Wake County Adult Drug Treatment Court

1
Wake CountyAdult Drug Treatment Court

• Process Evaluation Results

Submitted by Valerie Anderson, M.A. Nena
Lekwauwa Adam Ross Dr. Janis Kupersmidt innovation
Research Training
[phone] www.irtinc.us
2
Outline

• Background
• Team Composition, Roles and Functioning
• Program Eligibility, Referral, and Admission
• Treatment Services
• Sanctions
• Incentives
• Case Management Judicial Supervision
• Termination Graduation
• Results of Consumer Satisfaction Survey
• Challenges to Program Completion
• Life Improvements Attributed to Program
• Overall Strengths Barriers
• Overall Recommendations
• Timeline

3
BackgroundProgram History

• NC Drug Treatment Court Act enacted in 1995
• One of five original pilot courts
• Original grant application submitted by Carolina
  Correctional Services
• Began operation in 1996
• Originally operated in two courts (Superior and
  District)
• Consolidated into District Court in 2001
• AOC assumes administration of WCADTC on July 1,
  2005

4
BackgroundTransition of Court Management

• Reasons Provided for Transition
• High operating costs due to administrative
  overhead
• Lack of community networking and partnership
  with local organizations such as Treatment
  Alternatives for Safer Communities (TASC) and
  other relevant community agencies
• Goals of Transition
• Seamless and no harm provision of treatment
  services
• Increase number of community partnerships
• Recommendations Regarding Transition
• Conduct analyses of cost savings with transition
  to AOC court administration
• Formal training and orientation process for new
  team members
• Consider the potential role of TASC in
  performing case management services or serving
  as a member of the core court team
• Involve Local Management Committee in the
  planning process

5
Team MembersBackground and Training

• Strengths
• Most team members have attended State and
  National DTC trainings
• Team members have had prior relevant educational
  and professional training in preparation for
  their current roles

• Barriers
• Team members reported greater need for
  cross-training of team members
• Treatment Providers are not yet Certified
  Substance Abuse Counselors, although both are
  currently working towards this goal

6
Team Members Background and Training
Recommendations

• Conduct a needs assessment to determine team
  members specific needs for cross-training, and,
  if necessary, develop team-based cross-training
  sessions to meet these needs.
• Continue to provide support and structure (e.g.,
  set timelines and expectations) regarding
  Treatment Providers efforts to obtain
  certification in order for the program to be in
  compliance with 2005 Guidelines for NC Drug
  Treatment Courts.

7
Team MembersComposition and Roles

• Strengths
• Team composition and roles adhere to Best
  Practices Guidelines
• Clearly defined roles and responsibilities, in
  general
• Low turnover in Judge, Defense Attorney, and
  Probation Positions

• Barriers
• Rotating schedule for the ADA position, as
  opposed to one dedicated ADA
• Previously high turnover among treatment agencies
  
• Lack of male treatment providers
• Lack of understanding (among participants) of the
  role of the Defense Attorney
• Although in general, roles and responsibilities
  are clearly defined, occasionally, some team
  members perform functions outside out the scope
  of their prescribed role

8
Team Composition and Roles Recommendations

• Request dedicated ADA as team member.
• Recruit male treatment staff.
• Explain the role of the Defense Attorney to the
  participants during the admission and orientation
  process for new participants.
• Clarify policies and procedures regarding the
  criteria and process for excusing participants
  from court and treatment sessions, and document
  instances in which these standards are not met.

9
Team MembersDecision-Making Processes

• Strengths
• Orderly and comprehensive processing of
  individual cases during team meetings
• Two pre-court staffing meetings provide
  opportunities for revisiting and resolving cases
• Consensus-based decision-making about participant
  cases, in general

• Barriers
• Team members hold varying views about Judges
  role as final arbiter
• Treatment providers could take on more of a
  leadership role in team meetings
• Relatively small amount of time spent processing
  what works in team meetings
• Lack of available time to address broader court
  issues that arise during pre-court team meetings

10
Team Decision-Making ProcessesRecommendations

• Discuss and decide on Judges role as final
  arbiter of case decisions in which the team
  cannot reach a consensus.
• Consider a more active role for Treatment
  Providers in helping the team to integrate
  research on substance abuse into decision-making
  about participant cases.
• Document unresolved, broader court issues and
  table them for discussion during Local Management
  Committee meetings and/or staff retreats.
• Set aside time, either in team meetings or in a
  retreat, to process the factors associated with
  successful program compliance, progress, and
  completion.

