Download - Wake County Adult Drug Treatment Court
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Wake CountyAdult Drug Treatment Court
Process Evaluation Results
Submitted byValerie Anderson, M.A.
Nena LekwauwaAdam Ross
Dr. Janis Kupersmidtinnovation Research & Training
(919) 493-7700www.irtinc.us
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Outline
1. Background2. Team Composition, Roles and Functioning3. Program Eligibility, Referral, and Admission 4. Treatment Services5. Sanctions6. Incentives7. Case Management & Judicial Supervision8. Termination & Graduation9. Results of Consumer Satisfaction Survey10. Challenges to Program Completion11. Life Improvements Attributed to Program12. Overall Strengths & Barriers13. Overall Recommendations14. Timeline
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BackgroundProgram History
NC Drug Treatment Court Act enacted in 1995
One of five original pilot courts
Original grant application submitted by Carolina Correctional Services
Began operation in 1996
Originally operated in two courts (Superior and District)
Consolidated into District Court in 2001
AOC assumes administration of WCADTC on July 1, 2005
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BackgroundTransition of Court Management
Reasons Provided for Transition: High operating costs due to administrative overhead Lack of community networking and partnership with local
organizations such as Treatment Alternatives for Safer Communities (TASC) and other relevant community agencies
Goals of Transition:
Seamless and “no harm” provision of treatment services Increase number of community partnerships
Recommendations Regarding Transition: Conduct analyses of cost savings with transition to AOC court
administration Formal training and orientation process for new team members Consider the potential role of TASC in performing case
management services or serving as a member of the core court team
Involve Local Management Committee in the planning process
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Team MembersBackground and Training
Strengths
Most team members have attended State and National DTC trainings
Team members have had prior relevant educational and professional training in preparation for their current roles
Barriers Team members reported
greater need for cross-training of team members
Treatment Providers are not yet Certified Substance Abuse Counselors, although both are currently working towards this goal
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Team Members’ Background and Training Recommendations
Conduct a needs assessment to determine team members’ specific needs for cross-training, and, if necessary, develop team-based cross-training sessions to meet these needs.
Continue to provide support and structure (e.g., set timelines and expectations) regarding Treatment Providers’ efforts to obtain certification in order for the program to be in compliance with 2005 Guidelines for NC Drug Treatment Courts.
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Team MembersComposition and Roles
Strengths
Team composition and roles adhere to Best Practices Guidelines
Clearly defined roles and responsibilities, in general
Low turnover in Judge, Defense Attorney, and Probation Positions
Barriers
Rotating schedule for the ADA position, as opposed to one dedicated ADA
Previously high turnover among treatment agencies
Lack of male treatment providers
Lack of understanding (among participants) of the role of the Defense Attorney
Although in general, roles and responsibilities are clearly defined, occasionally, some team members perform functions outside out the scope of their prescribed role
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Team Composition and Roles Recommendations
Request dedicated ADA as team member.
Recruit male treatment staff.
Explain the role of the Defense Attorney to the participants during the admission and orientation process for new participants.
Clarify policies and procedures regarding the criteria and process for excusing participants from court and treatment sessions, and document instances in which these standards are not met.
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Team MembersDecision-Making Processes
Strengths Orderly and
comprehensive processing of individual cases during team meetings
Two pre-court staffing meetings provide opportunities for revisiting and resolving cases
Consensus-based decision-making about participant cases, in general
Barriers Team members hold varying
views about Judge’s role as final arbiter
Treatment providers could take on more of a leadership role in team meetings
Relatively small amount of time spent processing “what works” in team meetings
Lack of available time to address broader court issues that arise during pre-court team meetings
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Team Decision-Making ProcessesRecommendations
Discuss and decide on Judge’s role as final arbiter of case decisions in which the team cannot reach a consensus.
Consider a more active role for Treatment Providers in helping the team to integrate research on substance abuse into decision-making about participant cases.
Document unresolved, broader court issues and table them for discussion during Local Management Committee meetings and/or staff retreats.
Set aside time, either in team meetings or in a retreat, to process the factors associated with successful program compliance, progress, and completion.
