Predictors of Drug Court Client Graduation

Background: Substance use disorder in the United States adversely effects society by burdening the justice system with offender incarceration for drug-related crimes, it also strains in the healthcare system with costs in excess of $216 billion dollars for treatment of drug-related mental and physical illnesses. Many offenders of nonviolent crimes with substance use disorder have been diverted to Drug Court (DC) for year-long supervised community-based drug addiction treatment as an alternative to incarceration for non-violent drug-related crimes. Drug Court program outcomes, however, have been studied as a criminal justice intervention, rather than a primary care mental health intervention. The majority of DC program evaluation has focused on admission data and outcomes using univariate and bivariate analyses, rather than longitudinal data using multivariate analyses to identify multivariate predictors of DC graduation. Objective: The purpose of this study is to: (a) describe the Sample Severity for DC clients; (b) discuss the differences between Drug Court graduates and dropouts for Sample Severity, Drug Court Practices, and In-Program Behavior; and (c) develop a prediction model for Drug Court graduation. Methods: This is a descriptive longitudinal design using secondary data analysis of existing DC Shelby County DC data. Data were analyzed from January 1, 2009 through March 17, 2011 for clients admitted to Shelby County DC, and either graduated or dropped out of DC. The MultiSite Adult Drug Court Evaluation (MADCE) Model guided the data selected at three points in time: (a) admission to the DC program (Sample Severity data); (b) during the DC program (DC Practices and In-Program Behavior data); and (c) end of DC program (graduation or dropout data). Results: The sample consisted of 310 Shelby County DC clients, predominately male (80.0%), and African American (60.3%) with a mean age of 29.9 years. Most DC clients had a high school diploma or GED (54.5%) or no high school diploma or GED (41.9%). Thirty-four percent were employed at DC admission and worked an average of 10.4 hours per week. Marijuana (56.1%) and alcohol (15.5%) were the top two primary drugs of choice. To compare differences between DC graduates and dropouts, data were analyzed using t-tests or Chi-squared, as appropriate. There were (48.1%) graduates and fewer male graduates (Χ² = 4.19, p = .041), and fewer African American graduates (Χ² = 4.26, p = .039). There were more graduates who had a high school diploma/GED or a college degree than dropouts (Χ² = 5.21, p = .022), and more DC graduates were employed at DC admission (Χ² = 23.09, p = .001). Of the seven primary drugs of choice, there was only one significant difference with more graduates listing alcohol as their primary drug of choice than dropouts (Χ² = 14.05, p = .002). Of the six DC programs, there were significant differences for four programs. There were fewer graduates who participated in the Outpatient program (Χ² = 4.04, p = .039) and Residential program (Χ² = 8.00, p = .004), more graduates in the Outpatient DUI program (Χ² = 27.5, p = .001), and no graduates in the Early Assessment Intervention Treatment program (Χ² = 5.66, p = 017). Graduates spent more days in DC programs (t-test = 15.17, p = .001), and participated in fewer DC programs (t-test = 2.17, p = .031). Of the ten treatment agencies, there were significant differences for only on agency that had no graduates (Χ² = 4.70, p = .030). Of the 27 candidate predictor variables, there were six significant predictors. Having more diluted urine drug screens (OR = 5.081, p = .002) and greater number of days in the DC programs (OR = 1.019, p = .001) were positive predictors of graduation. Male gender (OR = 0.373, p = 0.47), no high school diploma/GED (OR = 0.214, p = .004), rearrests (OR = 0373, p = .002), and number of jail sentencing sanctions (OR = 0.439, p = .001) were negative predictors of graduation. The Hosmer and Lemeshow Goodness of Fit statistic (Χ² = 11.3724, df = 8, p = .182) documented that the model predicts the data well. The c statistic (0.949) documented highly acceptable predictive ability of the model with 94.9% of all possible pairs of graduates and dropouts predicted correctly. Discussion: The final prediction model suggests that males with no high school education diploma or GED, greater rearrests, and more jail sentencing sanctions are at-risk for not graduating from the Shelby County DC. Education is the only modifiable factor for DC graduation which has implications for DC practice changes and future health literacy research with the DC client population. Drug Court practice changes include: (a) evaluate client literacy and health literacy after drug detoxification; (b) develop and evaluate low literacy DC materials and programs; (c) integrate and require adult reading and GED classes; (d) evaluate need for and design and evaluate programs for men; (e) evaluate and refine exiting programs for women. Future research will: (a) validate the prediction model using cross-validation statistics; (b) develop separate prediction models for men and women; (c) develop a unified data base with continuous variables and MADCE Model variables for DC program reports and evaluation; and (d) use the MADCE Model and Social-Ecological Model to examine Offender Perceptions and Post-Program Outcomes in clients

