BJA GRANT PROJECT: Utah s Adult Drug Treatment Courts SEPTEMBER 20, 2016 1 Project Overview Grant from Bureau of Justice Assistance Contract with the National Center for State Courts to: Develop performance measures Conduct process evaluation Conduct outcome evaluation 2 1
Process Evaluation 3 Process Evaluation Defined Answers the question: Was the program implemented as intended? An implementation or process evaluation is designed to answer this and other key questions about who is being served and how the program is operating in accordance with best practices. Program processes are studied and a logic model of the program s operating theory is constructed. Participants are profiled and compared to intended target population. Services provided are compared to participants assessed needs. 4 2
Logic Model of Utah Adult Drug Courts 5 Court Selection The NCSC team examined the following factors in selecting the drug court sites included in this evaluation project: Time since program implementation Number served Jurisdiction type (e.g. urban, rural, etc.) 6 3
Court Selection Six sites were ultimately selected based on their longevity, total numbers served, data collection practices, readiness for evaluation and willingness for evaluation. Additionally, the selected programs are each located in a separate judicial circuit, represent rural to urban localities, and to the extent that was possible, are geographically dispersed across the state. 7 Programs Selected for Process Evaluation by Implementation Year Jurisdiction Implementation Year Salt Lake County 1995 Uintah County 1997 Cache County 2000 Weber County 2000 Sevier County 2003 Carbon County 2005 8 4
Methodology and Data Collection Qualitative Methods: Semi-structured interviews, semi-structured focus groups, observation and document reviews Quantitative Methods: Quantitative data used in this evaluation was extracted from the TEDS database and provided by the DSAMHS. Data was collected for all participants that exited a drug court in the study in 2014. 9 Team Composition Utah Adult Drug Court Team Members, by Role Role on the Team Courts Judge 100% Drug Court Coordinator 50% Prosecutor 83% Defense Attorney 83% Treatment Providers 100% Drug Court Case Manager 50% Adult Probation and Parole Officer 83% Law Enforcement Officer 67% Department of Child and Family Services Representative 17% 10 5
Eligibility, Screening and Assessment Utah s ADCs target adults charged with a felony drug crime, drug related crime or subsequent violation of probation. Participation in an ADC is generally available to individuals charged with a drug related crime with a high risk to reoffend and high needs due to a substance use disorder and other identified criminogenic needs, though additional legal and clinical criteria may be utilized to determine eligibility by each local ADC. 11 Eligibility, Screening and Assessment Legal Eligibility Governed by Utah Code Ann. 78A-5-201 Additional exclusion criteria may include a criminal history that contains a violent offense or sex offense or a drug distribution offense, lack of prior drug arrests or convictions, a history of violations of probation or parole, or a referral charge of drug distribution. Clinical Eligibility Generally based on meeting criteria for a substance use disorder based on the DSM-V. 12 6
Eligibility, Screening and Assessment Additional Eligibility Factors High risk and high need based on the administration of the Risk and Needs Triage (RANT). Cases involving referred defendants already under probation supervision may have the results of the Level of Service Inventory-Revised (LSI-R) available as well. The LSI-R is administered by an Adult Probation and Parole Officer (AP&P). Reside in the jurisdiction served by the ADC to enter the program and obtain services. 13 Screening and Assessment Legal Screening Shift from plea in abeyance to post-adjudication cases Clinical Screening and Assessment Bio-psycho-social interview Use of validated instruments Determination of presence of SA disorder and appropriate ASAM level of care 14 7
Participant Profile Number of Participants Exiting in 2014, by Program 15 Demographics Average Percent of Participants, by Sex 16 8
Demographics Average Percent of Participants, by Age Category 17 Demographics Average Percent of Participants, by Race 18 9
Demographics Average Percent of Participants, by Employment Status at Admission 19 Demographics Average Percent of Participants, by Marital Status at Admission 20 10
