Evaluating Drug Treatment Courts Lessons from Previous Research

Michael RempelCenter for Court Innovation(rempelm@courtinnovation.org)

Taller de Capacitacion para la implementacion de Tribunales de Tratamiento de Adicciones en Mexico, Toluca de Lerdo, Estado de Mexico, November 23-24, 2013,

Drug Court

Do Drug Courts Work?Positive

Outcomes• Reduced Recidivism

• Reduced Drug Use

• Cost Savings

Do Drug Courts Work? Recidivism:

Almost 100 evaluations of adult criminal drug courts Most reduce recidivism (about 4 of every 5 programs) Average recidivism reduction = 8-12 percentage points

Drug Use: All evaluations (five) show reductions in drug use Several studies show larger effects on serious drug use

(e.g., heroin or cocaine) than on marijuana use

Cost Savings: Multi-site studies all show savings, mainly from reductions in recidivism and incarceration

Reduced RecidivismPercent with Criminal Activity:

One Year Prior to 18-Month Interview

53% 50%40%* 36%**

0%

20%

40%

60%

80%

100%

Criminal Activity Drug-Related Activity

Drug Court (n = 951)Comparison (n = 523)

+ p < .10 * p < .05 ** p < .01 *** p < .001

Source: Rossman et al. (2011)

Reduced Drug UsePercent Used Drugs:

One Year Prior to 18-Month Interview

76%

58%

41%**

56%**

0%

20%

40%

60%

80%

100%

Any Drug Any Serious Drug

Drug Court (n = 951)Comparison (n = 523)

+ p < .10 * p < .05 ** p < .01 *** p < .001Note: Measures are reported use of eight drugs: alcohol, marijuana, cocaine, heroin, amphetamines, hallucinogens, prescription drugs (illegal use), and methadone (illegal use). "Serious" drugs omit marijuana and light alcohol use (less than four drinks per day for women and less than five for men).

Source: Rossman et al. (2011)

What’s Wrong with This Story? Almost 100 Recidivism Evaluations:

Average recidivism reduction = 8-12 percentage points But—The precise effect size varies widely:

Some drug courts produced large recidivism reductionsSome drug courts produced small recidivism reductionsSome (about 20%) had no effect or increased recidivism

Drug Court

Do Drug Courts Work?Positive

Outcomes• Reduced Recidivism

• Reduced Drug Use

• Cost Savings

Drug Court

Why Do Drug Courts Work?Positive

Outcomes• Reduced Recidivism

• Reduced Drug Use

• Cost Savings

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Target Population1. Risk Level: Likelihood of recidivism at baseline

Risk Principle Definition: Vary treatment by offender risk level.

High-Risk: Provide intensive treatment. Low-Risk: Treatment can be harmful: Why?

Removes offenders from work and school Surrounds offenders with high-risk peers

Impact with High-risk OffendersTreatment Effects For High Risk Offenders

-34

-18-15 -14

-6 -5-2 -2

2 3 3 35 6 7 8 8 9 10 10

12 12 12 13 13 1315

21 2224 25

2730

3234

0

10

20

30

40

-10

-20

-30

-40

Prob

abili

ty o

f Rei

n car

cera

tion

Note: Data from Lowenkamp, C. T., and Latessa, E. J. 2002. Evaluation of Ohio’s Community Based Correctional Facilities and Halfway House Programs. Cincinnati, OH: University of Cincinnati. Source for Slide: Latessa (2011)

27 of 35 programs produce positive effects

Impact with Low-risk Offenders

Note: Data from Lowenkamp, C. T., and Latessa, E. J. 2002. Evaluation of Ohio’s Community Based Correctional Facilities and Halfway House Programs. Cincinnati, OH: University of Cincinnati. Source for Slide: Latessa (2011)

23 of 34 programs produce negative effects

Program Impact by Risk Level Study of 86 Drug Courts:

Risk Level Effect Size

Low-Risk minus 3%Low- to Moderate-Risk zero (0%)Moderate- to High-Risk 3%High-Risk 9%

Source: Cissner et al. (2013).

Target Population1. Risk

2. Leverage: Possible legal consequences for failing

Impact by Amount of Leverage Impact of Legal Coercion on Retention

(The Brooklyn Treatment Court, N = 2,184)

47%

66%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Misdemeanor First Felony Predicate Felony

One-Year Retention Rate

Median Jail Alternative: 6 months in jail

Median Jail Alternative: 1 year in jail

Median Prison Alternative: 3-6 years in prison

Source: Rempel and DeStefano (2001).

Impact by Amount of Leverage Study of 86 Drug Courts:

Felony vs. Misdemeanor Court Effect Size

Felony Drug Court 12%Misdemeanor or Mixed Drug Court 1%

Other Population Factors Demographics: Age, sex, and race/ethnicity

Motivation: Offenders who present with greater interest or readiness-to-change at baseline

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Three Treatment Principles1. Risk Principle: Vary treatment by offender risk level.

