Transcript title: subtitle

EVALUATING THE IMPACT OF ADDING
THE RECLAIMING FUTURES APPROACH
TO JUVENILE TREATMENT DRUG COURTS
Michael L. Dennis, Ph.D.,
Chestnut Health Systems, Normal, IL
(On behalf of the Juvenile Drug Court Reclaiming Futures
National Program Office and Evaluation Team)
Presentation at the 8th Annual Metro East Meth+ Other Drugs Conference, Belleville, IL, April 25, 2013.
Supported by the Reclaiming Futures/Juvenile Drug Court Evaluation under Library of Congress contract no.
LCFRD11C0007 to University of Arizona Southwest Institute for Research on Women, Chestnut Health Systems &
Carnevale Associates The development of this presentation is funded by the Office of Juvenile Justice and
Delinquency Prevention (OJJDP) through an interagency agreement with the Library of Congress – contract
number LCFRD11C0007. The views expressed here are the authors and do not necessarily represent the official
policies of OJJDP or the Library of Congress; nor does mention of trade names, commercial practices, or
organizations imply endorsement by the U.S. Government.,
Presentation will be available from

www.chestnut.org\li\posters
Purpose
3
1. Illustrate why it is so important to intervene with
juvenile drug users
2. Review what we know about juvenile treatment
drug courts (JTDC) so far
3. Compare JTDC to a newer Reclaiming Futures
version of JTDC in terms of their impact on
substance use, recovery, emotional problems,
illegal activity and costs to society
4
Background
Adolescence is the Age of Onset
5
5
100%
Over 90% of
90% use and
80% problems start
between the
70% ages of 12-20
People with drug
dependence die an
average of 22.5 years
sooner than those
without a diagnosis
It takes decades before
most recover or die
60%
50%
40%
Heavy Alcohol use
(past month)
30%
Other Drug use
(past year)
20%
10%
0%
65+
59-64
Source: 2010 NSDUH, Neumark et al., 2000)
35-49
30-34
21-29
18-20
16-17
14-15
12-13
5
Any Abuse/Dep
(past year)
Adolescence Use Related to Range of Problems
6
6
Source: Dennis & McGeary, 1999; OAS, 1995
Importance for Life Course
7
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People who start using under age 15 use 60% more years than
those who start over age 18.
Entering treatment within the first 9 years of initial use leads to
57% fewer years of substance use than those who do not start
treatment until after 20 years of use.
Relapse is common and it takes an average of 3 to 4 treatment
admissions over 8 to 9 years before half reach recovery.
Of all people with abuse or dependence 2/3rds do eventually
reach a state of recovery.
Monitoring and early re-intervention with adults has been shown
to cut the time from relapse to readmission by 65%, increasing
abstinence and improving long term outcomes.
7
Source: Dennis et al., 2005, 2007; Scott & Dennis 2009
What Is Treatment?
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8
Motivational interviewing and other protocols to help them understand how
their problems are related to their substance use and that they are solvable.
Detoxification and medication to reduce pain/risk of withdrawal and relapse,
including tobacco cessation.
Evaluation of antecedents and consequences of use.
Group, individual or family outpatient including relapse prevention planning
and cognitive behavior therapie.
More systemic family approaches.
Proactive urine monitoring.
Motivational incentives / contingency management.
Residential, intensive outpatient (IOP) and other types of structured
environments to reduce short term risk of relapse.
Access to communities of recovery for long term support, including 12-step,
recovery coaches, recovery schools, recovery housing, workplace programs.
Continuing care, phases for multiple admission.
The Treatment Gap by Age
Higher rates of
unmet need in
general; Less
than 1 in 13
adolescents and
young adults
getting treatment
Highest rates
among young
adults
% Past Year
9
25%
100%
20%
80%
15%
60%
10%
40%
5%
20%
0%
Substance Use Disorder
Treatment
Unmet Need
9
<18
7%
0.5%
92%
18-25
20%
1.6%
92%
26+
7%
1.0%
86%
% Unmet Need
9
0%
Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on Drug Use and Health, 2009. [Computer file]
ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2012-02-10. doi:10.3886/ICPSR29621.v2. Retrieved from
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621/detail .
Health Disparities by Gender
Yet girls have
more unmet need
represent only
about 1/3rd of the
teens in treatment
Unlike adults,
among
adolescents
girls have
higher need
% Past Year
10
25%
100%
20%
80%
15%
60%
10%
40%
5%
20%
0%
Substance Use Disorder
Treatment
Unmet Need
All Males
12%
1.4%
89%
All
Female
6%
0.7%
88%
% Unmet Need
10
0%
Boys
Girls
7.08%
0.61%
91%
7.63%
0.44%
94%
10 Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on Drug Use and Health, 2009. [Computer file]
ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2012-02-10. doi:10.3886/ICPSR29621.v2. Retrieved from
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621/detail .
Other Problems in the
U.S. Adolescent Treatment System
11
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Only 67% stay the 45 days minimum recommended by ONC
Only 56% are positively discharged or transferred
Only 43% stay the 90 days recommended by research
Only 23% leaving higher levels of care are transferred to outpatient
continuing care.
The majority of programs do NOT use standardized assessment,
evidenced-based treatment, track the clinical fidelity of the treatment
they provide, or monitor health disparities in service delivery or client
outcomes
Varied staff education with a median of less than BA.