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Team MembersInteractions with and about Participants
Strengths Team members and
participants reported that team members maintain professional boundaries
Participants reported overall respect for and from the team members and perceive the team as committed, compassionate, and sincere
Participants reported especially positive regard for Judge, Treatment Providers, Probation Officer, and Assistant Director of Programs
Team members expressed genuine desire for the participants to succeed
Barriers Less positive regard was
expressed by participants for the Defense Attorney due to feelings of “betrayal”
Some participants expressed negative opinions about team members “playing favorites”
Some team members reported that participants know which team members can be manipulated into excusing them from meetings and/or court sessions
Occasional lapses in professionalism when discussing challenging participant cases in pre court staffing meetings were observed
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Team Member Interactions Recommendations
Clarify and clearly communicate to participants the rationale of the “non-adversarial approach,” and its implications for the role and functions of the Defense Attorney.
Use clear language in describing team approaches to differential treatment of participants, and consider how participants may interpret such language.
Adopt and enforce uniform standards and policies for excusing participants from required meetings and sessions.
Maintain professionalism when discussing participants, and agree on appropriate standards for using humor to diffuse difficult or challenging situations.
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Eligibility, Referral, and Admission Procedures
Strengths
Eligibility criteria clearly define the target population for the program
Team provides multiple opportunities to assure that participants are educated about program requirements
Participants begin treatment
immediately upon admission
Barriers
Basis for deviating from stated eligibility criteria are not clearly defined
Length of time between probation violation or arrest and eligibility screening is “longer than it should be”
In general, the program is a “hard sell” to many offenders and defense attorneys due to length of program and because it is not a deferral program
Disagreement among team members regarding who should administer the SASSI (Case Manager or Treatment Provider?)
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Program Eligibility, Referral, and AdmissionRecommendations
Formalize and document procedures for deciding when to make exceptions to the eligibility criteria.
Document and review the characteristics of cases that take an especially long time to complete the eligibility screening process after the initial probation violation or arrest in order to determine methods for accelerating the admissions process.
Enhance community awareness and education about the purpose and aims of the drug treatment court model.
Adopt SAMHSA’s standards regarding administration of the SASSI and other screening tools: Assure that personnel administering screening tools are adequately trained to properly administer, score, and interpret screening tools.
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Treatment Services Strengths Team members and participants identify treatment as an
essential program component. A wide variety of treatment services are available to
participants, including group therapy, individual counseling, and community-based 12-step recovery groups.
Participants can be referred to additional treatment services, such as residential treatment and detoxification, and for ancillary services, such as housing, vocational rehabilitation, and transportation.
Participants reported that Treatment Providers are helpful and easy to talk to.
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Treatment Services, Cont.Strengths Treatment Services are delivered in accordance with a
structured phase system, and Phase II participants receive both group and individual counseling.
Treatment providers use evidence-based cognitive-behavioral treatment programs for group therapy.
Participants find group therapy sessions particularly helpful, and identify peer support as a key component of group therapy.
Team members reported that treatment services are applicable for all cultural groups and for both genders.
The team has begun to establish more community connections to meet participants’ treatment needs, as evidenced by increasing numbers of referrals from the team to community mental health and substance abuse treatment services.
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Treatment Services Barriers Difficulty securing treatment services for dually diagnosed
participants Lack of male treatment providers may be a barrier for
some participants Participants did not articulate specific aspects of
treatment that were helpful outside of peer support Some participants attributed their recovery to 12-step
meetings rather than to court treatment services Treatment providers reported that they do not always
adhere to the treatment program guidelines for group therapy sessions due to the need to address pertinent recovery needs of the moment
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Treatment Services, Cont.Barriers Team members suspect the treatment court may not
be equally as effective across age. One team member felt the lack of male treatment
providers may make the treatment services less effective for male participants.
Team members believe families should be involved in treatment; there is currently no family component in place.
Team members reported that participants often arrive late and depart early from treatment sessions.
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Treatment ServicesRecommendations
Develop strategies to recruit more male treatment staff.
Work with Division of Mental Health and other community partners to identify treatment services for dually diagnosed participants.
Consider the possibility of inviting a member of Wake County Mental Health Services to serve on the Local Management Committee or as a core team member.
Explore the possibility of documenting levels of adherence to treatment manuals, as well as the circumstances (e.g., recovery needs or crises) that necessitate departures from the treatment plan.
Assess the specific skills that participants are acquiring in group therapy sessions. One possibility is to incorporate an assessment of these skills in the exit interview.
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Treatment ServicesRecommendations
Stricter enforcement of late arrival and early departure policies will maximize the benefit of treatment services.
Evaluate the effectiveness of the court for older participants as compared to younger participants, and for males as compared to females.
Consider the possibility of reviving the family component that was functional in prior years. Conducting a needs assessment to determine participants’ and family members’ need and desire for the program, willingness to participate, and time availability might help to assure better involvement on the part of families.