11
Team MembersInteractions with and about
Participants

• Strengths
• Team members and participants reported that team
  members maintain professional boundaries
• Participants reported overall respect for and
  from the team members and perceive the team as
  committed, compassionate, and sincere
• Participants reported especially positive regard
  for Judge, Treatment Providers, Probation
  Officer, and Assistant Director of Programs
• Team members expressed genuine desire for the
  participants to succeed

• Barriers
• Less positive regard was expressed by
  participants for the Defense Attorney due to
  feelings of betrayal
• Some participants expressed negative opinions
  about team members playing favorites
• Some team members reported that participants know
  which team members can be manipulated into
  excusing them from meetings and/or court sessions
• Occasional lapses in professionalism when
  discussing challenging participant cases in pre
  court staffing meetings were observed

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Team Member Interactions Recommendations

• Clarify and clearly communicate to participants
  the rationale of the non-adversarial approach,
  and its implications for the role and functions
  of the Defense Attorney.
• Use clear language in describing team approaches
  to differential treatment of participants, and
  consider how participants may interpret such
  language.
• Adopt and enforce uniform standards and policies
  for excusing participants from required meetings
  and sessions.
• Maintain professionalism when discussing
  participants, and agree on appropriate standards
  for using humor to diffuse difficult or
  challenging situations.

13
Eligibility, Referral, and Admission Procedures

• Barriers
• Basis for deviating from stated eligibility
  criteria are not clearly defined
• Length of time between probation violation or
  arrest and eligibility screening is longer than
  it should be
• In general, the program is a hard sell to many
  offenders and defense attorneys due to length of
  program and because it is not a deferral program
• Disagreement among team members regarding who
  should administer the SASSI (Case Manager or
  Treatment Provider?)

• Strengths
• Eligibility criteria clearly define the target
  population for the program
• Team provides multiple opportunities to assure
  that participants are educated about program
  requirements
• Participants begin treatment immediately upon
  admission

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Program Eligibility, Referral, and
AdmissionRecommendations

• Formalize and document procedures for deciding
  when to make exceptions to the eligibility
  criteria.
• Document and review the characteristics of cases
  that take an especially long time to complete the
  eligibility screening process after the initial
  probation violation or arrest in order to
  determine methods for accelerating the admissions
  process.
• Enhance community awareness and education about
  the purpose and aims of the drug treatment court
  model.
• Adopt SAMHSAs standards regarding administration
  of the SASSI and other screening tools Assure
  that personnel administering screening tools are
  adequately trained to properly administer, score,
  and interpret screening tools.

15
Treatment Services

• Strengths
• Team members and participants identify treatment
  as an essential program component.
• A wide variety of treatment services are
  available to participants, including group
  therapy, individual counseling, and
  community-based 12-step recovery groups.
• Participants can be referred to additional
  treatment services, such as residential treatment
  and detoxification, and for ancillary services,
  such as housing, vocational rehabilitation, and
  transportation.
• Participants reported that Treatment Providers
  are helpful and easy to talk to.

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Treatment Services, Cont.

• Strengths
• Treatment Services are delivered in accordance
  with a structured phase system, and Phase II
  participants receive both group and individual
  counseling.
• Treatment providers use evidence-based
  cognitive-behavioral treatment programs for group
  therapy.
• Participants find group therapy sessions
  particularly helpful, and identify peer support
  as a key component of group therapy.
• Team members reported that treatment services are
  applicable for all cultural groups and for both
  genders.
• The team has begun to establish more community
  connections to meet participants treatment
  needs, as evidenced by increasing numbers of
  referrals from the team to community mental
  health and substance abuse treatment services.