Average of 30-32% staff turnover every year
Most lack or are just starting the multi-year process of setting up
electronic medical records
Source: SAMHSA 2012 & Institute of Medicine (2006).
The Cost of Treatment (and unmet need)
Screening & Brief Inter.(1-2 days)
Outpatient (18 weeks)
In-prison Therap. Com. (28 weeks)
Intensive Outpatient (12 weeks)
Adolescent Outpatient (12 weeks)
Treatment Drug Court (46 weeks)
Methadone Maintenance (87 weeks)
Residential (13 weeks)
Therapeutic Community (33 weeks)
$70,000
$60,000
$50,000
$40,000
$30,000
$407
$1,132
$1,249
$1,384
$1,517
$2,486
$4,277
$10,228
$14,818
$22,000 / year
to incarcerate
an adult
12
$20,000
SBIRT models popular due to
ease of implementation and
low cost
$10,000
12
$0
12
• $750 per night in Medical Detox
• $1,115 per night in hospital
• $13,000 per week in intensive
care for premature baby
• $27,000 per robbery
• $67,000 per assault
$30,000/
child-year in
foster care
$70,000/year to
keep a child in
detention
Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars
Return on Investment (ROI)
13
Substance abuse treatment has been shown to have a
ROI within the year of between $1.28 to $7.26 per
dollar invested.
 GAO’s recent review of 11 drug court studies found that
the net benefit ranged from positive $47,852 to
negative $7,108 per participant.
 Best estimates are that Treatment Drug Courts have an
average ROI of $2.14 to $3.69 per dollar invested
when considering only service costs.
This also means that for every dollar treatment is cut,
it costs society more money than was saved within
the same year.
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13
Source: Bhati, et al., (2008); Ettner, et al., (2006), GAO (2012), Lee, et al., (2012)
Juvenile Justice and Substance Use
14
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About half of the youth in the juvenile justice system have
drug related problems (Office of Juvenile Justice and
Delinquency Prevention (OJJDP), 2001; Teplin et al., 2002).
Juvenile justice systems are the leading source of referral
among adolescents entering treatment for substance use
problems (Dennis et al., 2003; Dennis, White & Ives, 2009;
Ives et al 2010).
By 2009 there were 476 juvenile treatment drug courts
(JTDC) in approximately 16% of the Counties in the US and
they were growing at a rate of 4% per year (Huddleston &
Marlowe, 2011)
Source: Dennis, White & Ives, 2009
15
16 Key Strategies for JTDC
(BJA, 2003)
10 Key Components of DC
(NADCP, 1997)
1. Engage all stakeholders in creating an
1. Drug Courts integrate alcohol and
interdisciplinary, coordinated, and systemic other drug treatment services with justice
approach to working with youth and their system case processing.
families.
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2. Using a non-adversarial approach,
prosecution and defense counsel promote
public safety while protecting participants’
due process rights.
2. Using a non-adversarial approach,
prosecution and defense counsel promote
public safety while protecting
participants’ due process rights.
3. Define a target population and
eligibility criteria that are aligned with the
program’s goals and objectives.
3. Eligible participants are identified
early and promptly placed in the Drug
Court program.
4. Schedule frequent judicial reviews and
be sensitive to the effect that court
proceedings can have on youth and their
families.
7. Ongoing judicial interaction with each
Drug Court participant is essential
5. Establish a system for program
monitoring and evaluation to maintain
quality of service, assess program impact,
and
contribute
toWhite
knowledge
the field
Source:
Dennis,
& Ives, in
2009
8. Monitoring and evaluation measure the
achievement of program goals and gauge
effectiveness.
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16 Key Strategies for JTDC
(BJA, 2003)
10 Key Components of DC
(NADCP, 1997)
6. Build partnerships with community
organizations to expand the range of
opportunities available to youth and their
families.
10. Forging partnerships among
Drug Courts, public agencies, and
community-based organizations
generates local support and enhances
Drug Court program effectiveness.
7. Tailor interventions to the complex and
varied needs of youth and their families.
4. Drug Courts provide access to a
continuum of alcohol, drug, and other
related treatment and rehabilitation
services.
8. Tailor treatment to the developmental
needs of adolescents.
9. Design treatment to address the unique
needs of each gender.
10. Create policies and procedures that are
responsive to cultural differences and train
personnel to be culturally competent.
11. Maintain a focus on the strengths of youth
and their families during program planning
and in every interaction between the court and
those it serves.
16
Source: Dennis, White & Ives, 2009
17
16 Key Strategies for JTDC
(BJA, 2003)
10 Key Components of DC
(NADCP, 1997)
12. Recognize and engage the family as a
valued partner in all components of the
program.
13. Coordinate with the school system to
ensure that each participant enrolls
14. Design drug testing to be frequent,
random, and observed. Document testing
policies and procedures in writing.
5. Abstinence is monitored by frequent
alcohol and other drug testing.
15. Respond to compliance and noncompliance with incentives and sanctions that
are designed to reinforce or modify the
behavior of youth and their families.
6. A coordinated strategy governs
Drug Court responses to participants’
compliance.
16. Establish a confidentiality policy and
procedures that guard the privacy of the
youth while allowing the drug court team to
access key information.
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Source: Dennis, White & Ives, 2009
9. Continuing interdisciplinary
education promotes effective Drug
Court planning, imple-mentation, and
operations.
Reclaiming Futures (RF)
“more treatment, better treatment, beyond treatment”
18
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RF is a “systems change” approach to improving the access and
quality of substance use and mental health services to youth in the
juvenile justice system both in general and specifically applied to JTDC
here.
