national association of drug court professionals meeting june 12-15 washington, d.c. this study was...

National Association of Drug Court Professionals Meeting

June 12-15

Washington, D.C.

This study was funded by the Substance Abuse and Mental Health Services

Administration, Grant No. 270-02-7107

Are Family Treatment Drug Courts Effective?

Results from a Four Site National Study

www.npcresearch.com

NPC Research 2June 2007

NPC Project Team Beth Green, Ph.D., Principal Investigator Michael Finigan, Ph.D., Co-Principal

Investigator Sonia Worcel, M.S., M.A., Project Director Carrie Furrer, Ph.D., Research Analyst Scott Burrus, M. A., Research Coordinator Jennifer Aborn, Data Specialist Becky Jones, Data Specialist


Acknowledgements

NPC Site Research Coordinators and Data Collection Staff

FTDC judges, coordinators, and other team members at all four sites

FTDC parents State and county child welfare and treatment

agencies in California, Nevada, and New York


The FTDC National Evaluation

A study conducted by NPC Research

A federally funded national evaluation funded by the Center for Substance Abuse Treatment, SAMHSA

Four FTDCs in the study: Santa Clara, CA; San Diego, CA; Washoe, NV; Suffolk, NY


Primary Research Questions I. Outcome Analysis

How do treatment, child welfare, and court outcomes differ for families processed through FTDCs as compared to traditional child welfare case processing?

II. Black Box Analysis

How do FTDCs work? What factors influence program outcomes?

III. Qualitative Analysis

What features of drug court most influence parents’ recovery and ability to make progress on the case plan?

FTDC Experience

Intermediate Parent Outcomes

Intermediate Service Outcomes

Mediating Treatment &

Other Outcomes

Child Outcomes

6NPC Research – 1/26/07

General Conceptual Model for FTDC Effects


Four Sites With Different FTDC Models

San Diego: system-wide reform, the “Substance Abuse Recovery Maintenance System” (SARMS), with FTDC for non-compliant parents

Santa Clara: started as traditional FTDC model; Made some systems changes later in the study

Suffolk: neglect cases only, many children not in out-of-home placements

Washoe: traditional FTDC model


Study Samples Complex design based on FTDC models and

availability of comparison groups

– Suffolk and Washoe relied on within-county comparison groups of unserved eligible clients

– San Diego relied on comparison county comparison group, matched at the individual level

– Santa Clara relied on a combination of within-county and comparison county comparison groups


Final Study Samples

Site Drug Court System Comparison

San Diego 438

(104 DC, 334 SARMS)

205

Santa Clara 100 553

Suffolk 117 239

Washoe 84 127

Total N= 739 1124


Data Collection Strategies

Administrative record review– Treatment, court, and child welfare records

– Data were collected on both parents in two-parent families, but data presented today are for mothers only

Parent interviews– A subset of 253 parents across the 4 sites were

interviewed up to 4 times during their case

– These data not presented here

Qualitative parent and key stakeholder interviews and court observations


Administrative Data Tool Extensive data extraction tool captured the following

information:– Family Background (e.g., number/ages of children,

marital status)

– Child Welfare Case (e.g., hearing dates, out-of-home placements)

– FTDC Services (e.g., appearances, sanctions)

– Treatment Services (e.g., number & type of tx.)

– Permanency Outcomes (permanency decisions & custody arrangements)

– Child Welfare Recidivism (e.g., new referrals, petitions)


Sample Demographics

Samples were well-matched, with very few significant differences in demographic, risk, or case characteristics

California sites had larger Hispanic populations

Suffolk site had no meth users; this was the most common drug at the other 3 sites


Sample Demographics, cont’d

75% of parents were unemployed

60% of families were headed by single mothers

25-50% had less than high school education

Families had an average of 2 children and half had an infant


Mother Risk Factors

Collected information on the following maternal risk factors identified in administrative data sources:

– Mental illness

– Learning/developmental disorder

– Medical disability/condition

– History of domestic violence

Computed 0-4 risk index (one point for each risk factor present)


Average Number of Mother Risk Factors

2.3

1.8

2.3 2.22.4

2.2

2.62.7

0

0.5

1

1.5

2

2.5

3

# ris

k fa

cto

rs

San Diego* Santa Clara Suffolk Washoe

Drug Court Comparison

* Statistically significant at p<.001.


