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Effective Treatment Strategies in Juvenile Drug
Court Scott W. Henggeler, Ph.D. Professor, Medical University of South
Carolina Board Member, NADCP
JDC Has Two Primary Components
Judicial – Key features and outcomes described by Dr. Carey Treatment – The specific substance abuse treatment delivered to the youth and family by a therapist working within a provider organization in collaboration with the court
Substance abuse treatment is the focus of this presentation
Treating Substance Abuse in Adolescents
The vast majority of existing services are unproven or iatrogenic Evidence-based treatments (i.e., proven to be effective through rigorous outcome research) have been developed, but they have not been widely transported Evidence-based treatments have key commonalities discussed subsequently
The Best Resources for Identifying Effective Intervention Strategies for Treating Substance Abuse in Adolescents
National Institute on Drug Abuse (e.g., Principles of Drug Abuse Treatment for Adolescents) Blueprints for Healthy Youth Development (University of Colorado) SAMHSA’s National Registry of Evidence-Based Programs and Practices
NIDA Principles of Effective Treatment for Adolescents
Treatment should be individualized to youth’s strengths and context Behavioral therapies are effective Family and community (peers, school) are important aspects of treatment Legal sanctions or family pressure may be necessary Important to monitor drug use during treatment Duration of treatment (e.g., 3+ months) is important Treatment should be comprehensive
Blueprints Blueprints programs meet a set of criteria that
demonstrate their capacity to be adopted and implemented effectively in community settings Treatment and training specification Evaluation quality (e.g., 2 high quality RCTs to qualify for Model program status) Intervention impact – key outcomes sustained for at least 12 months Dissemination readiness – hiring, training, purveyor organization, ongoing quality assurance for supporting program fidelity, outcome tracking
Blueprints Model and Promising Programs
Model Programs for Treating Adolescent Substance Abuse Functional Family Therapy Multisystemic Therapy Multidimensional Treatment Foster Care
FFT, MST, and MTFC are also the best validated for treating youth criminality
Promising Programs – none cited
NREPP Programs
Functional Family Therapy Multisystemic Therapy Multidimensional Treatment Foster Care Brief Strategic Family Therapy Family Behavior Therapy Cognitive Behavioral Therapy Contingency Management
Functional Family Therapy (FFT)
Substance use is viewed as a symptom of dysfunctional family relationships Treatment phases: engagement, motivation, behavior change, generalization 300 programs worldwide fftinc.com Best specification:
Alexander, J. F., Waldron, H. B., Robbins, M. S., & Neeb, A. A. (2013). Functional family therapy for adolescent behavior problems. Washington, DC: American Psychological Association.
Multisystemic Therapy (MST)
Addresses multi-determined nature of adolescent substance abuse, addressing individual, family, peer, school, and community variables Home-based delivery of interventions 500+ programs worldwide mstservices.com Best specification:
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford Press.
Multidimensional Treatment Foster Care (MTFC)
For youth in foster care Multifaceted approach with individual youth, foster family, peers, school, and biological family Behavioral 100 sites in U.S. and Europe mtfc.com Best specification:
Chamberlain, P. (2003). Treating chronic juvenile offenders: Advances made through the Oregon multidimensional treatment foster care model. Washington, DC: American Psychological Association.
Brief Strategic Family Therapy (BSFT)
Uses family therapy techniques to modify family interactions that are maintaining youth substance use Clinic or home-based treatment delivery 100 sites worldwide bsft.org Best specification:
Szapocznik, J., Hervis, O., & Schwartz, S. (2003). Brief strategic family therapy for adolescent drug abuse. (NIH Publication No. 03-4751). Bethesda, MD: National Institute on Drug Abuse.