RF was adapted from the system of care frameworks from the
children’s mental health movement to be inclusive, continuous, strengthand culturally-based and rely upon both family and community
strengths.
RF’s goals are to stimulate the development of interdisciplinary
professional and community teams to install evidence-based and
culturally relevant screening, assessment, appropriate integrated care
coordination, treatment and developmentally appropriate recovery
support systems following engagement in the justice and treatment
systems.
RF provides access to a “community of practice” with other sites
around the US to help mentor, coach and collaborate in a mutual
development and continuous learning process
Reclaiming Futures (RF) - continued
“more treatment, better treatment, beyond treatment”
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RF sites commit to a process of rigorous system “redesign” to increase
availability,
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RF teaches how sites how to use
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quality of substance and mental health services,
integration of related graduated sanctions and incentives, and
post-justice/post-treatment positive youth development opportunities.
community engagement to develop innovative partnerships with a wide
range of community stakeholders (e.g., businesses, faith communities, civic
organizations, and service organizations, schools).
essential youth development activities to decrease stigma and increase a
youth’s sense of aspirational possibilities for his/her life
RF thus incorporates and compliments the 16 strategies for JTDC and
10 key components of DC in general, and impacts the whole system
Level of Evidence is Available on Drug Courts
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Beyond a
Reasonable
Doubt
Clear and
Convincing
Evidence
Preponderance
of the Evidence
Probable
Cause
Reasonable
Suspicion
STRONGER
Law
Science
Meta Analyses of Experiments/ Quasi Experiments
(Summary v Predictive, Specificity, Replicated,
Consistency)
Dismantling/ Matching study (What worked for whom)
Experimental Studies (Multi-site, Independent,
Replicated, Fidelity, Consistency)
Quasi-Experiments (Quality of Matching, Multi-site,
Independent, Replicated, Consistency)
Pre-Post (multiple waves), Expert Consensus
Correlation and Observational studies
Case Studies, Focus Groups
Pre-data Theories, Logic Models
Anecdotes, Analogies
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Source: Marlowe 2008, Ives et al 2010
Level of Evidence is Available on Drug Courts
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Beyond a
Reasonable
Doubt
Clear and
Convincing
Evidence
Preponderance
of the Evidence
Probable
Cause
Reasonable
Suspicion
21
STRONGER
Law
Science
Meta
of Experiments/
Experiments
AdultAnalyses
Drug Treatment
Courts:Quasi
5 meta
analyses
of(Summary
76 studies
found crime
reduced
7-26% with
v Predictive,
Specificity,
Replicated,
$1.74
to $6.32 return on investment
Consistency)
Dismantling/
Matching
study
(What
for whom)
DWI Treatment
Courts:
one
quasiworked
experiment
Experimental
Studies (Multi-site,
and five observational
studiesIndependent,
positive findings
Replicated, Fidelity, Consistency)
Family Drug Treatment
one multisite
Quasi-Experiments
(QualityCourts:
of Matching,
Multi-site,
quasi
experiment
with positive
findings for
Independent,
Replicated,
Consistency)
parent and child
Pre-Post (multiple waves), Expert Consensus
Correlation
and Treatment
Observational
studies
Juvenile Drug
Courts
– one 2006
Case
Studies, Focus
Groups
experiment,
one 2010
large multisite quasiPre-data
Theories,
Logic Models
experiment,
& several
small studies with similar
Anecdotes,
Analogies
or better effects
than regular adolescent
outpatient treatment
Source: Marlowe 2008, Ives et al 2010
Juvenile Treatment Drug Court Effectiveness
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Low levels of successful program completion among youths in drug
courts was noticeable in several early studies (Applegate &
Santana, 2000; Miller, Scocas & O’Connell, 1998; Rodriguez &
Webb, 2004).
JTDC was found to be more effective than traditional family court
with community service in reducing adolescent substance abuse
(particularly when using evidence-based treatment) and criminal
involvement during treatment (Henggeler et al., 2006).
JTDC youth did as well or better than matched youth treated in
community based treatment (Sloan, Smykla & Rush, 2004; Ives et
al., 2010).
But still much room for improvement.
23
Methods
GAIN Initial (GAIN-I)
24
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Administration Time: Core version 60-90 minutes; full version 110-140
minutes (depending on severity).
Training Requirements: 3.5 days (train the trainer) plus recommend
formal certification program (Administration certification within 3
months of training; Local Trainer certification within 6 months of
training); advanced clinical interpretation recommended for clinical
supervisors and lead clinicians.
Mode: Generally staff-administered on computer (can be done on
paper or self-administered with proctor).
Purpose: Designed to provide a standardized biopsychosocial for
people presenting to a substance abuse treatment using DSM-IV for
diagnosis and ASAM for placement and needing to meet common
requirements (CARF, COA, JCAHO, insurance, CDS/TEDS, Medicaid,
CSAT, NIDA) for assessment, diagnosis, placement, treatment planning,
accreditation, performance/outcome monitoring, economic analysis,
program planning, and supporting referral/communications with other
systems.
GAIN Initial (GAIN-I) (continued)
25
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25
Scales: The GAIN-I has 9 sections (access to care, substance use, physical
health, risk and protective behaviors, mental health, recovery environment,
legal, vocational, and staff ratings) that include 103 long (alpha over .9) and
short (alpha over .7) scales, summative indices, and over 3,000 created
variables to support clinical decision-making and evaluation. It is also
modularized to support customization.