Child Risk Factors

Collected information on the following child risk factors:– Developmental/educational issues

– Behavioral/emotional issues

– Child alcohol and drug issues

– Prenatal substance exposure

– Child sexually acting out

– Child was sexually abused

Computed 0-6 risk index (received one point for each risk factor)


Average Number of Child Risk Factors

11.2

1.51.3

1.10.9

1.31.1

0

0.5

1

1.5

2

2.5

3

# ris

k fa

cto

rs

San Diego* Santa Clara Suffolk Washoe




Summary: Sample Characteristics

Overall, samples were well-matched, with very few significant differences in demographic, risk, or case characteristics

Some site differences in terms of race/ethnicity, drug of choice, treatment history & prior CPS involvement


Part I: Outcome Analysis

How do treatment, child welfare, and court outcomes differ for families processed through FTDCs as compared to traditional child welfare case processing?


Outcomes: Analytic Approach Propensity scoring is a method for reducing bias in

effect estimates associated with selection bias in non-randomized designs (Rosenbaum & Rubin, 1983).

Propensity scores were modeled for each site using the following characteristics:– Race – Previous CPS involvement– Marital status – # mother risk factors

– Education – # child risk factors

– Employment status – # children on case

– Type of abuse allegation – Infant involved in case

– Mother’s age – Frequency of drug use

– Age 1st drug use – Previous TPR


Outcomes: Analytic Approach Outcomes were analyzed using weighted least

squares (WLS) regression Propensity scores were used as site-specific weights Data presented are adjusted means Treatment effects were estimated within each site,

and then pooled for an overall study effect size estimate

Effects of treatment group reflect FTDC vs. comparison group except San Diego, where FTDC and SARMS are combined and weighted, creating a “FTDC system” treatment group


Treatment Outcome Questions Compared to Control Parents, Did

Parents in FTDC:– Enter treatment at a higher rate?– Enter treatment more quickly following

their child welfare petition?– Spend more time in treatment? – Complete treatment at a higher rate?


Likelihood of Treatment Entry

60%67%

86%

60%

83%

61%

73%

61%

0%

20%

40%

60%

80%

100%

% M

others

San Diego Santa Clara* Suffolk* Washoe




Days to Treatment Entry

107100

110120

58

133

84

114

0

20

40

60

80

100

120

140

Days

San Diego Santa Clara Suffolk* Washoe




Days Spent in Treatment

179154

298

135

297

172

330

132

0

50

100

150

200

250

300

350

Days

San Diego Santa Clara* Suffolk* Washoe*




Percent Completing at Least One Treatment

31%

41%

69%

32%

61%

32%

62%

37%

0%

20%

40%

60%

80%

% of m

others

San Diego Santa Clara** Suffolk** Washoe*


* Statistically significant at p<.01. ** Statistically significant at p<.001.


Cross-site Effects on Substance Abuse Treatment

Strong cross-site treatment effects Compared to comparison parents, drug court

parents:– Were more likely to enter treatment

– Entered treatment more quickly than comparison parents

– Stayed in treatment longer than comparison parents

– Completed treatment more often than comparison parents


Child Welfare & Court System Outcome Questions

Did children of FTDC parents:– Receive more ancillary services?– Have fewer placement changes?– Spend less time in out-of-home care?– Have more kinship placements?

Were children of FTDC parents reunified at a higher rate?

Were FTDC parents less likely to become involved with the CWS subsequent to their case?

Were court cases shorter and less often contested?