Risk and Needs Percent of Results of RANT Administration, by Risk/Needs Level 21 Risk and Needs Average Percent of Participants, by Drug of Choice 22 11
Risk and Needs Range of Percentage of Participants in each Program, by Drug of Choice Minimum Maximum Alcohol 0% 40% Cocaine 0% 8% Heroin 3% 32% Marijuana 5% 25% Methamphetamines 22% 50% Other 0% 7% Other Opiates 2% 27% 23 Risk and Needs Average Percent of Participants, by Age of First Drug Use 24 12
Risk and Needs Average Percent of Participants with Mental Health Diagnosis, at Admission 25 Risk and Needs Average Percent of Participants at Admission, by Insurance Type 26 13
Program Structure Phase System Organized in systems that are four to five phases in length Each program has varying policies and procedures regarding the length or dosage of each phase requirement Length of Stay The average length of stay varies by program. Programs range on average from 16 to 24 months for those successfully completing the program. 27 Length of Stay Average Length of Stay Jurisdiction Length of stay (months) Cache County 16 Carbon County 24 Salt Lake County 22 Sevier County 19 Uintah County 21 Weber County 16 28 14
Treatment Services Average Length of Stay in Treatment Jurisdiction Length of Stay (Months) Cache County 18.6 Carbon County 11.1 Salt Lake County 14.3 Sevier County 9.2 Uintah County 16.1 Weber County 9.4 29 Substance Abuse Treatment Percentage of Program Substance Abuse Treatment Services Substance Abuse Service Available in ADC Referral in Community Gender-Specific Treatment Groups 83% - Individual Counseling 83% 17% Intensive Outpatient Substance Abuse Groups 100% - Medical Detox - 50% Medication Assisted Treatment 50% 17% Outpatient Substance Abuse Groups 100% - Peer Recovery Support Groups/Coaching 67% 17% Relapse Prevention Groups 100% - Residential Treatment 33% 67% Substance Abuse Case Management 83% - 30 15
Mental Health Treatment Percentage of Program Mental Health Services Mental Health Service Available in ADC Referral in Community Access to Psychotropic Medications 50% 50% Emergency Psychiatric Services 50% 33% Mental Health Case Management 83% - Outpatient Mental Health Treatment 100% - Psychiatric Evaluations 83% 17% Trauma Services 100% - 31 Ancillary Services Percentage of Program Ancillary Services Ancillary Service Available in ADC Referral in Community Anger Management 83% 17% Cognitive Behavioral Treatment 100% - Family Counseling 67% 17% GED Prep Services/Tutoring - 67% Life Skills Training 83% 17% Medical Screening - 100% Mentoring 83% 17% Parenting Classes 50% 50% Physical Health Services - 100% Vocational Training 33% 50% 32 16
Community Supervision Community supervision may be the responsibility of one or several team members depending on the individual structure of the program and also the type of court case involved. Law enforcement officers (trackers) may provide supervision for all participants. Adult Probation & Parole officers only provide supervision and services to those participants under court-ordered conditions of probation. 33 Community Supervision Community supervision may include, conducting home and office contacts, drug testing, collection of costs/fees/fines and restitution, completion of program orientation for new ADC participants, employment verifications and GPS monitoring. AP&P officers also administer the Level of Service Inventory- Revised (LSI-R) and develop individual case plans for participants on probation. 34 17
Drug Testing Conducted by: AP&P Case managers Treatment staff Law enforcement Contracted vendor Urinalysis collectors (to administer tests in the evenings) Each court reports randomly testing participants via a color code system. The frequency of testing varies across courts, occurring 2 to 3 times per week. Three courts indicated that testing may occur on weekends and holidays in addition to weekday testing 35 Drug Testing Percentage of Ability to Test Drugs, by Type Drug Ability to Test Drug Ability to Test Alcohol 100% Marijuana 100% Amphetamine 100% MDMA 50% Barbiturates 83% Methadone 100% Bath Salts 83% Methamphetamines 100% Benzodiazepines 100% Opiates 100% Buprenorphine 83% Phencyclidine (PCP) 33% Cocaine 100% Psilocybin (Mushrooms) 17% GHB 17% Synthetic Marijuana 83% Ketamine 17% Tramadol 17% LSD 33% 36 18