Family Behavior Therapy
Uses CBT and contingency management interventions Family based, individualized, and comprehensive Early stages of transport process Best specification:
Donohue, B., & Azrin, N. H. (2012). Treating adolescent substance abuse using family behavior therapy. Hoboken, NJ: Wiley
Cognitive Behavioral Therapy (CBT)
Problem solving skills Drug refusal skills Some variation of CBT is used in most evidence-based treatments of substance abuse as well as for other types of child and adolescent mental health and behavior problems
Contingency Management (CM) Uses CBT strategies Applies positive and negative contingencies based on clear behavioral contract (e.g., rewards abstinence, punishes truancy) Fits well with JDC and diverse provider organizations Not being actively transported Best specification:
Henggeler, S. W., Cunningham, P. B., Rowland, M. D., Schoenwald, S. K., Swenson, C. C., Sheidow, A. J., McCart, M. R, Donohue, B., Navas-Murphy, L. A., & Randall, J. (2012). Contingency management for adolescent substance abuse: A practitioner’s guide. New York: Guilford Press.
Commonalities of Effective Programs
Well specified target population, theory of change (targeting risk and protective factors), interventions, and training Ongoing quality assurance (supporting and tracking treatment adherence and youth outcomes) to sustain treatment and program fidelity Empower caregivers to support favorable outcomes Individualized to youth/family strengths and weaknesses (not one size fits all) Comprehensive services (individual, family, peer, school, community) provided Use of behavioral tracking and intervention techniques such as CBT (problem solving skills, drug refusal skills) and implementation of reward/punishment contingencies Treatment delivered in natural environment (not in out-of-home placements)
Informing policy, improving programs
Juvenile Drug Courts: Show me the money!
NADCP Annual Conference 2013 Shannon M. Carey, Ph.D.
5100 SW Macadam Ave., Ste. 575
Portland, OR 97239 503.243.2436
July, 2013
2
What are we talking about today?
• Are juvenile drug courts effective?
• How much does it cost to run a juvenile drug court program?
• How much does each agency invest?
• Do juvenile drug courts save taxpayer money?
• What promising practices are there for juvenile drug courts?
• Do best practices for adults apply?
Outcome and Cost Evaluations: • Examples from six JDC studies - NPC Clackamas, OR N = 53 Oakland, MI N=74 Harford, MD N = 102 St. Mary’s, MD N = 80 Baltimore County, MD N = 156 Anne Arundel, MD N = 154
• Participant demographics Majority white (68-90%), Average age at arrest = 14-17 Marijuana and alcohol primary drugs
3
5
Are juvenile drug courts effective?
• Recidivism/Rearrests o Juvenile o Adult
• Substance use o Drug tests o Drug arrests
Measured effectiveness with reduced recidivism and reduced substance use
YES. Juvenile Arrests
6
0
0.5
1
1.5
2
2.5
3 6 9 12 15 18 21 24Ave
rag
e N
um
ber
of
Re-
arre
sts
Months
All Participants
Graduated
Comparison
Average Number of Re-Arrests Over 24 months
Do juvenile drug courts reduce recidivism in Clackamas, OR?
7
YES. Juvenile Arrests (2 yr)
Do juvenile drug courts reduce recidivism in Harford, MD?
(n=75) (n=82)
Drug Court Sample Comparison Group
0.6
1 Ave # Juvenile Re-Arrests
YES. Juvenile Recidivism (2 yr)
8
0
2
4
6
8
10
12
14
# of juvenile justice
complaints
# of adjudication
hearings
Days in secure detention
Days on community detention
Days in Shelter Care
Days in Group Home
Graduates
All Drug Court Comparison
Do juvenile drug courts reduce other recidivism in Harford, MD?
9
YES. Harford: Adult Recidivism (2 yr)
0
10
20
30
40
50
60
70
Ave # arrests Ave # days in jail
Ave #days in prison
Ave # days parole/
probation
0.2 3 3
49
0.2 8
11
65
Drug Court Sample (n=75)
ComparisonGroup (n=82)
Do juvenile drug courts reduce recidivism into the adult system?
10
Clackamas: Adult and Juvenile arrests • 2 years from drug court entry Graduates 29% All Participants 44% Comparison 82%
90% reduction in new arrests
Do juvenile drug courts reduce recidivism into the adult system?
11
YES. Oakland: Juvenile and Adult Arrests (2 yr)
0
0.5
1
1.5
2
2.5
2 Years Prior 2 Years Post
2.5
0.27
JDC Participants
Do juvenile drug courts reduce recidivism into the adult system?
Do juvenile drug court reduce drug use?
