A Study of Family Drug Treatment Courts in the US and UK:Winston Churchill Fellowship

The case for a Family Drug Treatment Court in Australia: Putting children firstGreg Levine, Magistrate, Childrens Court of VictoriaBarbara Kamler, Emeritus Professor, Deakin University6th World Congress on Family Law and Childrens Rights17-20 March 2013, Sydney AustraliaParental substance misuse: An urgent problemIn England and Wales substance misuse is a significant factor in up to two thirds of care proceedings (Harwin et al, 2011). In the United States, between 60 and 80 percent of substantiated cases of child abuse and neglect cases involve substance misuse by a custodial parent or guardian (Young et al, 2007).In Australia, statistics are anecdotally similar. Families involved in child protection cases are characterised by one or more intersecting problems: drug or alcohol misuse, family violence, poverty, lack of education, inadequate housing, intellectual disability or mental illness (Victorian Law Reform Commission, 2010).

Increase in out-of-home care: Low reunification once children removedAustralia-wide, the number of children in out-of-home care has risen every year over the last 10 years, with 35,895 estimated in out-of-home care as of 30 June, 2011.Over the past decade, the number of Victorian children and young people in out-of home care has increased by 44 per cent, bringing the total number in care to 5,700 by June 2011. (Cummins et al, 2012: xxvi). In Victoria, during 2010-11 approximately 3000 children and young people were placed in accommodation away from their family home, and on average stayed in care for 18 months, some in 3 or 4 placements in a single year. The psycho-social costs to the child are extremely high: Inadequate foster care supply, placement instability, lack of certainty about returning to the birth family adversely affects childrens development, including emotional difficulties, behavioural problems and poor academic performance (Lamont, 2011).

How do we deal with the problem of parental substance misuse now?Children are removed from families. DHS file Protection Applications.Court Hearing. Orders made to facilitate parental rehabilitation and recovery, including: drug treatment programs, regular drug testing, attend parenting and anger management courses, relationship or domestic violence counseling, help to find suitable accommodation.Court responsibility ceases. Judicial officer has no further contact with family after orders are made, no knowledge of outcomes, no continuity of decision making. It is left to the individual social worker to follow up treatment and services for families - or cases may be unallocated in a context of ongoing crises and high case loads in child protection services.The result: Poor outcomes for children, family rehabilitation and reunificationLITTLE EFFECTIVE COORDINATION OR/COMMUNICATION between the multiple agencies parents are ordered to access. With NO SYSTEMATIC SUPPORT, parents are less likely to comply with or complete substance misuse treatment. Judicial officers are likely to allow parents MORE TIME TO REHABILITATE for the sake of the family. A regular criticism made of the Childrens Court in Victoria is that it allows parents too many opportunities to prove they can rehabilitate.This results in cases drifting on for years and LACK OF STABILITY FOR CHILDREN in escalating costs of out-of-home care and long-term problems for children, families, the child protection system, the courts and the broader community. Key features of the Family Drug Treatment CourtA problem-solving rather than adversarial approach to decision makingMultidisciplinary Team attached to the court who provide carefully coordinated case management and treatment for parents and childrenJudicial continuity through a docket systemQuicker child-focused time lines for family reunification or permanent placement outside the home (12 months)Frequent court hearings to foster parental compliance and connectionClosely monitored rehabilitation to keep parents focused on recovery and improved parenting with careful attention to childrens developmental needsChurchill Program: March April 2012San Jose, California: Santa Clara County Dependency Drug Treatment CourtOmaha, Nebraska: Zero to Five Family Drug Treatment Court, Douglas CountyMiami, Florida: Drug Dependency Court, Miami Dade CountyWashington, DC: Family Treatment Court of the D.C. Superior CourtNew York City: Manhattan Family Treatment Court, New York County Family CourtLondon, UK: Family Drug and Alcohol Court, Inner London Family Proceedings CourtDrug Court DVD Short.mp4How do FDTCs differ from the Criminal Drug Courts?Family Drug Treatment Courts draw on best practice from the adult criminal drug court model and adhere to its ten key components. BUT FDTCs differ in the focus, structure, purpose and scope of their activity because the best interests of the child must also be served. FDTCs provide every necessary service to parents, but they must also address and prioritise the needs of children and the family.

Key differences between FDTCs and Criminal Drug CourtsProgram incentivesScope of servicesMeasures of successGender profile of participantsProgram incentivesIn the Criminal Drug Court the principle incentive is to avoid incarceration. In the FDTC the key incentive is family reunification. Parents who succeed know they will have their children returned. But timelines are child-focused and sensitive to childrens developmental needs. When parents cannot address the issues that interfere with their ability to care protectively, permanent plans are made to place children in out-of-home care.