Court Status Hearings: Staffing Percentage of Staffing Attendance, by Role Team Member Attendance Judge 100% Coordinator 100% Prosecutor 100% Defense Attorney 100% Treatment Provider 83% Drug Court Case Manager 50% Adult Probation and Parole Officer 83% Law Enforcement Officer 67% Department of Child and Family Services Representative 17% Court Clerk 67% Law Clerk 17% 501 3 Representative 17% Ancillary Serice Provider 17% County Attorney Administrative Staff 33% Civil Attorney 17% 37 Court Status Hearings: Hearings Percentage of Status Hearing Attendance, by Role Team Member Attendance Judge 100% Coordinator 100% Prosecutor 100% Defense Attorney 100% Treatment Provider 100% Drug Court Case Manager 50% Adult Probation and Parole Officer 83% Law Enforcement Officer 67% Department of Child and Family Services Representative 17% Court Clerk 67% Law Clerk 17% 501 3 Representative 17% Ancillary Serice Provider 17% County Attorney Administrative Staff 33% Civil Attorney 17% 38 19
Court Status Hearings: Hearings Average Minutes per Case, by Court 39 Sanctions and Incentives Percentage of Sanction Use Sanctions Use Attend sentencing proceedings on another Judge 17% Community Service 100% Essays/Homework 83% Extra AA/NA Meetings 33% Fine 83% Increased Drug Tests 67% Jail 100% Phase Restart or Demotion 50% Verbal Reprimand 50% 40 20
Sanctions and Incentives Percentage of Incentive Use Incentives Use Applause/Verbal Praise 100% Candy Bars 17% Fast Pass (called first on docket) 50% Gift Card 100% Medallions and Plaques 17% Monetary Gift 17% Phase Promotion 67% Reduction in Monitoring 50% Reduction in Program or Drug Test Fees 67% 41 Program Exit Graduation requirements can include: A period of extended sobriety Completion of treatment plan Pay all drug court fees Community service project Completion of a relapse prevention or a continuing care plan 42 21
Program Exit Termination reasons may include: New convictions for violent offenses, drug distribution, sexual assault Violence within the program Drug test tampering Absconding for a period of time specified by the individual ADCs 43 Clients Perspectives: Requirements & Motivation Programmatic requirements: Participants provided mixed feedback regarding general understanding of programmatic requirements. Many participants feel that the rules are always changing and not all rules are communicated in writing. There is a lack of clarity regarding the roles of some drug court team members, such as the public defender. 44 22
Clients Perspectives: Requirements & Motivation Motivation for success: Sense of community and structure of drug court. Prospect of a failed drug test, community service, jail sanctions or even death. The possibility of returning to court for sentencing on charges and going to prison if terminated also motivates participants to succeed. Some treatment staff can be motivating to participants as they feel they genuinely care for participants and their progress. 45 Clients Perspectives: Sanctions & Incentives Sanctions Lack of consistency when issuing sanctions. The current sanctioning system can be biased, inconsistent, unfair and uninformed. The judge does explain the reasoning behind the different sanctions. Would like the opportunity to explain their side of the story during sanctioning. Excessive use of jail. Prefer more treatment responses to behaviors, such as report writing or community service. 46 23
Clients Perspectives: Sanctions & Incentives Incentives: There is a lack of incentives or a lack of effective incentives. Some participants voiced that tangible rewards were not motivating in comparison to intangible rewards such as a weekend pass or permission to do recreational activities. Some participants also voiced that monetary rewards could be used toward more treatment or discounted program fees. 47 Clients Perspectives: Gaps in Services Treatment: Individual counseling Improved access to psychiatric services and psychotropic medications Services for veterans and spouses, particularly trauma services In-patient/residential treatment Acceptance of private insurance/medicaid 48 24
Clients Perspectives: Gaps in Services Recovery support services: Sober living housing Transitional housing Public housing assistance (currently waits lists of 2 years or longer) Educational, vocational and employment assistance Public transportation Healthy living and dietary education 49 Clients Perspectives: Gaps in Services Drug testing: Drug testing at alternate times and locations to accommodate work schedules 50 25
Team Member Feedback ADC team members at each site were asked to identify service and resource gaps in their ADCs. Treatment: Increase in-patient/residential treatment availability Detoxification services as an alternative to jail Family treatment services Expand access to mental health treatment Increase access to and funding for medication 51 Team Member Feedback Recovery support services: Sober housing, particularly for women Transitional housing Public transportation Employment counseling and assistance Peer support and mentoring Establish and support alumni groups 52 26