Child Welfare: Levels of Analysis Analysis of child welfare outcomes is

complicated by the fact that multiple children may have outcomes for each parent

Two levels of analysis: children “nested” within parents

C1 C2 C3

P1

C1 C2

P2


Outcomes for children within a family are likely to be similar

Analyzing each child’s outcome can result in bias in significance testing

SPSS linear mixed models used to adjust the error terms to reduce possible bias caused by the “nesting” of children within families

Child Welfare: Levels of Analysis


Children’s Experiences During the Case

Number of services for children (medical, early intervention, mental health, education, substance abuse, and “other” services)

Children’s living situations during case

– # of living situation changes

– Days & % of case in parental care

– Days & % of case in out of home placements

– Days & % of case in kinship care


Number of Services for ChildrenSite Drug Court Comparison

San Diego*

mean

N=788

1.4

N=475

1.2

Santa Clara

mean

N=199

1.3

N=1,132

1.2

Suffolk

mean

N=259

0.5

N=491

0.5

Washoe

mean

N=148

1.7

N=226

1.7



Number of Living Situations During CW Case

Site Drug Court Comparison

San Diego

mean

N=482

3.3

N=844

3.3

Santa Clara*

mean

N=201

4.0

N=1,150

3.4

Suffolk

mean

N=262

1.9

N=497

1.9

Washoe

mean

N=166

3.3

N=246

3.2

* Statistically significant at p<.001., controlling for length of case


Time in Parental CareSite Drug Court Comparison

San Diego

mean days

% of case

N=788

150

26%

N=456

143

28%

Santa Clara

mean days**

% of case*

N=174

207

31%

N=1,100

128

23%

Suffolk

mean days

% of case

N=262

284

46%

N=495

269

47%

Washoe

mean days**

% of case**

N=164

286

50%

N=244

90

20%

Overall Average Days 232 days

38%

158 days

29%



Time in Out-of-Home PlacementsSite Drug Court Comparison

San Diego

mean days

% of case

N=824

226

33%

N=463

232

34%

Santa Clara

mean days

% of case

N=194

190

28%

N=1,112

218

33%

Suffolk

mean days

% of case

N=262

114

18%

N=496

82

14%

Washoe

mean days*

% of case*

N=165

199

33%

N=245

336

58%

Overall Average 182 days

28%

217 days

35%



Time in Kinship CareSite Drug Court Comparison

San Diego

mean days

% of case

N=819

252

39%

N=459

244

37%

Santa Clara

mean days

% of case

N=198

247

37%

N=1,115

287

43%

Suffolk

mean days

% of case

N=262

198

36%

N=495

228

39%

Washoe

mean days

% of case

N=164

102

17%

N=245

129

23%


Cross-site Children’s Experiences Effects

No significant difference between groups in number of services children received

Drug court children had significantly more living situation changes than comparison children

Drug court children spent significantly less time in out-of-home placements and more time with parents than comparison children, especially in Santa Clara and Washoe sites


Permanency Outcomes Time to permanent placement Permanency decisions:

– % reunification– % terminations of parental rights– % another permanency outcome

About one-fourth (24%) of children had not yet reached permanency at the end of the 2-year window:– San Diego: 20%– Santa Clara: 12%– Suffolk: 57%– Washoe: 13%


Days to Permanent Placement

286255

347

243216

163

277 262

0

50

100

150

200

250

300

350

400

Days

San Diego Santa Clara* Suffolk Washoe




San Diego Permanency Decisions

56%45%

24%28%

20%27%

0%

20%

40%

60%

80%

100%

% o

f child

ren

Reunified* TPR Other**




Santa Clara Permanency Decisions

76%

44%

11%

34%

13%22%

0%

20%

40%

60%

80%

100%

% o

f ch

ildre

n

Reunified* TPR Other




Suffolk Permanency Decisions

57% 55%

8% 11%

35% 35%

0%

20%

40%

60%

80%

100%

% o

f child

ren

Reunified TPR Other



Washoe Permanency Decisions

91%

45%

3%

34%

5%

20%

0%

20%

40%

60%

80%

100%

% o

f ch

ildre

n

Reunified** TPR** Other*




Cross-site Permanency Effects

Drug court cases took significantly longer than comparison cases to reach permanent placement

Drug court children were significantly more likely to be reunified and less likely to have TPRs than comparison children, in all sites except for Suffolk


Parents’ Subsequent Involvement with Child Welfare

% With second petition on original case % With a new CPS referral % With a new CPS petition (new case) % With subsequent out-of-home

placements % With subsequent TPR % With a new drug-exposed baby


Cross-site Effects

When we pooled results across sites, there were no significant differences between drug court and comparison families on any of the child welfare recidivism outcomes