2. Need Principle: Assess and treat criminogenic needs.

Huh … “Criminogenic Needs”? What is a “criminogenic“ need? It is a need

that is statistically associated with recidivism. So what? We already know that drug court

participants all need drug treatment

Addiction Crime

The “Central Eight” Factors1. History of criminal behavior (STATIC)

2. Antisocial personality/temperment (Mostly STATIC)

3. Criminal thinking

4. Antisocial peers

5. Family or marital problems

6. School or work problems

7. Lack of pro-social leisure/recreational activities

8. Substance abuse

Criminal Thinking The Concept: Thoughts, attitudes, and decision-

making strategies that dispose individuals to crime.

Examples: Legal Cynicism: Negative views of the law and authority External locus of control: Actions cannot lead to success Anger and Impulsivity: Poor decision-making skills Neutralizations (excuses): Blaming the victim; minimizing

harm; blaming the “system”; believing crime is inevitable

Sample Treatments: Thinking for a Change (T4C), Moral Reconation Therapy (MRT), Reasoning and Rehabilitation (R&R), and Interactive Journaling

What About Other Needs? Non-Criminogenic Needs

Examples: Trauma historyDepression, anxiety, and other mental health disordersPoor parenting skillsLow self-esteemMedical needs

Why Assess: Ethical reasons (they greatly affect individual well-being)These needs can interfere with treatment for criminogenic

needs (trauma especially should be treated simultaneously)

Three Treatment Principles1. Risk Principle: Vary treatment by offender risk level.

2. Need Principle: Assess and treat criminogenic needs.

3. Responsivity Principle: Use cognitive-behavioral therapy (CBT) and adapt to the specific offender needs.

Cognitive-Behavioral Therapy Key Elements:

The Present: current people, places, and behaviors Thinking Errors: legal cynicism, external control, sense

of hopelessness, sense of victimization Cognitive Restructuring: effort to change the automatic

thoughts & feelings that lead to (e.g.) crime and drug use Anger: often involves an anger control element Problem-Solving Skills: versus impulsive reactions Multiple Needs: Adaptable to different needs (antisocial

peers, triggers to drug use, triggers to violence, etc.) Education? No!

Risk-Need-Responsivity Impact Drug Court Effects (Gutierrez and Bourgon 2009)

No RNR principles: 11 of 25 drug courts: +.05 1 RNR principle: 13 of 25 drug courts: +.11 2 RNR principles: 1 of 25 drug courts: +.31 3 RNR principles: 0 of 25 drug courts: ?????

Implementation Issues Setting (community-based better than jail/prison)

Risk Level (high-risk focus; separate groups by risk)

Group Size (ideally < 12 per group)

Manualized Curricula (written lesson plans)

Fidelity to Curriculum: Frequent staff training and retraining Regular observation by supervisory staff Regular debriefing/supervision given by supervisory staff

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Deterrence: Elements Leverage: Threat of prison for failing (Anglin et al. 1989; Hiller et al.

1998)

Interim Sanctions (e.g., Marlowe and Kirby 1999; Taxman et al. 1991):

Certainty: Sanction for every infraction Celerity: Imposed soon after the infraction Severity: Serious enough to be undesirable Certainty is more critical than severity (Nagin & Pogarsky 2001)

Positive Incentives: Rewards for progress

Deterrence: Drug Court Results Leverage:

Target Population: Felony defendants (v. misdemeanor) Additional Policies to Increase Leverage:

Guilty plea at entry (“post-plea” model) Jail alternative set in advance of participation Jail alternative always imposed on those who fail

Sanctions: Apply interim sanctions with greater certainty Make greater use of a formal sanctions schedule

Rewards: Frequent incentives improve outcomes

Role of Perceptions Greater compliance when:

More staff note consequence of failing More staff note that consequence of failing will be severe More times that participants must promise to comply

Clear reminders given early and often

What About Supervision? Qualified Impact … Little direct effect of judicial

hearings, drug testing, or probation meetings, but: Supervision matters more with high-risk participants Supervision can facilitate imposing sanctions Supervision—especially appearing regularly before the

judge—can facilitate procedural justice …

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

A Simple Definition Procedural justice concerns the perceived

fairness of court procedures and interpersonal treatment while a case is processed.

BUT—Isn’t winning the case the most important thing?

Procedures v. Outcomes Most people don’t like to lose Procedural justice theory assumes that:

People know they will sometimes lose People will be more likely to accept losing if they:

Perceive the process was fair. Believe they were treated with dignity and respect. Had a chance to be heard.

Source: Tyler (2012).