Continue to identify and forge connections with community partners to enhance community awareness and support for the program, and to increase the diversity of treatment services available for participants.
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SanctionsStrengths Comprehensive list of sanctions
is made available to participants upon admission to program
Participants find threat of jail to be a useful deterrent
Individualized approach to imposing sanctions is used to meet participants’ recovery needs
Consensus-based development of sanctions
Team members consider participant’s history of sanctions
In general, participants perceive the sanctions used by the court as fair and useful
Barriers
Some participants perceive inconsistent application of sanctions
In retrospect, some former participants reported that team members were too lenient in their use of sanctions (“I needed a sanction.”)
Team does not enforce threatened sanctions consistently
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Sanctions Recommendations
Proactively communicate the theory and rationale behind the use of sanctions.
Monitor and evaluate the current level of sanction enforcement.
Explore the adoption of individualized behavior contracts to complement the current contract.
Employ a specific psychological framework or approach (e.g., behavior modification) to develop sanctions that address recovery needs, and evaluate the extent to which sanctions are currently imposed according to the selected framework.
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IncentivesStrengths Participants reported that
graduation is the greatest reward because it signifies having achieved a new lifestyle (clean and sober)
Participants appreciate early release from court and verbal praise from the Judge
Participants are generally satisfied with the court’s use of incentives
Team members prefer positive reinforcement over punitive methods of trying to bring about behavior change
Barriers Variability in standards of
progress that merit rewards (i.e., baby steps vs. giant leaps) causes participants to perceive inconsistent application
Team members reported that rewards provide instant gratification, but result in minimal lasting impact
Lack of sufficient number of tangible incentives
Early release is a “mixed blessing” for some due to transportation barriers and conflicts
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Incentives Recommendations Proactively communicate the theory and rationale
behind the use of incentives.
Utilize successful program alumni and friends of the program to solicit donations from community businesses. This would also help increase visibility of the program.
Obtain specialized training or network with other drug treatment courts to identify a wider variety of incentives and incentive strategies.
Discuss possibilities for addressing participants’ complaints regarding lengthy travel times only to be dismissed from court early.
Continue to recognize the value of verbal praise and continue to use it frequently.
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Case Management & Judicial SupervisionStrengths Participants reported that
drug screening is a useful deterrent to drug use
Instant drug screens return results quickly
Participants find status hearings to be an effective deterrent“If I didn’t have court to go
to, I wouldn’t be afraid of anything. I could relapse several times.”
Team members reported that the non-adversarial relationship participants form with the Judge is especially helpful
Barriers Participants report that in the
past, lack of male staff to supervise drug testing has contributed to manipulation of drug screens
Some team members and participants reported instant tests are not always accurate
Noise levels in the rear of the courtroom may prevent some participants from focusing on court proceedings
Phase system does not document or reflect systematic decrease in number of supervision contacts required (Case Management and Probation)
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Case Management & Judicial SupervisionRecommendations
Male surveillance officer currently administers drug screens at treatment groups and court sessions. The team should evaluate whether this is an appropriate long-term solution.
Document and evaluate instances of inaccurate instant screens to determine whether these instances can be attributed to a particular drug or drugs.
Require participants to sit in the front of the courtroom, and have security personnel circulate to maintain appropriate atmosphere.
Review Phase System, as written, and determine whether more specific requirements regarding the number of Case Management and Probation contacts are necessary.
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TerminationStrengths Consensus-based termination
decisions Termination is considered a “last
resort” due to team members’ desire to keep participants in treatment
Team members all agree the policy is fair
Zero-tolerance termination policy for violence
Barriers Policy relies heavily on subjective
judgments. “Good cause” “Level of participation” “Conduct that is detrimental to the
program” Program graduates advocate stricter
policies and enforcement as a means of removing participants who reduce morale and make group sessions difficult
Participants reported they are unsure about what actions result in termination
Lack of consensus regarding the appropriateness of the program for repeat participants
Lack of formalized follow-up procedures results in difficulty contacting former participants for evaluation purposes
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Termination Recommendations Review the termination policy and decide on more
specific language and objective criteria to clarify the “grey areas.”
Consider and discuss the effects that maintaining “difficult” participants may have on other participants.
Evaluate the effectiveness of the program for one-time participants as compared to repeat participants (graduates and terminated).
Consider developing follow-up procedures to monitor outcomes for terminated participants.