Time frame is likely too short to adequately assess subsequent involvement with child welfare


Court Outcomes

Contested hearings Indication of noncompliance with case

plan Time to case closure


Cross-site Court Effects No significant differences in number of

contested hearings between FTDC and comparison cases

FTDC parents had significantly fewer incidents of noncompliance with court orders than comparison parents

FTDC cases took significantly longer to reach case closure than comparison cases


Summary: Outcomes for FTDCs Strong treatment outcomes: FTDC parents

more likely to enter treatment, spend more time in treatment, and complete treatment

Longer time to permanent placement and case closure for FTDC parents could be explained by the longer treatment stays

Cases took longer to reach permanency and closure, but FTDC children spent more of this time with their parents


Outcomes for FTDCs, cont’d

FTDC children were more likely to be reunified with their parents at the end of the case

No differences in child welfare recidivism, but follow-up period was short


Part II: Black Box Analysis

How do FTDCs work? What factors influence program outcomes?


Unpacking the “Black Box” of Family Treatment Drug Court

Outcome analysis tells us whether FTDCs work

Analysis of parent characteristics and experiences with services can begin to tell us about how, why, and for whom FTDCs work

A preliminary look within the FTDC sample


Conceptual Model for Understanding How FTDC Works

FTDC Treatment

Parent Characteristics

Child WelfareOutcomes


FTDC Treatment Child WelfareOutcomes

How Do FTDC Experiences Influence Outcomes?



Key Questions About FTDC

Key Questions:– Does how long it takes parents to enter

FTDC relate to key outcomes?– Does time spent in FTDC relate to

outcomes?– Do the number of FTDC appearances

relate to outcomes?– Does FTDC graduation relate to

outcomes?

Outcomes: days in treatment, treatment completion, & reunification


FTDC Processing VariablesSan

DiegoSanta Clara

Suffolk Washoe

Days from petition to drug court entry

227A 101 N.A. 105

Days spent in drug court

209C 355 449B 353

Number of drug court appearances

17 (approx.

2 per month)

15 (approx.

1 per month)

31 (approx.

2 per month)

25 (approx.

2 per month)

A San Diego is significantly different from Santa Clara and Washoe.B Suffolk is significantly higher than all other sites.C San Diego is significantly lower than all other sites.


Drug Court Graduation

29%

84%

30%

77%

58%

13%

26%18%

13%3%

44%

5%0%

20%

40%

60%

80%

100%

Graduated Terminated Still Enrolled

San Diego Santa Clara Suffolk Washoe


FTDC Experiences and Substance Abuse Treatment Outcomes

Variable Statistically Significant?

Nature of Relationship to Treatment Outcomes

Time to FTDC entry (petition to entry)

No No relationship

Time spent in FTDC Yes Longer stays in FTDC are related to longer stays in tx

and more tx completion

Number of FTDC appearances

Yes More FTDC appearances are related to longer stays in tx

and more tx completion

FTDC graduation Yes Graduation is related to longer stays in tx and more tx

completion


FTDC Experiences and Reunification


Nature of Relationship to Reunification

Time to FTDC entry

No No relationship

Time spent in FTDC

Yes The more time spent in FTDC, the greater the likelihood of

reunification

Number of FTDC appearances

Yes The greater number of FTDC appearances, the greater likelihood of reunification

FTDC graduation Yes Parents who graduate from family treatment drug court are

more likely to be reunified


How Do Treatment Experiences Relate to Outcomes?

FTDC Treatment Child WelfareOutcomes



Key Questions Does time to treatment entry relate to

outcomes:– time spent in treatment– treatment completion– reunification

Does likelihood of treatment entry relate to reunification?

Does time spent in treatment relate to treatment completion or reunification?

Does treatment completion relate to reunification?


Treatment Experiences and Treatment Completion

Variable

(administrative data)

Statistically Significant?

Nature of Relationship to Treatment Outcomes

Time to treatment entry

Yes Faster time to treatment is related to longer treatment stays and higher rates of

treatment completion

Time in treatment Yes Longer treatment stays are related to higher rates of

treatment completion


Treatment Experiences and Reunification


Nature of Relationship to Reunification

Likelihood of treatment entry

No No relationship

Time to treatment No No relationship

Time spent in treatment

No No relationship

Treatment completion

Yes Mothers who completed at least one treatment

episode are more likely to be reunified


Do Parent Characteristics Influence Outcomes?