Procedural Justice Dimensions Voice: Participants’ side is heard

Respect: Treated with dignity and respect

Neutrality: Decisions unbiased and consistent

Understanding: Participants understand responsibilities, decisions, and reasons for decisions

Helpfulness: Interest in participants’ personal situation and needs for services

Procedural Justice Findings Compliance: Increases compliance with court

orders and reduces future crime (e.g., Lind et al. 1993; Tyler and Huo 2002)

Procedural v. Distributive: More influential than distributive justice (win or lose) (see Tyler 1990; Tyler and Huo 2002)

Aid to Deterrence: Complements deterrence by reducing perceptions of unfair consequences

Rectifies Inequality: Effect is greater among those with negative views of the criminal justice system

Role of the Judge: Greatest influence on overall perceptions (Abuwala and Farole 2008; Curtis et al., forthcoming; Frazer 2006; Rossman et al. 2011)

Procedural Justice: Drug Courts

Source: The Multi-Site Adult Drug Court Evaluation (MADCE), see Rossman et al. (2011).

Offender Perceptions of Fairness

2.86

3.24

3.86

3.21

3.26*

3.78***

4.26**

4.11***

1.00 2.00 3.00 4.00 5.00

Perceptions ofDistributive Justice

Perceptions of CourtProcedural Justice

Perceptions ofSupervision Officer

Perceptions of Judge

Comparison (N = 524) Drug Court (N = 1,009)

* p < .05 ** p < .01 *** p < .001

Note: Distributive justice questions were on a 1-4 scale.

Role of the Judge Offender Perceptions: Perceptions of judge were a

key factor in reducing crime and drug use (Rossman et al. 2011)

Judicial Demeanor: Drug courts produced greater reductions in crime and drug use when the judge was rated as more respectful, fair, attentive, consistent, caring, and knowledgeable (Rossman et al. 2011)

Role of Time: More than 2X greater impact when judges averaged > 3 minutes/hearing (Carey et al. 2012)

Judicial Interaction Checklist Sample Measures:

Length of judicial status hearing (in minutes) Judge provided praise/reward if compliant Judge imposed sanction if noncompliant Judge asked “probing” questions (> 1-sentence answer) Judge reviewed treatment and other responsibilities Judge repeated benefits of compliance (e.g., graduation) Judge repeated consequences of noncompliance (e.g., jail) Judge expressed an interest in treatment needs

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Collaboration: Practice Key Elements: Weekly team meetings; less

adversarial approach in the courtroom

Findings: Drug courts reduce recidivism more where: Treatment attends team meetings (Carey et al. 2012)

Treatment attends court sessions (Carey et al. 2012)

Treatment communicates with court by e-mail (Carey et al. 2012)

Dedicated prosecutor and defense attorney both attend staffing meetings and court sessions (Cissner et al. 2012)

How Measure Success?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Impact Evaluation 101 Follow-up Periods? (1, 2, or 3 years) Outcomes (re-arrest; re-conviction; drug use;

employment status; family relationships) Design (approach to comparison group construction)

Question:Should you track recidivism rates at your drug court if you do not have a comparison group?

Impact Evaluation: Design Experiment: Study subjects randomly assigned;

those in each condition will be comparable at baseline.

Quasi-Experiment: Naturally occurring comparison group; statistical methods increase comparability. Pre-Post: eligible cases before program opened Contemporaneous: eligible cases not referred or identified

Non-Experiment: Graduates v. dropouts

Performance Monitoring Volume: # referrals? # participants Background Characteristics: Demographics, drug

type; criminal history; current charges; employment and school status; and risk level (high, medium, low)

Program Outcomes: (1) open (active in the drug court; not yet closed); (2) graduated; and (3) failed

Retention Rate: Indicator that predicts likely impact: 1-Year Rate: (open + graduated) / # enrolled > 1 year ago Benchmarks: 1-year > 60%; 2-year & 3-year > 50%)

Months to Graduation (enrollment date to exit date)

Additional Data Considerations Identifiers: case-level and person-level ID numbers

Key Dates: Arrest date/court filing date Participation/enrollment date Exit date (graduation/failure date)

Tracking System: 1 row per drug court episode; historical data is saved. Microsoft Excel or Microsoft Access Relational Database

Review and Reflection Participant Feedback:

Anonymous exit surveys Focus groups led by local University professor

Courtroom Observation: Invite independent observer to evaluate the drug court session

Policy Review: Review all program policies in light of known evidence-based practices

Why Do Drug Courts Work?Evidence-Based

Principles• Treatment

• Deterrence

• Procedural Justice

• Collaboration

Positive Outcomes

• Reduced Recidivism• Reduced Drug Use• Cost Savings

Target Population

• High-Risk

• High-Leverage

Research Resources (USA) National Institute of Justice: http

://www.nij.gov/nij/topics/courts/drug-courts/welcome.htm

Research to Practice (R2P) Project: http://www.research2practice.org/index.html

National Association of Drug Court Professionals: General Page: http://www.nadcp.org/

Evidence-Based Standards: http://www.nadcp.org/Standards

Drug Court Clearinghouse at American University: http://www.american.edu/spa/jpo/drug-court-clearinghouse.cfm

Center for Court Innovation: General Drug Court Page: http://www.courtinnovation.org/topic/drug-court

Training and Technical Assistance: http://www.nadcp.org/