made to appointments required. Mean Proportion Participants also appear to be compliant with drug testing, which is used to monitor their ability to achieve abstinence from drugs while in the program. Negative drug tests were recorded for almost all participants for cocaine (97%), marijuana (97%), opiates (99%), and methamphetamines (99%). These findings describe results from 1621 tests for methamphetamines, 2720 tests for opiates, 2778 tests for marijuana, and 2777 tests for cocaine. Table 13. FIRST Level-II Drug Test Results Drug of Choice Type of Result Cocaine Marijuana Opiates Methamphetamines Admitted use 0% 0% 0% 0% Did not show for test 0% 0% 0% 0% Contaminated 0% 0% 0% 0% Specimen Excused positive 0% 0% 0% 0% Lab rejected specimen 1% 2% 1% 1% Negative, based on test 97% 97% 99% 99% Positive, based on test 3% 1% 1% 0% Refused/Unable to 0% 0% 0% 0% give specimen Specimen not submitted for analysis 0% 0% 0% 0% A total of 33 candidates were ineligible for participation in the FIRST Level-II Program for a variety of reasons. As seen in Table 14, more than a third (40%) of the participants were ineligible due to noncompliance with pre-admission requirements. Other common reasons for ineligibility were unwillingness to participate (18%) and other reasons (27%). IRT,