Transcript EVALUATING THE IMPACT OF ADDING THE RECLAIMING FUTURES APPROACH TO JUVENILE TREATMENT DRUG COURTS Michael L.

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 Reclaiming Futures Leadership Institute, Asheville, NC, May 8, 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. Available from
www.gaincc.org/presentations.
Purpose
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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
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Background
Adolescence is the Age of Onset
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4
100%
Over 90% of
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
90%
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
4
Any Abuse/Dep
(past year)
Adolescence Use Related to Range of Problems
5
0%
been arrested
(OR=29.6)
dropped out of
school (OR=5.2)
been to emergency
room (OR=2.4)
gotten into physical
fights (OR=7.2)
have conduct
disorder (OR=8.9)
engaged in illegal
activity (OR=10.9)
5
20%
40%
60%
80%
1%
No or Infrequent Use
23%
6%
Weekly or More Use
25%
17%
33%
11%
13%
17%
Source: Dennis & McGeary, 1999; OAS, 1995
47%
57%
69%
100%
Problems in the Adolescent Treatment System
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Less than 1 in 13 adolescents (8%) with substance use disorders get
into treatment
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).
Juvenile Justice and Substance Use
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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
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.
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Methods
Juvenile Treatment Drug Court (JTDC) Sites & Data
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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) Sites & Data
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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.
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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.
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Source: Dennis, White & Ives, 2009
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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”
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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, strength- and
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 fellowships” 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” in order to
increase the
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RF teaches how sites how to use
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availability and quality of substance and mental health services,
integration of graduated sanctions and incentives, and
positive youth development opportunities during and after treatment and
justice system involvement
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
GAIN Training and Data Management
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All intake and follow-up data collected using the Global Appraisal of
Individual Needs (GAIN) (www.gaincc.org/gaini )
The GAIN Coordinating Center (GCC) provided local trainers and
several staff from each site with initial 3.5 days of training and
participated in a mastery based certification program (Administration
certification within 3 months of training; Local Trainer certification
within 6 months of training)
Local trainers and/or on line training was used to handle staff turnover
Interviews were generally staff-administered on computer using PC or
web-based software and used to computer generate tentative
diagnosis, treatment planning statements and placement
recommendations
Data cleaned, de-identified and combined GCC staff for analysis
Preliminary data analysis reviewed by RF national program, coaches
and other cross-site evaluation team members.
Matching with Propensity Score Weights
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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
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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%
General Victimization Scale: RF-JTDC
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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
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High
Severity
(4-15)
20%
23%
40%
60%
38%
80% 100%
Major Clinical Problems* by Victimization: RF-JTDC
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# 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)
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Results: Services
Days of Services Received*
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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
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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*
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$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$Year Prior
Year After
Raw Change
% Change
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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%
Level of Care: JTDC vs. RF-JTDC \a, b
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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%
\a OP: Outpatient, IOP: Intensive Outpatient; STR: Short Term Residential; M-LTR: Medium to Long Term Residential; CC-OP
Continuing Care Outpatient.
\b Distribution of clients by Level of Care is significantly different between JTDC and RF-JTDC.
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Source: JTDC vs. RF-JTDC (weighted n=1112)
Type of Treatment: JTDC vs. RF-JTDC \a, b
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100%
80%
60%
40%
20%
0%
Other JTDC
RF-JTDC
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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)
Family Engagement in the First 3 months \a, b
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100%
80%
60%
40%
20%
0%
Meet in home\a
Other JTDC
RF-JTDC
34%
21%
Meet w/ family
2+ times \a
62%
41%
Meet w/ family
re commun.\a
55%
36%
Help family get
other service
18%
17%
GAIN Family
Scale\a
42%
29%
\a Significantly different between JTDC and RF-JTDC.
\b Gap closes but still significantly different at 12 months; Differences not significant on direct or wrap around services.
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Source: JTDC vs. RF-JTDC (weighted n=1112)
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Results: Outcomes
Change in Days of Abstinence \a
30
30
360
270
180
90
0
Year Prior
Year After
Raw Change
% Change
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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 Days of Victimization \a
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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.
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Source: JTDC vs. RF-JTDC (weighted n=1112)
8.51
1.95
-6.56
-77%
Change in Emotional Problems Scale \a
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30%
25%
20%
15%
10%
5%
0%
Year Prior
Year After
Raw Change
% Change
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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 Number of Crimes Reported \a
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35
30
25
20
15
10
5
0
Year Prior
Year After
Raw Change
% Change
Juvenile Treatment Drug
Court \b
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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)
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10
-18
-65%
Change in Number of Crimes by Type \a
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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
\b
11
6
-5
-44%
RF-JTDC
\b, d
9
3
-7
-71%
Change in Cost of Crime to Society \a
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$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)
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Discussion
Reprise
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Relative to JTDC, the Reclaiming Futures JTDC provided a
matched cohort of youth with more services.
Both groups did well at reducing substance use, crime and
emotional problems
Relative to JTDC, the Reclaiming Futures JTDC did better in
terms of:
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Relative to JTDC, the Reclaiming Futures JTDC did worse in
terms of
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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%).
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Providing family services (42% vs. 29%)
Reducing emotional problem scale (-18% vs. -21%)
Reprise (continued)
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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. $-4334, nsd).
The average annual cost of crime was significantly
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reduced for both JTDC ($ -132,359; -50%) and Reclaiming
Futures JTDC ($ -216,231; -75%)
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lower in the year after intake for youth in Reclaiming Futures
JTDC ($132,142 vs. $70,921 per youth).
Reductions in the cost of crime are far greater than the
reduction in services that have often been the focus on past
economic analyses.
Some Important Limitations
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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 measures of compliance with 16 strategies
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.
Next Steps
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Running by site to verify and better understand the
findings.
Will work to publish these findings
OJJDP has just funded another round of Reclaiming Futures
JTDC that will hopefully improve mental health and family
services
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 that will include
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More formal measures of court operations and the 16 strategies
Include more formal costs estimates
Include more quantitative and qualitative data
Examining health disparities by gender and race
Questions?
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• 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]
41
References
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system: Improving public health and safety. Journal American Medical Association, 301(2), 183-190
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of abstinence and other aspects of recovery. Evaluation Review, 31(6), 585-612.
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(GAIN): Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL: Chestnut Health
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(Ed.), Handbook on Adolescent Substance Abuse Prevention and Treatment: Evidence-Based Practice. New London,
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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),
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of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469
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Acknowledgement & Disclaimer
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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
Cost to Society Supplemental Information
46
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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)
47
47
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)
48
48
48
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).
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
49
$20,000
SBIRT models popular due to
ease of implementation and
low cost
$10,000
49
$0
49
• $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)
50
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.

50
Source: Bhati, et al., (2008); Ettner, et al., (2006), GAO (2012), Lee, et al., (2012)