Response Set: Breadth (past-year symptom counts for behavior and lifetime
for utilization), recency (48 hours, 3-7 days, 1-4 weeks, 2-3 months, 4-12
months, 1+ years, never), and prevalence (past 90 days); patient and staff
ratings.
Interpretation:
 Items can be used individually or to create specific diagnostic or treatment
planning statements.
 Items can be summed into scales or indices for each behavior problem or
type of service utilization.
 All scales, indices, and selected individual items have interpretative cut
points to facilitate clinical interpretation and decision making.
Cost to Society
26
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Costs of Service Utilization (conservative) based on the
frequency of using tangible services (e.g., behavioral, physical and
mental health care utilization, days in detention, probation, parole)
in the 12 months before and after intake valued by economists
(French et al., 2003; Salomé et al., 2003), adjusted for inflation to
2010 dollars and summed.
Costs of Crime (tangible & intangible) based on the frequency of
committing crimes (e.g., property crime, interpersonal crime,
drug/other crime) in the 12 months before and after intake valued
on tangible and intangible costs by economists (McCollister et al.,
2010), adjusted for inflation to 2010 dollars and summed.
Service Utilization Unit Costs (conservative)
27
27
Description
Inpatient Physical health (PH) hospitalization)
PH Emergency room
Outpatient PH clinic/doctor’s office
Mental Health (MH) hospitalization
MH Emergency room
See MD in office or clinic for MH
Detoxification for AOD use
AOD Emergency room
Residential for AOD use
Intensive outpatient program for AOD use
Regular outpatient program
Unit
Days
Times
Times
Nights
Times
Times
Days
Times
Nights
Days
Times
Cost in 2010$
$ 2,135.46
$ 6,278,83
$ 66.48
$ 2,135.46
$ 6,278.83
$ 77.32
$ 227.67
$ 262.23
$ 117.90
$ 91.48
$ 31.51
Arrests
Probation
Parole
Jail/prison/juvenile detention
Times
Days
Days
Days
$2,125.81
$ 5.76
$ 18.59
$ 81.58
Cost of Crime (tangible & intangible)
28
28
28
Offense
Murder
Rape/sexual assault
Aggravated assault
Robbery
Arson
Motor vehicle theft
Household burglary
Larceny/theft
Stolen property
Vandalism
Forgery/counterfeit
Embezzlement
Fraud
Tangible\a
$1,340,409
$43,247
$20,484
$22,436
$17,225
$11,045
$6,469
$3,694
$8,361
$5,096
$5,520
$5,746
$5,276
Intangible\b
$8,851,318
$209,322
$99,630
$23,670
$5,382
$275
$337
$10
$$$$$-
Total\c
$9,418,451
$252,450
$112,209
$44,361
$22,126
$11,294
$6,775
$3,703
$8,361
$5,096
$5,520
$5,746
$5,276
\a Including the 2011 est. cost to the victim, justice system, and criminal career.
\b Including the 2011 est. cost of pain & suffering, prorated risk of homicide.
\c Total is the sum of 2011 est. cost less any uncorrected risk-of-homicide crime victim cost
SOURCE: McCollister, K. E., French, M. T., & Fang, F. (2010).
Juvenile Treatment Drug Court (JTDC)
29
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Cohort of 16 CSAT grantee sites using the GAIN in Box
Elder, MT; Buffalo, NY; Laredo, TX; San Antonio, TX (2);
San Rafael, CA;Belmont, CA; Tarzana, CA; Pontiac, MI;
San Jose, CA; Austin, TX; Peabody, MA; Providence, RI;
Detroit, MI; Philadelphia, PA, & Viera, FL.
Intake data collected on1,934 adolescents from these
sites between January 2006 through November 2011
Analysis on 1,351 (79% of 1712 due) adolescents with
1+ follow-up at 3, 6, and 12-months post intake.
Reclaiming Futures JTDC (RF-JTDC)
30
30
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30
Cohort of 10 grantee CSAT and/or OJJDP sites using
the GAIN in Cherokee Nation, OK; Denver, CO; Greene
County,MO; Hardin County, OH; Hocking County, OH;
Nassau County, NY; & Seattle, WA; Snohomish County,
WA; Travis County, TX; & Ventura County, CA.
Intake data cllected on 811 adolescents from these sites
between January 2008 through December 2011
Analysis on 556 (89% of 625 due) adolescents with 1+
follow-up at 3, 6, and 12-months post intake.
Matching with Propensity Score Weights
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31
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31
A comparison of 63 intake characteristics found that 26 (41%) differed
significantly between JTDC and RF-JTDC.
To make a stronger quasi-experimental comparisons of the groups, we
controlled for these differences by using them to create propensity
score that reflected how similar the people in the JTDC comparison
group were to those in the RF-JTDC.