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GraduationStrengths Clearly stated and
objective criteria for successful program completion
Graduation ceremony to publicly honor graduates
Successful program graduates are encouraged to maintain contact with program
Barriers No formal program in
place to retain alumni Some participants are
disgruntled about “undeserving” graduates who manage to complete the program simply by avoiding jail
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GraduationRecommendations
Investigate and monitor the reported problem of “undeserving” graduates.
Develop a program to retain alumni as treatment and recovery resources and role models.
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Consumer Satisfaction Survey Demographic Characteristics of Respondents
QUESTION n RESPONSE FREQUENCY
SEX
Female 8 34.8%
Male 15 65.2%
ETHNICITY
Hispanic 1 4.8%
Not Hispanic 20 95.2%
MARITAL STATUS
Divorced or Separated 5 21.7%
Married 7 30.4%
Single 11 47.8%
LIVING ARRANGEMENT
Community Housing 2 8.7%
Incarcerated 0 0.0%
Independent 21 91.3%
RACE
Black 6 27.3%
White 15 68.2%
Other 1 4.5%
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Consumer Satisfaction SurveyDemographics
QUESTION n RESPONSE FREQUENCY
CHILDREN UNDER 18 LIVING AT HOME
Yes 12 54.5%
No 10 45.5%
EMPLOYMENT
Full Time 13 61.9%
Part Time 3 14.3%
Unemployed 5 23.8%
AGE (Average) 33
TIME SPENT IN PROGRAM (Average) 6 months
PRIMARY DRUG OF CHOICE
Alcohol 2 9.1%
Cocaine 2 9.1%
Crack 7 31.8%
Heroin 2 9.1%
Marijuana 5 22.7%
Other 4 18.2%
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Consumer Satisfaction SurveyDemographics
QUESTION n RESPONSE FREQUENCY
CRIME
DWI 1 4.3%
Obtaining Property Under False Pretenses 2 8.7%
Possession 4 17.4%
Probation on Revocation Appeal 3 13.0%
Theft 1 4.3%
Multiple 8 34.8%
Other 4 17.4%
CRIMINAL HISTORY
Yes 18 78.3%
No 5 21.7%
TREATMENT HISTORY
Yes 11 47.8%
No 12 52.2%
COMPLETED HIGH SCHOOL
Yes 15 68.2%
No 7 31.8%
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Consumer Satisfaction SurveySatisfaction with Program Components
How satisfied are you with the various parts of your Drug Treatment Court?
(1 = very unsatisfied 4 = very satisfied)
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Consumer Satisfaction SurveySatisfaction with Program Components
n NA Mean Standard Deviation Minimum Maximum
1. Frequency of court appearances 22 0 2.68 0.84 1 4
2. Interactions with the judge 23 0 3.35 0.88 1 4
3. Interactions with the DTC team 21 0 3.14 0.73 1 4
4. Cooperation of agencies with each other 18 4 3.11 0.58 2 4
5. Substance abuse treatment services 23 0 3.13 0.46 2 4
6. Mental health treatment services 16 7 3.19 0.54 2 4
7. Vocational treatment services 13 10 2.69 1.03 1 4
8. Other services received 12 10 2.83 0.58 1 4
9. Sanctions received 16 7 2.69 0.95 1 4
10. Incentives received 18 4 3.06 0.8 1 4
11. Drug testing 21 1 3.10 0.54 2 4
12. Community service activities 21 2 2.52 0.93 1 4
13. Pro-social activities organized by the DTC 18 5 2.83 0.86 1 4
14. Drug Court program overall 23 0 2.87 0.97 1 4
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Consumer Satisfaction SurveyProtection of Rights
How well do you feel that your legal rights were protected?
(1 = not at all 4 = completely)
n NA Mean Standard Deviation Minimum Maximum
15. Protection of overall rights 23 0 2.13 0.55 1 3
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Consumer Satisfaction SurveyDifficulty of Program Requirements
How easy or difficult is it for you to complete the following program requirements?