The family drug & alcohol court (FDAC) evaluation project

This report presents the findings from the evaluation of the first pilot Family Drug and Alcohol Court (FDAC) in Britain. FDAC is a new approach to care proceedings, in cases where parental substance misuse is a key element in the local authority decision to bring proceedings. It is being piloted at the Inner London Family Proceedings Court in Wells Street. Initially the pilot was to run for three years, to the end of December 2010, but is now to continue until March 2012. The work is co-funded by the Department for Education (formerly the Department for Children, Schools and Families), the Ministry of Justice, the Home Office, the Department of Health and the three pilot authorities (Camden, Islington and Westminster). The evaluation was conducted by a research team at Brunel University, with funding from the Nuffield Foundation and the Home Office. FDAC is a specialist court for a problem that is anything but special. Its potential to help break the inter-generational cycle of harm associated with parental substance misuse goes straight to the heart of public policy and professional practice. Parental substance misuse is a formidable social problem and a key factor in around a third of long-term cases in children’s services in some areas. It is a major risk factor for child maltreatment, family separation and offending in adults, and for poor educational performance and substance misuse by children and young people. The parents’ many difficulties create serious problems for their children and place major demands on health, welfare and criminal justice services. For these reasons, parental substance misuse is a cross-cutting government agenda. FDAC is distinctive because it is a court-based family intervention which aims to improve children’s outcomes by addressing the entrenched difficulties of their parents. It has been adapted to English law and practice from a model of family treatment drug courts that is used widely in the USA and is showing promising results with a higher number of cases where parents and children were able to remain together safely, and with swifter alternative placement decisions for children if parents were unable to address their substance misuse successfully. The catalysts for the FDAC pilot were the encouraging evidence from the USA and concerns about the response to parental substance misuse through ordinary care proceedings in England: poor coordination of adult and children’s services; late interventions to protect children; delays in reaching decisions in court; and soaring costs of proceedings, linked to the cost of expert evidence.The work is co-funded by the Department for Education (formerly the Department for Children, Schools and Families), the Ministry of Justice, the Home Office, the Department of Health and the three pilot authorities (Camden, Islington and Westminster).1 The evaluation was conducted by a research team at Brunel University, with funding from the Nuffield Foundation and the Home Office

Compulsory treatment in Australia: a discussion paper on the compulsory treatment of individuals dependent on alcohol and/or other drugs

This discussion paper presents a national perspective of the current operation of compulsory alcohol and/or other drug (AOD) treatment, within the context of existing research evidence, ethical considerations and international practice. It is intended to inform ongoing debate on the place of compulsory treatment in Australia. Particular areas of interest are the development, implementation and effectiveness of drug diversion and civil commitment practices

Drug Courts: A Review of the Evidence

Provides an overview of drug courts designed to integrate drug treatment into the criminal justice system in cases of low-level defendants and reviews research on their operation, efficacy, and concerns about its impact on the prison population

Mental health problems: Are they or are they not a risk factor for dropout from drug treatment? A systematic review of the evidence