12
Baltimore, MD: Percent of Positive UAs in 2 Month Increments
YES!
0%5%
10%15%20%25%30%35%40%45%
2 4 6 8 10 12
Pe
rce
nt
of
Ind
ivd
ua
ls w
ith
P
osi
tiv
e T
est
s
Months of Program Participation
Do juvenile drug court reduce drug use?
13
Clackamas, OR: Percent of Positive UAs in 2 Month Increments
0
0.05
0.1
0.15
0.2
0.25
0.3
2 4 6 8 10 12
Perc
ent p
ositi
ve U
As
Months
Pre-enhancement
Post-enhancement
YES!
00.020.040.060.080.1
0.120.140.16
3 6 9 12 15 18
Ave
rage
# o
f Dru
g-R
elat
ed R
e-ar
rest
s
Months
Pre-enhancement
Comparison
14
Clackamas: Mean Number of Drug Related Re-Arrests in 3-Month Blocks
Do juvenile drug court reduce drug use?
15
How much does it cost to run a juvenile drug court program?
Cost Analysis Approach: TICA
Varies (services, # of team members, etc.)
Clackamas: Program Transactions
Transaction Transaction Unit Cost
Avg. # of Program Related
Transactions
Avg. Cost per Participant
Drug Court Appearances $373.83 29.55 $11,047
Case Management $29.78 356.82 Days $10,626 Individual Treatment Sessions $52.48 8.35 $438
Group Treatment Sessions $16.33 37.88 $619
Family Therapy Sessions $19.99 9.12 $182
Parent Support Group $9.54 26.41 $252
Parent Education Classes $9.33 4.47 $42
Drug Tests (UAs) $6.00 70.96 $426 Drug Patches $20.00 1.19 $24
(Total Program Cost $23,656/$64 per day)
Harford: Program Transactions
(Total Program Cost $11,689/$41 per day)
Transaction Unit Cost Average # of Transactions
Average Cost per Participant
Drug Court Appearances $249.96 12.19 $3,047
Case Management $11.56 283 Days $3,271 Individual D&A Treatment Sessions $62.83 9.68 $608 Group D&A Treatment Sessions $42.01 33.63 $1,413
Drug Tests (UAs) $36.85 55 $2,027
Mental Health Treatment $29.73 9.43 Months $280 Individual Education Sessions $55.21 9.43 Months $521 Group Job Training Sessions $55.21 9.43 Months $521
Program cost comparison
*Over $25,000 on Detention Costs 18
Program Cost per participant
Cost per day (per participant)
Harford $11,689 $41
Clackamas $23,656 $64
Anne Arundel $27,234 $86
Baltimore County* $56,631 $139
St. Mary’s $33,768 $99
Oakland $22,564 $64
19
Harford: Options for High-Risk Youth
Placement Options Cost Per Day
Harford Juvenile Drug Court Program $41
Detention $296
Residential Treatment $220
Emergency Shelter Care $275
Community Detention $24
20
Placement Options
Placement Options Cost Per Day
CCJDC Program
$66
Residential Treatment
$134
Shelter Care
$115
Short-term Detention
$187
Long-term Detention
$171
Adult Jail
$97
Clackamas: Options for High-Risk Youth
21
How much does each agency invest?