After propensity score weighting of the JTDC group, 19 (73%) of the of
the original 26 differences were eliminated
6 (23%) were reduced but still statistically significant (having high count
of multi-morbidity*, high health problems*, prior mental health
treatment*, 1+ year behind in school**, Hispanic**, Caucasian*), and
1 (4%) was slightly enlarged (Expelled or dropped out of school*)
*RF-JTDC higher **JTDC higher
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Results: Baseline Needs
Count of Major Clinical Problems at Intake: RF-JTDC
33
33
Cannabis disorder
74%
30%
Alcohol disorder
Other drug disorder
42%
48%
CD
Four
37%
ADHD
Three
30%
Depression
Trauma
26%
Anxiety
Two
11%
Violence/ illegal activity
88%
Victimization
One
62%
Suicide
11%
None
50%
Major Clinical Problems*
0%
Source: RF-JTDC (weighted n=556)
Five to
Twelve
20%
14% 14% 10%9%3%
40%
60%
80%
100%
Number of Clinical Problems:
JTDC vs. RF-JTDC
34
100%
None
90%
80%
One
70%
Two
60%
50%
Three
40%
30%
59%
64%
20%
10%
0%
Other JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
RF-JTDC
Four to
Twelve
*Based on count of self
reporting criteria to
suggest alcohol,
cannabis, or other drug
disorder, depression,
anxiety, trauma, suicide,
ADHD, CD, victimization,
violence/ illegal activity
General Victimization Scale: RF-JTDC
35
35
Ever attacked w/ gun, knife, other…
39%
31%
24%
Ever hurt by striking/beating
Abused emotionally
Ever forced into sex acts
6%
60%
Age of 1st abuse < 18
29%
31%
25%
18%
Any several times or for long time
Any with more than one person…
Was person family member/trusted one
Were you afraid for your life/injury
People you told not believe you/help…
Currently worried: being attacked
Low
Severity
(0)
4%
5%
Currently worried: being beaten/hurt
Currently worried: emotional abuse
Currently worried: forced into sex acts
1%
40%
General Victimization Scale
(Number of 15 items endorsed)
0%
Source: RF-JTDC (weighted n=556)
Moderat
e
Severity
(1-3)
9%
6%
6%
Result in oral, vaginal, anal sex
35
High
Severity
(4-15)
20%
23%
40%
60%
38%
80% 100%
Major Clinical Problems* by Victimization: RF-JTDC
36
36
# of Major Clinical Problems
100%
None
90%
80%
One
70%
60%
Two
50%
Three
40%
74%
30%
20%
10%
Four
53%
18%
Five to
Twelve
0%
Low
Moderate
High
Severity of Victimization
*Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug
disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal
activity
Source: RF-JTDC (weighted n=556)
Severity of Victimization:
JTDC vs. RF-JTDC
37
100%
90%
Low (0)
80%
70%
60%
Moderate
(1-3)
50%
40%
30%
20%
41%
40%
Other JTDC (n=556)
RF-JDC (n=556)
10%
0%
Source: JTDC vs. RF-JTDC (weighted n=1112)
High (4-15)
Age of Onset: JTDC
Cumulative % of Total
38
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Victimization
Mental Health
Substance Use
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Age at First Time
Source: JTDC (weighted n=556)
Age of Onset: RF-JTDC
Cumulative % of Total
39
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
RF-JTDC Early Onset
and Higher Prevalence
of Mental Health and
Victimization
Victimization
Mental Health
Substance Use
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Age at First Time
Source: RF-JTDC (weighted n=556)
40
Results: Services
Days of Services Received*
41
Total Days
300
Substance
Abuse
Treatment
Mental
Health
Treatment
Physical Health
Treatment
Juvenile Justice
System
250
200
150
100
50
0
SA Tx
JTDC /a
Year Prior
Year After
Raw Change
% Change
41
23
56
33
145%
SA Tx
RF-JTDC
/a,b
31
85
54
174%
MH Tx
JTDC
MH Tx
RF-JTDC
PH Tx
JTDC
PH Tx
RF-JTDC
JJS
JTDC /a
56
61
5
10%
70
61
-9
-13%
35
31
-4
-11%
33
32
-1
-3%
215
263
48
22%
JJS
RF-JTDC
/a, b
239
291
52
22%
*Days of Substance Abuse (SA), Mental Health (MH), Physical Health (PH) treatment and Juvenile Justice System (JJS) Involvement
(primarily days on probation (>70% of total days).)
\a p<.05 that post minus pre change is statistically significant
\b p<.05 that year after values for Reclaiming Futures JTDC is higher than the average for other JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
Average Annual Cost of Service Utilization*
42
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$Year Prior
Year After
Raw Change
% Change
42
Other JTDC
$21,303
$16,968
$(4,334)
-20%
*Behavioral, physical, mental health treatment, incarceration, probation and parole.
Subset to records with valid responses at both time periods.
Source: JTDC vs. RF-JTDC (weighted n=1112)
RF-JTDC
$23,818
$20,249
$(3,568)
-15%
SA Treatment Retention: JTDC vs. RF-JTDC
43
100%
80%
Rate
60%
40%
20%
0%
Initiation \a
JTDC
RF-JTDC
78%
65%
Engagement
\b
61%
68%
Continuing
Care \c
82%
78%
Any
Self-Help \d
38%
19%
\a Initiating treatment within 14 days of GAIN interview (JTDC significantly higher than RF-JTDC)
\b Engaged in treatment at least 30 days and at least 3 + days of actual treatment (R-JTDC significantly higher
than JTDC)
43
\c Received any treatment 90 to 180 days post intake interview (not statistically different)
\d Any days of self help in the year post intake interview (JTDC significantly higher than RF-JTDC)
Source: JTDC vs. RF-JTDC (weighted n=1112)
Level of Care: JTDC vs. RF-JTDC*
44
44
100%
80%
60%
40%
20%
0%
Other JTDC
RF-JTDC
OP
64%
71%
IOP
32%
12%
STR
0.2%
M-LTR
2%
16%
CC-OP
2%
0.2%
*OP: Outpatient, IOP: Intensive Outpatient; STR: Short Term Residential; M-LTR: Medium to Long Term Residential; CC-OP
Continuing Care Outpatient. Distribution of clients by Level of Care is significantly different between JTDC and RF-JTDC.