17
Treatment Services

• Barriers
• Difficulty securing treatment services for dually
  diagnosed participants
• Lack of male treatment providers may be a barrier
  for some participants
• Participants did not articulate specific aspects
  of treatment that were helpful outside of peer
  support
• Some participants attributed their recovery to
  12-step meetings rather than to court treatment
  services
• Treatment providers reported that they do not
  always adhere to the treatment program guidelines
  for group therapy sessions due to the need to
  address pertinent recovery needs of the moment

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Treatment Services, Cont.

• Barriers
• Team members suspect the treatment court may not
  be equally as effective across age.
• One team member felt the lack of male treatment
  providers may make the treatment services less
  effective for male participants.
• Team members believe families should be involved
  in treatment there is currently no family
  component in place.
• Team members reported that participants often
  arrive late and depart early from treatment
  sessions.

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Treatment ServicesRecommendations

• Develop strategies to recruit more male treatment
  staff.
• Work with Division of Mental Health and other
  community partners to identify treatment services
  for dually diagnosed participants.
• Consider the possibility of inviting a member of
  Wake County Mental Health Services to serve on
  the Local Management Committee or as a core team
  member.
• Explore the possibility of documenting levels of
  adherence to treatment manuals, as well as the
  circumstances (e.g., recovery needs or crises)
  that necessitate departures from the treatment
  plan.
• Assess the specific skills that participants are
  acquiring in group therapy sessions. One
  possibility is to incorporate an assessment of
  these skills in the exit interview.

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Treatment ServicesRecommendations

• Stricter enforcement of late arrival and early
  departure policies will maximize the benefit of
  treatment services.
• Evaluate the effectiveness of the court for older
  participants as compared to younger participants,
  and for males as compared to females.
• Consider the possibility of reviving the family
  component that was functional in prior years.
  Conducting a needs assessment to determine
  participants and family members need and desire
  for the program, willingness to participate, and
  time availability might help to assure better
  involvement on the part of families.
• Continue to identify and forge connections with
  community partners to enhance community awareness
  and support for the program, and to increase the
  diversity of treatment services available for
  participants.

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Sanctions

• Strengths
• Comprehensive list of sanctions is made available
  to participants upon admission to program
• Participants find threat of jail to be a useful
  deterrent
• Individualized approach to imposing sanctions is
  used to meet participants recovery needs
• Consensus-based development of sanctions
• Team members consider participants history of
  sanctions
• In general, participants perceive the sanctions
  used by the court as fair and useful

• Barriers
• Some participants perceive inconsistent
  application of sanctions
• In retrospect, some former participants reported
  that team members were too lenient in their use
  of sanctions (I needed a sanction.)
• Team does not enforce threatened sanctions
  consistently

22
Sanctions Recommendations

• Proactively communicate the theory and rationale
  behind the use of sanctions.
• Monitor and evaluate the current level of
  sanction enforcement.
• Explore the adoption of individualized behavior
  contracts to complement the current contract.
• Employ a specific psychological framework or
  approach (e.g., behavior modification) to develop
  sanctions that address recovery needs, and
  evaluate the extent to which sanctions are
  currently imposed according to the selected
  framework.

23
Incentives

• Barriers
• Variability in standards of progress that merit
  rewards (i.e., baby steps vs. giant leaps) causes
  participants to perceive inconsistent application
• Team members reported that rewards provide
  instant gratification, but result in minimal
  lasting impact
• Lack of sufficient number of tangible incentives
• Early release is a mixed blessing for some due
  to transportation barriers and conflicts

• Strengths
• Participants reported that graduation is the
  greatest reward because it signifies having
  achieved a new lifestyle (clean and sober)
• Participants appreciate early release from court
  and verbal praise from the Judge
• Participants are generally satisfied with the
  courts use of incentives
• Team members prefer positive reinforcement over
  punitive methods of trying to bring about
  behavior change

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Incentives Recommendations

• Proactively communicate the theory and rationale
  behind the use of incentives.
• Utilize successful program alumni and friends of
  the program to solicit donations from community
  businesses. This would also help increase
  visibility of the program.
• Obtain specialized training or network with other
  drug treatment courts to identify a wider variety
  of incentives and incentive strategies.
• Discuss possibilities for addressing
  participants complaints regarding lengthy travel
  times only to be dismissed from court early.
• Continue to recognize the value of verbal praise
  and continue to use it frequently.