Varies widely: JDC’s are implemented in a variety of ways
No standard model
Some don’t follow the 10KC or 16 Juvenile Strategies
22
Clackamas: Agency Investment per Participant
Agency Average Agency Cost per Participant
Circuit Court $1,413
District Attorney $1,234
Defense Attorney $600
Juvenile Department $12,974 Clackamas County Mental Health (Treatment + Testing) $6,299
Oregon Youth Authority $855
C-TEC Youth Services $281
Total $23,656
23
Oakland: Agency Investment per Participant
Agency Average Agency Cost
per participant
Circuit Court $11,675
Prosecutor $287
Defense Advisor $196
Oakland Family Services $3,314
JAMS (Drug Testing) $309
Easter Seals $102 Health and Human Services Department (Treatment) $5,929
Treatment $753
Total $22,565
24
St. Mary’s: Agency Investment per Participant
Agency Average Agency Cost
per Participant
St. Mary’s County Circuit Court $2,177 St. Mary’s County State’s Attorney’s Office $785 Maryland Office of the Public Defender $905 MD Department of Juvenile Services $19,111 Maryland Alcohol and Drug Abuse Administration (Treatment) $3,266
St. Mary’s County Sheriff ’s Office $4,249 St. Mary’s County Public Schools $1,000 Mental Health Authority $142 Walden Sierra $1,703 Maryland Office of Problem Solving Courts $428
Total $33,766
26
Clackamas: Outcome Cost Findings
Transaction Unit Cost All Participants Comparison
Group Re-arrests/Referrals $200.72 $171 $406 Formal Hearings $89.80 $40 $61 Probation Violation Hearings $44.90 $34 $53 Felony Cases $390.00 $12 $148 Misdemeanor Cases $280.00 $59 $92 Probation Violation Cases $150.00 $48 $68 Residential Treatment Days $134.19 $4,046 $7,592 Foster Care Days $29.78 $448 $390 Shelter Care Days $115.57 $7 $529 Juvenile Probation Days $1.70 $256 $363 Jail Bookings (Adult) $20.59 $13 $4 Jail Bed Days (Adult) $96.77 $102 $19 Total $10,357.00 $19,427.00
Savings Across Programs
Savings Per JDC Participant over 2 years
• Clackamas County Oregon = $9,070
• Baltimore County Maryland = $8,762
• Harford County Maryland = $5,702
• St. Mary’s County Maryland = $2,962
• Anne Arundel Maryland = -$172
• Oakland County Michigan = NA
28
Which Agencies Save the Most?
• Harford: 72% in outcome costs savings for Maryland Division of Corrections
• Baltimore: 85% Department of Juvenile Services
• Clackamas: 78% Oregon Youth Authority
*Due to reduced detention and jail costs
Taking a closer look
30
Re-Arrests Pre and Post Enhancement
0
0.1
0.2
0.3
0.4
0.5
3 6 9 12 15 18
Aver
age
# of
re-a
rres
ts
Months
Comparison
Taking a closer look
31
Re-Arrests Pre and Post Enhancement
0
0.1
0.2
0.3
0.4
0.5
3 6 9 12 15 18
Aver
age
# of
re-a
rres
ts
Months
Pre-enhancement
Comparison
Taking a closer look
32
Re-Arrests Pre and Post Enhancement
0
0.1
0.2
0.3
0.4
0.5
3 6 9 12 15 18
Aver
age
# of
re-a
rres
ts
Months
Pre-enhancement
Post-enhancement
Comparison
Clackamas Enhancements
• Addition of Community Resource Liaison position Find and create new community resources
including community service opportunities Work to link youth to community resources
• Family Therapist almost at full-time Already required family therapy More home visits Required parenting class instituted
33
34
Community Resource Liaison: • Added a Family Representative
• Oregon Youth Authority
• Developed connections with residential treatment programs
• Trained community guides
• Strong relationships with local agencies and community leaders
Clackamas Enhancements
Community Liaison: (Paradigm Shift) • Arranges for (reserves) community service
slots each week and brings to team at client progress meetings
• Increased the variety of community service options Youth can choose a service that is meaningful to
them Youth that don’t do well together can be sent to
different service options
• Attends end of court session to sign kids up
35
Clackamas Enhancements
Taking a Closer Look
CC BC HC SMC AA
Savings $9,070 $8,762 $5,702 $2,962 -172
Court Sessions 357/29 407/26 283/12 341/13 315/40
2 weeks 2 weeks 3 weeks 4 weeks 1 week
Drug Courts That Held Status Hearings Every 2 Weeks During Phase 1 Had 50% Greater Reductions in