44
Source: JTDC vs. RF-JTDC (weighted n=1112)
Type of Treatment: JTDC vs. RF-JTDC \a,b
45
45
100%
80%
60%
40%
20%
0%
Other JTDC
RF-JTDC
45
A-CRA/
ACC
31%
53%
MET/ CBT
7C
23%
8%
0%
13%
Other
EBTx
23%
17%
Local
Manual
15%
0%
Other
8%
9%
\a A-CRA/ ACC: Adolescent Community Reinforcement Approach/ Assertive Continuing Care;
MET/CBT: Motivational Enhancement Therapy/Cognitive Behavior Therapy; 7C: Seven Challenges; EBTx: Other evidenced based
treatment approaches; Local manual but not replicated; Other all else.
\b Distribution of clients by Type of Treatment is significantly different between JTDC and RF-JTDC.
Source: JTDC vs. RF-JTDC (weighted n=1112)
Discharge Status: JTDC vs. RF-JTDC \a
46
46
100%
80%
60%
40%
20%
0%
Still in
Treatment
Other JTDC
19%
RF-JTDC
22%
Completed
33%
26%
Transfer
14%
25%
Back to
JJS \b
13%
5%
\a JJS: Juvenile justice system; AMA: Against medical advice; ASR: At staff request.
\b Difference represents a small significant effect (Cohen’s d>.2)
46
Source: JTDC vs. RF-JTDC (weighted n=1112)
AMA or
ASR \b
3%
9%
Other \b
13%
6%
47
Results: Outcomes
Change in Days of Abstinence \a
48
48
360
270
180
90
0
Year Prior
Year After
Raw Change
% Change
48
Juvenile Treatment Drug
Court \b
246
304
58
24%
Reclaiming Futures JTDC
\b, c
223
317
94
42%
\a Days of abstinence s while living in the community; If coming from detention at intake, based on the days before detention.
\b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC
\c Amount of change is significantly better for RF-JTDC than JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
Change in Being in Early Recovery \a
49
49
60%
50%
40%
30%
20%
10%
0%
Year Prior
Year After
Raw Change
% Change
49
Juvenile Treatment Drug
Court \b
33%
50%
17%
50%
Reclaiming Futures JTDC
\b
35%
55%
20%
57%
\a No past month use, abuse or dependence symptoms while living in the community.
\b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
Change in Days of Victimization \a
50
50
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Year Before
Year After
Raw Change
% Change
Juvenile Treatment Drug
Court
5.88
3.22
-2.65
-45%
Reclaiming Futures JTDC
\a Number of days victimized (physically, sexually, or emotionally ) in past year.
50
Source: JTDC vs. RF-JTDC (weighted n=1112)
8.51
1.95
-6.56
-77%
Change in Emotional Problems Scale \a
51
51
30%
25%
20%
15%
10%
5%
0%
Year Prior
Year After
Raw Change
% Change
51
Juvenile Treatment Drug
Court \b, c
24%
18%
-6%
-24%
Reclaiming Futures JTDC
\b
26%
21%
-5%
-18%
\a Proportional average of recency and days of emotional problems (bothered, kept from responsibilities, disturbed by
memories, paying attention, self-control) in past 90.
\b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC
\c Amount of change is significantly better for JTDC than RF-JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
Change in Illegal Activities Scale \a
52
52
0.12
0.10
0.08
0.06
0.04
0.02
0.00
Intake
At last FU
Raw Change
% Change
52
Juvenile Treatment Drug
Court
0.11
0.10
-0.01
-13%
Reclaiming Futures JTDC \b
0.11
0.08
-0.03
-24%
\a Recency and days (during the past 90) of illegal activity and supporting oneself financially with illegal activity.
\b Change within condition is statistically & clinically significant for RF-JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
Change in Number of Crimes Reported \a
53
53
35
30
25
20
15
10
5
0
Year Prior
Year After
Raw Change
% Change
Juvenile Treatment Drug
Court \b
29
16
-13
-45%
Reclaiming Futures JTDC\b, c
\a sum of the number of crimes in the past year
\b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC
\c Amount of change is significantly better for RF-JTDC than JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
28
10
-18
-65%
Change in Number of Crimes by Type \a
54
54
Property
Violent
Drug/Other
20
15
10
5
0
Year Prior
Year After
Raw Change
% Change
JTDC
\b
14
7
-7
-51%
RF-JTDC
\b
14
5
-8
-61%
JTDC
5
3
-1
-30%
\a Sum of all crimes reported within type.
\b Change within condition is statistically & clinically significant
\c Amount of change is significantly better for RF-JTDC than JTDC
\d In the year after, significantly lower for RF-JTDC than JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
RF-JTDC
\b, c, d
5
2
-3
-65%
JTDC
\b2
11
6
-5
-44%
RF-JTDC
\b, d
9
3
-7
-71%
Change in Cost of Crime to Society \a
55
55
$300,000
$250,000
$200,000
$150,000
$100,000
$50,000
$Year Prior
Year After\c
Raw Change
% Change
Juvenile Treatment Drug
Court \b
$264,501
$132,142
$(132,359)
-50%
Reclaiming Futures JTDC
\b,c
$287,152
$70,921
$(216,231)
-75%
\a Based on the frequency of crime (crimes capped at 99th percentile to minimize the impact of outliers) times the average cost to
society of that crime estimated by McCollister, et al., (2010) in 2011 dollars.