25
Case Management Judicial Supervision

• Strengths
• Participants reported that drug screening is a
  useful deterrent to drug use
• Instant drug screens return results quickly
• Participants find status hearings to be an
  effective deterrent
• If I didnt have court to go to, I wouldnt be
  afraid of anything. I could relapse several
  times.
• Team members reported that the non-adversarial
  relationship participants form with the Judge is
  especially helpful

• Barriers
• Participants report that in the past, lack of
  male staff to supervise drug testing has
  contributed to manipulation of drug screens
• Some team members and participants reported
  instant tests are not always accurate
• Noise levels in the rear of the courtroom may
  prevent some participants from focusing on court
  proceedings
• Phase system does not document or reflect
  systematic decrease in number of supervision
  contacts required (Case Management and Probation)

26
Case Management Judicial SupervisionRecommendat
ions

• Male surveillance officer currently administers
  drug screens at treatment groups and court
  sessions. The team should evaluate whether this
  is an appropriate long-term solution.
• Document and evaluate instances of inaccurate
  instant screens to determine whether these
  instances can be attributed to a particular drug
  or drugs.
• Require participants to sit in the front of the
  courtroom, and have security personnel circulate
  to maintain appropriate atmosphere.
• Review Phase System, as written, and determine
  whether more specific requirements regarding the
  number of Case Management and Probation contacts
  are necessary.

27
Termination

• Strengths
• Consensus-based termination decisions
• Termination is considered a last resort due to
  team members desire to keep participants in
  treatment
• Team members all agree the policy is fair
• Zero-tolerance termination policy for violence

• Barriers
• Policy relies heavily on subjective judgments.
• Good cause
• Level of participation
• Conduct that is detrimental to the program
• Program graduates advocate stricter policies and
  enforcement as a means of removing participants
  who reduce morale and make group sessions
  difficult
• Participants reported they are unsure about what
  actions result in termination
• Lack of consensus regarding the appropriateness
  of the program for repeat participants
• Lack of formalized follow-up procedures results
  in difficulty contacting former participants for
  evaluation purposes

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Termination Recommendations

• Review the termination policy and decide on more
  specific language and objective criteria to
  clarify the grey areas.
• Consider and discuss the effects that maintaining
  difficult participants may have on other
  participants.
• Evaluate the effectiveness of the program for
  one-time participants as compared to repeat
  participants (graduates and terminated).
• Consider developing follow-up procedures to
  monitor outcomes for terminated participants.

29
Graduation

• Strengths
• Clearly stated and objective criteria for
  successful program completion
• Graduation ceremony to publicly honor graduates
• Successful program graduates are encouraged to
  maintain contact with program

• Barriers
• No formal program in place to retain alumni
• Some participants are disgruntled about
  undeserving graduates who manage to complete
  the program simply by avoiding jail

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GraduationRecommendations

• Investigate and monitor the reported problem of
  undeserving graduates.
• Develop a program to retain alumni as treatment
  and recovery resources and role models.