Background: A sizeable number of recent studies investigating whether clients with substance misuse and mental health problems (dual diagnosis clients) are at heightened risk of dropout from drug treatment have been published. It is timely that their findings are brought together in a comprehensive review of the current evidence. Aims: The aim of the review is to examine whether dually diagnosed clients are less likely to be retained in drug treatment than clients without mental health problems, and, if so, whether this varies for clients diagnosed with different types of mental health problems. Methods: The review considers peer-reviewed research published after 1 January 1990, which was located using the literature databases Medline and PsycInfo. Predefined search terms were used. Further papers were identified from the bibliographies of relevant publications. Findings: 58 studies (84% from the USA) met the inclusion criteria for the review. The findings suggest that for most clients, having a past history of mental health problems does not influence the likelihood of being retained in drug treatment. The body of evidence regarding concurrent mental health problems is contradictory. On the whole, the majority of studies suggest that neither presence nor severity of depressive, anxiety, or other Axis-I disorders is related to retention, but these findings are not entirely unequivocal, as a few studies report strong positive or negative associations between depression and anxiety disorders and retention. Few researchers looked separately at psychotic spectrum disorders hence no conclusions could be drawn. The presence of most personality disorders also did not appear to affect treatment tenure, with the exception of antisocial personality disorder, for which the evidence points towards a greater risk of dropout. Conclusions: The balance of evidence suggests that, overall, dual diagnosis clients with Axis-I disorders who seek treatment in drug treatment services are retained as well as clients without dual diagnosis. Subgroups of clients who appear more vulnerable to premature dropout include those with antisocial personality disorder. Methodological shortcomings of the reviewed studies and resulting implications for this review and future research are discussed

New South Wales drug court evaluation: Cost-effectiveness, CHERE Project Report 17a

In this report we examine an issue central to the creation of the NSW Drug Court: namely its cost-effectiveness, compared with conventional sanctions, in reducing drug-related crime. We were particularly fortunate in undertaking this evaluation, to receive the support and cooperation of the Drug Court and the Attorney General in evaluating the Drug Court using a randomised controlled trial. Randomised controlled trials, in which individuals are randomly allocated to ?treatment? and ?control? groups are recognised as being the ?gold standard? when it comes to outcome evaluation. They provide more assurance of control over extraneous factors which might otherwise bias an evaluation than any other form of research design. To our knowledge, this is the first occasion on which a criminal justice program in Australia has been evaluated using a randomised control design. The evaluation is a first in one other way as well. Very few evaluations of criminal justice or crime prevention programs (either in Australia or overseas) pay much heed to the cost of the program. This greatly hampers the capacity of Government to make rational decisions about the allocation of scarce resources across competing programs. Of course, decisions on programs which affect the liberty of citizens cannot, and should not, be made on the grounds of cost-effectiveness alone. Nevertheless it is to be hoped that our efforts will convince others of the feasibility and value of introducing cost-effectiveness analyses into criminal justice evaluation.Economic evaluation, treatment programs

What Makes A Court Problem-Solving: Universal Performance Indicators for Problem-Solving Justice

This report identifies a set of universal performance indicators for specialized "problem-solving courts" and related experiments in problem-solving justice. Traditional performance indicators related to caseload and processing efficiency can assist court managers in monitoring case flow, assigning cases to judges, and adhering to budgetary and statutory due process guidelines. Yet, these indicators are ultimately limited in scope. Faced with the recent explosion of problem solving courts and other experiments seeking to address the underlying problems of litigants, victims, and communities, there is an urgent need to complement traditional court performance indicators with ones of a problem-solving nature. With funding from the State Justice Institute (SJI), the Center for Court Innovation conducted an investigation designed to achieve three purposes. The first was to establish a set of universal performance indicators against which to judge the effectiveness of specialized problem-solving courts, of which there are currently more than 3,000 nationwide. The second purpose was to develop performance indicators specific to each of the four major problem-solving court models: drug, mental health, domestic violence, and community courts. The third purpose was to assist traditional court managers by establishing a more limited set of indicators, designed to capture problem-solving activity throughout the courthouse, not only within a specialized court context

Improving Community Adaptation Outcomes for Youth Graduating from Residential Mental Health Programs: A Synthesis Review (FULL REPORT)

The focus of this synthesis review was to understand the capacity of systems of care and integrated program models to foster successful community adaptation for children and youth graduating from children\u27s residential mental health treatment