\b Year after is significantly lower than year before .
\c At follow-up RF-JTDC is significantly lower than JTDC
Source: JTDC vs. RF-JTDC (weighted n=1112)
56
Discussion
Limitations
57
57






57
This analysis is based on self-reported data.
There was data missing due to attrition (11% to 21%), so
outcomes had to be estimated based on the average of the
observed waves.
No formal cost analyses of JTDC or Reclaiming Futures JTDC
were done so cost estimates here are likely to be lower bound
estimates.
While adjusted for inflation, the costs of service utilization are
somewhat dated and should ideally be updated.
The cost of crime was based on estimates developed for adults
(McCollister et al., 2010) that have been applied here to youth.
The cost of service and crime estimates have very large
variance and there are also subgroups with changes going in
both directions – collecting reducing the power of the statistical
tests that could be done.
Reprise
58
58



Relative to JTDC, the Reclaiming Futures JTDC reached more
clinically severe youth, provided them with more services and
did as well or better on outcomes even after adjusting for
baselines differences.
Both groups did well at reducing substance use, crime and
emotional problems
Relative to JTDC, the Reclaiming Futures JTDC did better in
terms of:




Relative to JTDC, the Reclaiming Futures JTDC did worse in
terms of

58
increasing the days of alcohol and drug abstinence (58 vs. 94 days) in
the year after intake.
reducing the number of violent crimes (-30% vs. -65%)
the number of crimes overall (-45% vs. -65%), property crimes (-51%
vs. -61%), and substance related crimes (- 44% vs. -71%).
Reducing emotional problem scale (-18% vs. -21%)
Reprise (continued)
59
59




59
The overall costs of utilizing services related to substance
use, mental health, health and juvenile justice nominally
decreased for both Reclaiming Futures-JTDC and JTDC ($3568 vs. $-4334, nsd).
The annual cost of crime was significantly reduced for both
JTDC ($ -132,359; -50%) and Reclaiming Futures JTDC ($
-216,231; -75%).
The average costs of crime was significantly lower in the
year after intake for clients in Reclaiming Futures JTDC vs.
other JTDC ($132,142 vs. $70,921 per youth).
Reductions in the cost of crime are far greater than the
reduction in services that are often the focus on past
economic analyses.
Next Steps
60
60




60
Running by site to verify and better understand the
findings.
Will work to publish these findings and to do more
comprehensive analyses in terms of case mix adjustment
and costs
OJJDP has just funded another round of Reclaiming
Futures JTDC
University of Arizona has just been funded to conduct a
more formal evaluation of the RF-JTDC model and how
it compares to other JTDC
References
61
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61
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
61
Applegate, B. K., & Santana, S. (2000). Intervening with youthful substance abusers: A preliminary analysis of a
juvenile drug court. The Justice System Journal, 21(3), 281-300.
Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved
Offenders. Washington, DC: Urban Institute.
Bureau of Justice Assistance (2003). Juvenile Drug Courts:Strategies in Practice. Washington, DC: Author
Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids. Accessed on 6/3/09 from
http://www.connectforkids.org/node/571
Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice
system: Improving public health and safety. Journal American Medical Association, 301(2), 183-190
Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration
of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.
Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice ,
4(1), 45-55.
Dennis, M. L., Scott, C. K., Funk, R. R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment.
Journal of Substance Abuse Treatment, 28(2 Suppl), S51-S62.
Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs
(GAIN): Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL: Chestnut Health
Systems. Retrieved from www.gaincc.org.
Dennis, M.L., White, M., Ives, M.I (2009). Individual characteristics and needs associated with substance misuse of
adolescents and young adults in addiction treatment. In Carl Leukefeld, Tom Gullotta and Michele Staton Tindall
(Ed.), Handbook on Adolescent Substance Abuse Prevention and Treatment: Evidence-Based Practice. New London,
CT: Child and Family Agency Press.
Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the
California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services Research,
41(1), 192-213.
References
62

62









62
French, M. T., Roebuck, M. C., Dennis, M. L., Diamond, G., Godley, S. H., Liddle, H. A., et al. (2003). Outpatient
marijuana treatment for adolescents: Economic evaluation of a multisite field experiment. Evaluation Review, 27(4),
421-459.
French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates
of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469
General Account Office (GAO, 2011). Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could
Enhance Future Performance Measure Revision Efforts. Washington, DC: Author. Retrieved from
http://www.gao.gov/Products/GAO-12-53 on April 18, 2012.
Health Serve Res. 2006 February; 41(1): 192–213. Health Research and Education Trust
Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., Chapman, J. E. (2006).
Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and
Clinical Psychology, 74(1), 42-54.
Institute of Medicine (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions .
National Academy Press. Retrieved from http://www.nap.edu/catalog.php?record_id=11470
Ives, M.L., Chan, Y.F., Modisette, K.C., & Dennis, M.L. (2010). Characteristics, needs, services, and outcomes of youths
in juvenile treatment drug courts as compared to adolescent outpatient treatment. Drug Court Review, 7(1), 10-56.