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Consumer Satisfaction Survey Demographic
Characteristics of Respondents
QUESTION n RESPONSE FREQUENCY
SEX SEX SEX
Female 8 34.8
Male 15 65.2
ETHNICITY ETHNICITY ETHNICITY
Hispanic 1 4.8
Not Hispanic 20 95.2
MARITAL STATUS MARITAL STATUS MARITAL STATUS
Divorced or Separated 5 21.7
Married 7 30.4
Single 11 47.8
LIVING ARRANGEMENT LIVING ARRANGEMENT LIVING ARRANGEMENT
Community Housing 2 8.7
Incarcerated 0 0.0
Independent 21 91.3
RACE RACE RACE
Black 6 27.3
White 15 68.2
Other 1 4.5
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Consumer Satisfaction SurveyDemographics
QUESTION n RESPONSE FREQUENCY
CHILDREN UNDER 18 LIVING AT HOME CHILDREN UNDER 18 LIVING AT HOME CHILDREN UNDER 18 LIVING AT HOME
Yes 12 54.5
No 10 45.5
EMPLOYMENT EMPLOYMENT EMPLOYMENT
Full Time 13 61.9
Part Time 3 14.3
Unemployed 5 23.8
AGE (Average) 33 AGE (Average) 33 AGE (Average) 33
TIME SPENT IN PROGRAM (Average) 6 months TIME SPENT IN PROGRAM (Average) 6 months TIME SPENT IN PROGRAM (Average) 6 months
PRIMARY DRUG OF CHOICE PRIMARY DRUG OF CHOICE PRIMARY DRUG OF CHOICE
Alcohol 2 9.1
Cocaine 2 9.1
Crack 7 31.8
Heroin 2 9.1
Marijuana 5 22.7
Other 4 18.2
33
Consumer Satisfaction SurveyDemographics
QUESTION n RESPONSE FREQUENCY
CRIME CRIME CRIME
DWI 1 4.3
Obtaining Property Under False Pretenses 2 8.7
Possession 4 17.4
Probation on Revocation Appeal 3 13.0
Theft 1 4.3
Multiple 8 34.8
Other 4 17.4
CRIMINAL HISTORY CRIMINAL HISTORY CRIMINAL HISTORY
Yes 18 78.3
No 5 21.7
TREATMENT HISTORY TREATMENT HISTORY TREATMENT HISTORY
Yes 11 47.8
No 12 52.2
COMPLETED HIGH SCHOOL COMPLETED HIGH SCHOOL COMPLETED HIGH SCHOOL
Yes 15 68.2
No 7 31.8
34
Consumer Satisfaction SurveySatisfaction with
Program Components

• How satisfied are you with the various parts of
  your Drug Treatment Court?
• (1 very unsatisfied ? 4 very satisfied)

35
Consumer Satisfaction SurveySatisfaction with
Program Components
  n NA Mean Standard Deviation Minimum Maximum
1. Frequency of court appearances 22 0 2.68 0.84 1 4
2. Interactions with the judge 23 0 3.35 0.88 1 4
3. Interactions with the DTC team 21 0 3.14 0.73 1 4
4. Cooperation of agencies with each other 18 4 3.11 0.58 2 4
5. Substance abuse treatment services 23 0 3.13 0.46 2 4
6. Mental health treatment services 16 7 3.19 0.54 2 4
7. Vocational treatment services 13 10 2.69 1.03 1 4
8. Other services received 12 10 2.83 0.58 1 4
9. Sanctions received 16 7 2.69 0.95 1 4
10. Incentives received 18 4 3.06 0.8 1 4
11. Drug testing 21 1 3.10 0.54 2 4
12. Community service activities 21 2 2.52 0.93 1 4
13. Pro-social activities organized by the DTC 18 5 2.83 0.86 1 4
14. Drug Court program overall 23 0 2.87 0.97 1 4
36
Consumer Satisfaction SurveyProtection of Rights

• How well do you feel that your legal rights were
  protected?
• (1 not at all ? 4 completely)

  n NA Mean Standard Deviation Minimum Maximum
15. Protection of overall rights 23 0 2.13 0.55 1 3
37
Consumer Satisfaction SurveyDifficulty of
Program Requirements

• How easy or difficult is it for you to complete
  the following program requirements?
• ( 1 very difficult ? 5 very easy)

38
Consumer Satisfaction SurveyDifficulty of
Program Requirements
  n NA Mean Standard Deviation Minimum Maximum
1. Making it to court appearances 22 0 2.50 1.01 1 5
2. Attending mental health treatment services 11 11 2.45 0.93 1 5
3. Cooperating with mental health treatment program 11 10 2.18 0.87 2 5
4. Taking medication regularly 8 15 2.63 0.74 2 4
5. Attending SA treatment services 20 3 2.60 0.94 1 5
6. Cooperating with SA treatment services 21 2 2.43 0.93 1 5
7. Attending other services 16 7 2.81 1.28 1 5
8. Going to drug testing 21 2 2.14 0.91 1 5
9. Cooperating with drug testing 20 1 1.90 0.85 2 5
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Consumer Satisfaction SurveyDifficulty of
Program Requirements
  n NA Mean Standard Deviation Minimum Maximum
10. Attending meetings with probation officer 21 1 2.05 0.8 2 5
11. Attending meetings with case manager 23 0 2.48 1.08 1 5
12. Attending AA/NA meetings 23 0 2.91 1.47 1 5
13. Participating in AA/NA meetings 23 0 2.78 1.24 1 5
14. Paying court fees 23 0 3.00 1.09 1 5
15. Paying court fines 20 2 3.25 1.21 1 5
16. Staying away from bad influences 21 1 2.14 0.85 2 5
17. Staying clean and sober 22 1 2.45 1.01 1 5
18. Staying crime-free 22 1 1.91 0.92 2 5
40
Challenges to Program Compliance and Completion
as Reported by Participants