Recidivism
Note: Difference is significant at p<.1
0%
10%
20%
30%
40%
50%
Drug court has review hearings every two weeks
N=14
Drug court has review hearings
more or less often N=35
46%
31%
Perc
ent R
educ
tion
in R
ecid
ivis
m
Adult
Taking a Closer Look
CC BC HC SMC AA
Savings $9,070 $8,762 $5,702 $2,962 -172
Court Sessions 357/29 407/26 283/12 341/13 315/40
2 weeks 2 weeks 3 weeks 4 weeks 1 week
Drug Tests 71 37 55 34
Self pay 2/week 3/mo 2/week 3/mo
Drug Courts Where Drug Tests are Collected at Least Two Times per Week In the First Phase had
a 61% Higher Cost Savings
0%
10%
20%
30%
40%
Participants drug tested at least 2X per week
N=53
Participants tested LESS often than 2X per week
N=12
29%
18%
Perc
ent i
ncre
ase
in c
ost s
avin
gs
Adult
Taking a Closer Look
CC BC HC SMC AA
Savings $9,070 $8,762 $5,702 $2,962 -172
Court Sessions 357/29 407/26 283/12 341/13 315/40
2 weeks 2 weeks 3 weeks 4 weeks 1 week
Drug Tests 71 37 55 34 Self pay
Family Counseling Yes Yes No No Self pay
Parenting Yes No No No No
True in adult, family, juvenile
Drug courts that offer parenting classes had 68% greater reductions in recidivism and 52% greater cost savings
Program provides parenting classes
N=44
Program does NOT provide parenting classes
N=17
38%
23%
% R
educ
tion
in
Rec
idiv
ism
Taking a Closer Look
CC BC HC SMC AA
Savings $9,070 $8,762 $5,702 $2,962 -172
Court Sessions 357/29 407/26 283/12 341/13 315/40
2 weeks 2 weeks 3 weeks 4 weeks weekly
Drug Tests 71 37 55 34 Self pay
Family Counseling Yes Yes No No Self pay
Parenting Yes No No No No
Treatment Youth and parent
Youth Gender Specific + MH
Youth + MH Youth Self pay
Drug courts that offer mental health treatment had 80% greater reductions in recidivism
0% 5%
10% 15% 20% 25% 30% 35% 40%
MH Tx Provided N=52
MH Tx NOT Provided N=10
36%
20%
% R
educ
tion
in R
ecid
ivis
m
Adult
45
A closer look at the use of detention
Detention costs were very high in most of the juvenile programs
46
Clackamas Detention Costs Averaged per Youth
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000D
eten
tio
n C
ost
s
Year 1Year 2
Year 1 $747 $9,785 $2,598
Year 2 $393 $2,876 $1,791
Graduated Terminated Comparison
A closer look at the use of detention
47
Detention Costs per Youth Across Programs
$-
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
Baltimore Harford AA Clackamas
Terminated
Graduated
A closer look at the use of detention
Drug Courts where sanctions were imposed in advance of a regularly scheduled court hearing
had double the cost savings
Sanctions Imposed Swiftly
N=36
Sanctions NOT Imposed Swiftly
N=17
28%
14%
% In
crea
se in
Cos
t Sav
ings
Note: Difference is significant at p<.05 Adult
Note: Difference is significant at p<.05
5. Drug Courts Where in Order to Graduate Participants Must Have a Job or be in School had
83% Higher Cost Savings
Note: Difference is significant at p<.05
4. Drug Courts Where the Defense Attorney Attends Drug Court Team Meetings (Staffings) had
93% Higher Cost Savings
Note: Difference is significant at p<.10
6. Drug Courts Where a Representative from Treatment Attends Court Sessions had
81% Higher Cost Savings
Note: Difference is significant at p<.15 (Trend)
7. Drug Courts Where Team Members are Given a Copy of the Guidelines for Sanctions had
72% Higher Cost Savings
Note: Difference is significant at p<.05
9. Drug Courts where Law Enforcement is a member of the drug court team had
88% greater reductions in recidivism
0.45
0.24
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
0.45
0.50
Yes N=20
No N=29
% re
duct
ion
in #
of r
earr
ests
Law Enforcement is a Member of Drug Court Team
Note: Difference is significant at p<.05
1. Drug Courts Where Review of The Data and Stats Has Led to Modifications in Drug Court Operations had
131% Higher Cost Savings
Conclusions
In spite of mixed results from other juvenile drug court studies – juvenile
drug courts can be effective
Juvenile drug courts need more quality studies, especially in best practices, so the model can be implemented more
consistently
56
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