Team Member Feedback Program capacity and structure: Implement an increased variety of sanction options Add a separate docket for low-risk, high-need participants Drug testing: Expand drug testing hours Drug court team: Increase treatment staff Increase community supervision staff (law enforcement and probation) Provide training to all new and existing staff 53 NCSC Recommendations: Eligibility, Screening and Assessment Target High-Risk and High-Need Participants: Target high-risk and high-need defendants Use the Risk and Needs Triage (RANT) as a screening tool to assist in identifying potentially appropriate participants and not to determine clinical eligibility. 54 27
NCSC Recommendations: Eligibility, Screening and Assessment Legal Screening: Ensure the process is transparent to all ADC team members and is based on objective criteria. Criteria should be in writing and shared with potential referral sources. Clinical Screening and Assessment: Both clinical screening and assessment should occur, as screening instruments alone do not accurately provide a diagnosis. Clinical assessments, including structured interviews and the use of validated tools, should be completed prior to program entry to ensure the program targets high-needs defendants. 55 NCSC Recommendations: Drug Court Team Team Composition: ADC team should include, at a minimum, a judge, program coordinator, prosecutor, defense attorney, community supervision officer and treatment representative. Establish clear role definition and job descriptions that are documented in writing. Training: Establish a formal orientation process for new team members. Provide on-going drug court related training opportunities to all team members annually. 56 28
NCSC Recommendations: Drug Court Team Communication: Have the appropriate consent and release of information protections in place so treatment and other information may be readily shared. Reports should be produced for each individual that is discussed during staffing meetings that include, at a minimum, drug testing results, adjustment to treatment and compliance with supervision and/or court requirements. Additional information such as prior sanctions and incentives, demographic information and court case information and any other information the ADC team would find useful on a recurring basis may also be included. 57 NCSC Recommendations: Drug Testing Testing Procedures: Document all procedures in writing, based on evidence based practices and are uniform across all testing agencies. Randomization: Institute a truly random drug testing process where each day the odds of being testing are the same as any other day of the week. Every effort should be made to conduct testing during non-business hours (evenings, holidays, weekends). 58 29
NCSC Recommendations: Drug Testing Validity: Policies and procedures should address the validity of specimens, particularly dilution. Testing for validity should include measurements of temperature, creatinine and specific gravity. All team members should receive training regarding drug testing procedures, including appropriate responses to the provision of invalid samples. 59 NCSC Recommendations: Treatment Case plans should be devised based on standardized assessment tools and should be individualized and address treatment, responsivity, criminogenic and maintenance needs of participants. Assign level of care based on a standardized assessment. Provide access to a continuum of care that includes residential treatment and sober housing along with outpatient treatment. Utilize manualized curriculum, implemented with fidelity. 60 30
NCSC Recommendations: Sanctions and Incentives Devise a written schedule of both potential sanctions and incentives that is graduated in nature and includes both the behavior that would elicit the sanction or incentive and the range of sanctions and incentives that could be ordered. Jail sanctions should be both immediate and certain though used sparingly and not typically in magnitudes of greater than 3 to 5 days. Use of jail as a means of detoxification or while awaiting placement in residential treatment should be used in rare instances. 61 NCSC Recommendations: Data Collection and Evaluation Utilize an electronic management information system to collect case-level data related to all aspects of the ADC services, including referral, court, treatment, supervision, drug testing, sanction & incentives, ancillary services, etc. Ensure the timeliness and reliability of data that is collected. Institute a data quality assurance component. 62 31