( 1 = very difficult 5 = very easy)
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Consumer Satisfaction SurveyDifficulty of Program Requirements
n NA MeanStandard Deviation Minimum Maximum
1. Making it to court appearances 22 0 2.50 1.01 1 5
2. Attending mental health treatment services 11 11 2.45 0.93 1 5
3. Cooperating with mental health treatment program 11 10 2.18 0.87 2 5
4. Taking medication regularly 8 15 2.63 0.74 2 4
5. Attending SA treatment services 20 3 2.60 0.94 1 5
6. Cooperating with SA treatment services 21 2 2.43 0.93 1 5
7. Attending other services 16 7 2.81 1.28 1 5
8. Going to drug testing 21 2 2.14 0.91 1 5
9. Cooperating with drug testing 20 1 1.90 0.85 2 5
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Consumer Satisfaction SurveyDifficulty of Program Requirements
n NA MeanStandard Deviation Minimum Maximum
10. Attending meetings with probation officer
21 1 2.05 0.8 2 5
11. Attending meetings with case manager
23 0 2.48 1.08 1 5
12. Attending AA/NA meetings 23 0 2.91 1.47 1 5
13. Participating in AA/NA meetings
23 0 2.78 1.24 1 5
14. Paying court fees 23 0 3.00 1.09 1 5
15. Paying court fines 20 2 3.25 1.21 1 5
16. Staying away from bad influences
21 1 2.14 0.85 2 5
17. Staying clean and sober 22 1 2.45 1.01 1 5
18. Staying crime-free 22 1 1.91 0.92 2 5
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Challenges to Program Compliance and Completion as Reported by Participants
Frequency of required meetings and court sessions Participants question why those who are doing well and on the verge of
completion have to attend court. Participants feel that number of weekly NA/AA meetings should diminish over
time.
“Court ALWAYS starts late!” Many active participants reported that drug court status hearings
frequently begin late This is particularly inconvenient for participants who rely on others for rides to
and from court Active participants reported that required meetings conflict with job
requirements Employers are not always understanding of their obligations Lost wages due to requirement to attend court
Transportation difficulties were reported to be a barrier to full participation by active and former participants
Many participants have their licenses revoked and are reliant on others for transportation
Long travel distances for a few participants who do not live in Raleigh Lack of child care options was reported as a barrier by three active female
participants Difficulty fulfilling community service and court fee requirements
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Life Improvements Attributed to the Program
Participants’ comments Gainful employment Improved finances due to elimination of drug purchases Improved relationships with and attitudes toward family
members and friends Increased understanding about addiction Increased honesty with self and others Decreased (or eliminated) drug use
Team members’ comments “Participants change in every way” Improved physical appearance Improved attitude, self-esteem Better employment situation Better understanding of the legal system Gain a sense of community
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Overall StrengthsTeam composition, roles and functions adhere to Best Practices Guidelines
Positive interactions between team members and participants
Orderly and comprehensive processing of individual cases
Treatment services are delivered according to a structured phase system, and are guided by evidence-based treatment programs for recovery and relapse prevention
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Overall StrengthsConsensus-based decision-making is used to arrive at the best course of action for participants
Individualized approach to the delivery of sanctions is designed to meet participants’ recovery needs
Both team members and participants attribute positive life changes to the drug treatment court program
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Overall Barriers
Lack of consensus among team members regarding Judge’s role as final arbiter.
Lack of time spent processing “what works.”
Justice system team members do not have as much time as they would like to devote to the program due to other caseloads and responsibilities.
Participants are unclear about the role of the Defense Attorney.
Reasons for making exceptions to the stated eligibility criteria are not clearly defined.
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Overall BarriersThe program is a “hard sell” for many offenders and
defense attorneys
Lack of treatment services for dually diagnosed participants
Some participants perceive inconsistent use of sanctions and rewards
Termination policy is largely based on subjective judgments and criteria that are not clearly defined
Lack of consensus among team members regarding appropriateness of the program for repeat participants
Lack of follow-up procedures for discharged participants
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Overall RecommendationsConsider recruiting male treatment providers.
Clarify the role of the Defense Attorney for participants.
Discuss and gain consensus regarding Judge’s role as final arbiter.
Plan for opportunities to discuss broader court issues.
Identify the factors that contribute to longer processing time (eligibility screening) for some referred cases.
Work with community partners to identify treatment services for dually diagnosed participants, and consider inviting a mental health professional to be a core team member or Local Management Committee member
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Overall RecommendationsExplore the possibility of implementing
individualized behavior contracts.
Monitor possible instances of inaccurate drug screens.
Review, and perhaps revise, termination policy.
Evaluate the effectiveness of the program for one-time vs. repeat participants and gain consensus regarding the suitability of the program for repeat participants.
Explore the possibility of re-establishing a family program.
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TimelineDraft of Report to WCADTC: April 25, 2005
Feedback from WCADTC: April 28, 2005
Final Draft Delivered: April 30, 2005