Lee, M. T., Garnick, D. W., O'Brien, P. L., Ponos, L., Ritter, G. A., & Acevedo, A. G. M. D. (2012). Adolescent
treatment initiation and engagement in an evidence based practice initiative. Journal of Substance Abuse
Treatment, 42(4), 346-355.
Marlowe, D. B. (2008). Recent studies of drug courts and DWI courts Crime reduction and cost savings. NADCP.
McCollister, K. E., French, M. T., & Fang, F. (2010). The cost of crime to society: New crime-specific estimates for
policy and program evaluation. Drug and Alcohol Dependence 108 (1-2) 98-109.
References
63

63







63
Miller, M L, Scocas, E A & O'Connell, J P (1998). Evaluation of the Juvenile Drug Court Diversion Program, Bureau
of Justice Assistance, Rockville, MD. Publication # 100703-980304.
http://www.ncjrs.gov/pdffiles1/Digitization/172247NCJRS.pdf.
National Association of Drug Court Professionals (1997). The 10 Key Components. Washington, DC: Author
Rodriguez, N., & Webb, V. J. (2004). Multiple measures of juvenile drug court effectiveness Results of a quasiexperimental design. Crime & Delinquency, 50(2), 292-314.
Salom鬠H.J., French, M.T., Scott, C.K, Foss,M. and Dennis, M.L. (2003). Investigating the Variation in the Costs and
Benefits of Addiction Treatment: Econometric Analysis of the Chicago Target Cities Project. Evaluation and
Programming Planning, 26(3):325-338.
Scott, C. K., & Dennis, M. L. (2009). Results from two randomized clinical trials evaluating the impact of quarterly
recovery management checkups with adult chronic substance users. Addiction, 104(6), 959-971. Retrieved from
http//www.pubmedcentral.gov/articlerender.fcgi?artid=2695999
Sloan III, J. J., Smykla, J. O., & Rush, J. P. (2004). Do juvenile drug courts reduce recidivism? Outcomes of drug court
and an adolescent substance abuse program. American Journal of Criminal Justice, 29(1), 95-116.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on
Drug Use and Health, 2009. [Computer file] ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political
and Social Research [distributor], 2012-02-10. doi:10.3886/ICPSR29621.v2. Retrieved from
http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621/detail .
Substance Abuse and Mental Health Services Administration (2012). Center for Behavioral Health Statistics and
Quality. Treatment Episode Data Set Discharges (TEDS-D), 2009. ICPSR33621-v1. Ann Arbor, MI: Inter-university
Consortium for Political and Social Research [distributor], 2012-10-25.
Acknowledgement & Disclaimer
64
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64
The development of this presentation was funded by the Office of Juvenile Justice and Delinquency Prevention
(OJJDP) through an interagency agreement with the Library of Congress (LOC) and contract number
LCFRD11C0007 to the University of Arizona’s (UA’) Southwest Institute for Research on Women (SIROW).
The presentation builds on earlier analyses done under Substance Abuse and Mental Health Services Administration
(SAMHSA) contract 270-07-0191 and uses data provided by 27 Juvenile Treatment Drug Court (JTDC) grantees
funded by OJJDP & SAMHSA’s Center for Substance Abuse Treatment (CSAT): TI17433, TI17434, TI17446,
TI17475, TI17484, TI17476, TI17486, TI17490, TI17517, TI17523, TI17535; 655371, 655372, 655373,
(TI22838, TI22856, TI22874, TI22907, TI23025, TI23037, TI20921, TI20925, TI20920, TI20924, TI20938,
TI20941.
The Reclaiming Futures National Program Office received direct support from OJJDP to work with a subset of the
grantees to implement their model in the context of Juvenile Treatment Drug Courts (see www.reclaimingfutures.org)
The presenter and the SIROW wish to acknowledge the contributions of the Reclaiming Futures National Program
Office , our evaluation team partners (UA SIROW, Chestnut Health Systems , Carnevale Associates, Randy Muck),
the OJJDP & SAMHSA project officers, grantees and their participants for agreeing to share their data to support
this secondary analysis and several individuals who have assisted with preparing or providing feedback on the
presentation including: Jimmy Carlton, John Carnevale, Monica Davis, Michael Dennis, Barbara Estrada, Michael
French, Mark Fulop, Lori Howell, Pamela Ihnes, Melissa Ives, Nora Jones, Raanan Kagan, Josephine Korchmaros,
Rachel Kohlbecker, Kathryn McCollister, Rachel Meckley, Daniel Merrigan, Kate Moritz, Randy Muck, Laura Nissen,
Scott Olsen, Erika Ostlie, Mac Prichard, Susan Richardson and ., Sally Stevens, Liz Wu.
The views expressed here are the authors and do not represent the official policies of the government; The mention
of any trade names, commercial practices, or organizations does not imply endorsement by the authors or the U.S.
Government
Questions?
65
65
• Poster available from www.chestnut.org\li\posters
• For questions about this presentation, please contact Michael
Dennis at 309-451-7801 or [email protected].
• For questions about Reclaiming Futures, please contact Susan
Richardson at (503) 725-8914 or [email protected]
• For questions on the National Cross-Site Evaluation, contact
Monica Davis, Evaluation Coordinator at 520-295-9339 x211 or
[email protected]
65