Outcome Evaluation 63 Outcome Evaluation Defined Answers the question: Is the program effective? Outcomes are short-term impacts and include considerations such as drug testing results, in-program recidivism and treatment dosages. Long-term impacts include post-program recidivism and employment. Outcome/impact analyses determine whether the program (or something else, such as a change in policy or law) is responsible for the outcomes/impacts observed and typically require a valid comparison group. 64 32
Research Questions In-Program Recidivism To what extent have drug court participants been arrested on new charges while they are active in the program? When participants have been arrested, what are the types of charges (e.g., drug possession, traffic infraction, violent offense)? To what extent have the drug court participants remained arrest-free after their admission to the program? What percentage of all clients is rearrested during their time in the drug court program? What are the characteristics of clients who are rearrested during the program, compared to those who are not rearrested? 65 Research Questions Post-Program Recidivism To what extent have program participants and the comparison group been arrested and/or convicted of new charges following participation in the program or business as usual? When they have been arrested and/or convicted, what are the types of charges (e.g., drug possession, traffic infraction, violent offense)? What percentage of each group is convicted during their time in the program and/or business as usual? What are the characteristics of those who are rearrested or convicted? 66 33
Drug Court Sample by Jurisdiction Jurisdiction Numbers Served Cache County 151 Salt Lake County 390 Uintah County 18 Weber County 146 Represents participants that exited the programs between July 1, 2011 and June 30, 2013. 67 Comparison Group Selection Propensity Score Matching (PSM) Assists in determining if the treatment (drug court) has a causal effect on the outcome Matches treatment and control groups in terms of what affects the outcome except for the receipt of treatment, such as: Race Gender Age Prior number of felony convictions Charge type Equal numbers of members in both groups at the jurisdiction level 68 34
Outcome Data Results: Preliminary Findings Age at Program Admission 69 Outcome Data Results: Preliminary Findings Age at Program Exit 70 35
Outcome Data Results: Preliminary Findings Sex of Participants 71 Outcome Data Results: Preliminary Findings Race/Ethnicity of Participants 72 36
Outcome Data Results: Preliminary Findings Exit Type, by Length of Stay Length of Stay Graduated Terminated Other Under 1 year (206) 1 year to 2 years (333) 2 years to 3 years (127) 3 years to 4 years (38) 32% (66) 75% (250) 61% (77) 42% (16) 49% (100) 21% (70) 37% (47) 53% (20) 19% (40) 4% (13) 2% (3) 5% (2) 73 Outcome Data Results: Preliminary Findings Exit Type, by Gender Graduated Terminated Other Male (452) 59% (266) 33% (148) 8% (38) Female (253) 57% (144) 35% (89) 8% (20) 74 37
Outcome Data Results: Preliminary Findings Exit Type, by County Cache County (151) Salt Lake City County (390) Uintah County (18) Weber County (146) Graduated Terminated Other 52% (78) 64% (248) 72% (13) 49% (71) 29% (44) 29% (114) 28% (5) 51% (74) 19% (29) 7% (28) 0% (0) 2% (1) 75 Outcome Data Results: Preliminary Findings Exit Type, by Race/Ethnicity African-American (22) White (629) Hispanic (21) Other (33) Graduated Terminated Other 32% (7) 60% (376) 52% (11) 48% (16) 59% (13) 33% (205) 48% (10) 27% (9) 9% (2) 8% (48) 0% (0) 24% (8) 76 38
Outcome Data Results: Preliminary Findings Exit Type, by Age Age at Exit Graduated Terminated Other 19-21 52% 32% 16% (31) (16) (10) (5) 22-30 (306) 31-39 (215) 40-49 (99) 50-59 (47) 60-66 (6) 55% (169) 57% (122) 67% (66) 70% (33) 50% (3) 34% (104) 35% (76) 31% (31) 28% (13) 50% (3) 11% (33) 8% (17) 2% (2) 2% (1) 0% (0) 77 Outcome Evaluation: Next Steps Attempt to obtain additional data: Court data from AOC Criminal history data from UT Bureau of Criminal Identification Treatment data from DSAMHS Supervision data from Department of Corrections, Parole and Probation Create comparison group using PSM methods Prepare a final report with in-program and post-program recidivism for program participants and comparison groups 78 39
Questions? Michelle White mwhite@ncsc.org 303-308-4342 79 40