FTDC TreatmentChild Welfare

Outcomes



Do Parent Characteristics Influence Outcomes?

Parent characteristics examined:– Demographic variables– History of substance abuse, mental health– Child welfare history– Maternal risk factors– Child risk factors– Psychosocial characteristics (perceived

stress, perceptions of control, social support)


Summary: Influences of Parent Characteristics

FTDC Experience– More appearances for white, older, lower risk moms– Less graduation for African American moms

Treatment Completion/Retention Better For:– Less educated moms– More years drug use– More treatment motivation

Reunification More Likely For:– Lower risk moms– Moms with no CPS history

No strong, consistent pattern of differences for different “types” of parents

FTDC:Time spentAppearancesGraduation

TreatmentCompletion


Child WelfareOutcomes

Speed of Tx entryDuration of Tx

How Do FTDCs Work? Summary of Findings from Quantitative Data


FTDC (TX vs Control)

TreatmentCompletion

Reunification

Does FTDC Influence Reunification “Above and Beyond” its Effect on

Treatment Completion?


.14***

.28***


Part III: Qualitative Parent Interviews

What features of drug court most influence parents’ recovery and ability to make progress on the case plan?


Brief, open-ended questions asked of 219 parents, and in-depth qualitative interviews with 30 parents

Interviews provide contextual data to facilitate the interpretation of the quantitative data

Parents’ perspective of what facilitates the drug court process

Qualitative Parent Interviews


Emotional Support

Parents talked about how the drug court team, and in particular the judge and the drug court-dedicated case workers, provide a support system.

“The drug court team and the drug court case worker have helped me a lot. My first case worker, that wasn’t the drug court one, didn’t spend much time with me, but my drug court case worker always knew what was going on with me, and helped me get what I needed to get my kids back.”


Accountability and Collaboration

Parents also explained how frequent hearings and attendance in drug court provided accountability for their behavior because:– “the team knows what’s going on with you and you

get immediate support for whatever is going on as soon as you need it.”

– “it’s helpful going every two weeks because things can come up during that time, and in drug court these problems are addressed quickly.”


Accountability and Collaboration, cont’d

Frequent court attendance means that the judge and others are well informed about the parents’ cases and able to provide appropriate support for recovery and other issues facing the parent. “(attending drug court regularly) helps you feel less alone, that someone knows what’s going on in your life and the all the issues that you face, they know how to support you and what you need.”


Practical Support

Participants in drug court receive practical assistance. Parents talked about:– how the drug court helped get them housing and

employment, – helped with life improvement needs such as tattoo

removal, dentures and obtaining birth control.

These practical and external supports helped to increase parents’ sense of confidence and ability to make improvements in their lives.


Sense of Accomplishment Parents who graduated from drug court spoke

eloquently about the significance of graduation. Parents discussed how graduation from drug court gave them a sense of accomplishment, some for the first time in their life. “It (graduation) was great. Everyone applauded for me, I got a hug from the Judge, and they gave me flowers. I felt like a beauty queen. I also felt that my graduated meant that I finished something I started, and this is the first time I ever accomplished something like this in my life. Now I feel like I can succeed in life.”


Putting It All Together—What Have We Learned?

Data strongly support the effectiveness of the FTDC model in improving both treatment and child welfare outcomes; “traditional” FTDC models may be most effective

FTDC influence on outcomes goes beyond its positive influence on treatment retention and completion – but what accounts for this remains largely unknown

Retention of families in FTDC programs is important to success

FTDC influence on child welfare recidivism needs additional data and research


For More Information:

The final report is posted on NPC’s website: www.npcresearch.com

E-mail Sonia Worcel at [email protected]

Article on an earlier phase of the FTDC study: Green, Furrer, Worcel, Burrus & Finigan (2007). How Effective Are Family Treatment Drug Courts? Outcomes from a Four-Site National Study, Child Maltreatment 12(1), 43-50.

national association of drug court professionals meeting june 12-15 washington, d.c. this study was...

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