• Frequency of required meetings and court sessions
• Participants question why those who are doing
  well and on the verge of completion have to
  attend court.
• Participants feel that number of weekly NA/AA
  meetings should diminish over time.
• Court ALWAYS starts late!
• Many active participants reported that drug
  court status hearings frequently begin late
• This is particularly inconvenient for
  participants who rely on others for rides to and
  from court
• Active participants reported that required
  meetings conflict with job requirements
• Employers are not always understanding of their
  obligations
• Lost wages due to requirement to attend court
• Transportation difficulties were reported to be a
  barrier to full participation by active and
  former participants
• Many participants have their licenses revoked
  and are reliant on others for transportation
• Long travel distances for a few participants
  who do not live in Raleigh
• Lack of child care options was reported as a
  barrier by three active female participants

41
Life Improvements Attributed to the Program

• Participants comments
• Gainful employment
• Improved finances due to elimination of drug
  purchases
• Improved relationships with and attitudes toward
  family members and friends
• Increased understanding about addiction
• Increased honesty with self and others
• Decreased (or eliminated) drug use
• Team members comments
• Participants change in every way
• Improved physical appearance
• Improved attitude, self-esteem
• Better employment situation
• Better understanding of the legal system
• Gain a sense of community

42
Overall Strengths

• Team composition, roles and functions adhere to
  Best Practices Guidelines
• Positive interactions between team members and
  participants
• Orderly and comprehensive processing of
  individual cases
• Treatment services are delivered according to a
  structured phase system, and are guided by
  evidence-based treatment programs for recovery
  and relapse prevention

43
Overall Strengths

• Consensus-based decision-making is used to arrive
  at the best course of action for participants
• Individualized approach to the delivery of
  sanctions is designed to meet participants
  recovery needs
• Both team members and participants attribute
  positive life changes to the drug treatment court
  program

44
Overall Barriers

• Lack of consensus among team members regarding
  Judges role as final arbiter.
• Lack of time spent processing what works.
• Justice system team members do not have as much
  time as they would like to devote to the program
  due to other caseloads and responsibilities.
• Participants are unclear about the role of the
  Defense Attorney.
• Reasons for making exceptions to the stated
  eligibility criteria are not clearly defined.

45
Overall Barriers

• The program is a hard sell for many offenders
  and defense attorneys
• Lack of treatment services for dually diagnosed
  participants
• Some participants perceive inconsistent use of
  sanctions and rewards
• Termination policy is largely based on subjective
  judgments and criteria that are not clearly
  defined
• Lack of consensus among team members regarding
  appropriateness of the program for repeat
  participants
• Lack of follow-up procedures for discharged
  participants

46
Overall Recommendations

• Consider recruiting male treatment providers.
• Clarify the role of the Defense Attorney for
  participants.
• Discuss and gain consensus regarding Judges role
  as final arbiter.
• Plan for opportunities to discuss broader court
  issues.
• Identify the factors that contribute to longer
  processing time (eligibility screening) for some
  referred cases.
• Work with community partners to identify
  treatment services for dually diagnosed
  participants, and consider inviting a mental
  health professional to be a core team member or
  Local Management Committee member

47
Overall Recommendations

• Explore the possibility of implementing
  individualized behavior contracts.
• Monitor possible instances of inaccurate drug
  screens.
• Review, and perhaps revise, termination policy.
• Evaluate the effectiveness of the program for
  one-time vs. repeat participants and gain
  consensus regarding the suitability of the
  program for repeat participants.
• Explore the possibility of re-establishing a
  family program.

48
Timeline

• Draft of Report to WCADTC April 25, 2005
• Feedback from WCADTC April 28, 2005
• Final Draft Delivered April 30, 2005