Scope of servicesThe Criminal Drug Court provides coordinated substance misuse rehabilitation, treatment and closely monitored case management services for participants. In the FDTC there is the additional need to coordinate protective services for children with adult services and address all factors that impede family reunification. Thus FDTC partners include 1) the court; 2) child protection services and; 3) a wide array of drug treatment and other service providers for parents, children and families

Measures of successTo graduate from the Criminal Drug Court participants must follow court orders, stay clean and sober for a sufficient period of time and not continue offending. In the FDTC being drug free is only one measure of success. Parents also need to demonstrate effective parenting, the capacity to provide income, safe housing and a home free of turmoil and violence in a relatively short period of time (12 months).

Gender profile of participantsMost Criminal Drug Court participants are male, while women comprise more than 85% of the participants in FDTCs. As of 2001, 87% of FDTC graduates in the US were women and 13% were men (Cooper, 2001). This gender difference has significant treatment implications, with most FDTCs structuring services to meet womens specific needs, such as dealing with low self esteem and depression, childhood trauma, domestic violence, co-occurring health disorders as well as taking a comprehensive approach to treating the mother-child relationship and including children, especially infants, in treatment. (Edwards and Ray, 2005:5)

Positive evaluations: parental recovery, family reunification, cost benefitsParents in Family Drug Treatment Courts are twice as likely to begin and complete treatment. Treatment completion rates were 20 to 30 percent higher for FDTC participants than for the comparison participants.Children of Family Drug Treatment Court participants spend significantly less time in out-of-home placements, such as foster care.Family re-unification rates were 20 to 40 percent higher for Family Drug Treatment Court participants than for comparison groups. (Marlow and Carey, 2012:2-3)

Human benefitsinterrupting the cycle of intergenerational substance abuse and child neglect reduction in cumulative harm to children enabling a more productive futureincrease in childrens stability through family reunification or early permanency planning outside the home. .

Cost benefitsPrimarily realised through reduction in government administration and foster care costs. Further savings from reduced court time in achieving permanent placement; increased judicial efficiency; decrease in legal costs.Several US evaluations report cost savings from a reduced reliance on out-of-home child placements. For example, savings were approximately $10,000 per child in Maine, $15,000 in Montana, $13,000 in Oregon. The average net cost savings for FDTCs ranged from $5,000 to $13,000 per family. In the UK, the average cost per family was 8740 over the life of a case. This cost was offset by savings from more children staying with their families. Further cost reductions came from: (a) shorter care placements (4,000 per child); (b) shorter court hearings (682 per family); fewer contested cases; (c) expert witnesses replaced by specialist team (1,200 per case).

Critical factor: Collaborative approach to rehabilitation and reunificationThe Judicial officer keeps control of the case from start through to permanency planning and establishes a motivating relationship with parents through frequent hearings, sometimes weekly at the startThe Judicial officer works with a Multidisciplinary Team of experts attached to the court (social work, substance use, mental health) who develop an intensive treatment plan and coordinated access to all necessary services, eg- domestic violence and trauma counseling, housing, child development Intensive monitoring of the family by the Team, for getting clean; but also to repair the child-parent relationship, develop healthy parenting. The Team discusses progress in treatment plans before each court hearing and makes adjustments, as requiredAll Team members work for the same goal reunification- and if/when it is clear the parent cannot succeed , alternate planning begins early, with parents part of the process

Without collaboration, it is difficult to make a difference to familiesRecent experiences in Victoria. A judicial inclination to move to the docket system to maintain contact and improve oversight of parent progress. Problem: The judicial officer makes a significant difference, but it is the Judge working with the TEAM that achieves the results of the FDTC.

Progress to dateWritten and distributed the Churchill Fellowship Report Meetings and discussions with senior people in government, including the Attorney General and Minister for Community Services and Mental HealthMeetings with (a) CEOs and senior officials in non-government agencies involved in child protection, legal aid and the private legal profession, mental health, drug and alcohol therapeutic services; and (b )researchers in social work, addiction studies, mental health to explore evaluation models of the Victorian FDTC and parent mentoring approachesNumerous presentations to national and international conferencesFormation of a Steering Group to develop the first Australian FDTC and a budget for a 3 year trial of the FDTC in the Childrens Court of Victoria

Key challengeAcquiring appropriate funding and resourcing for the successful running of the FDTC, including:the appointment of a full time FDTC Coordinatorthe appointment of an Interdisciplinary FDTC Team (5-6 members, social work, substance use, mental health)the location of an appropriate venue and legal staffing for FDTC court hearings, meeting rooms and offices for the Team new methods to introduce/sustain the docket systemPositive signs. Steering Group commitment, expertise, lobbyingIn mid-October, we invited a committed group of experts to serve as the Inaugural Steering Group of the FDTC to develop a program model and logic, budget, governance policies, eligibility and assessment criteria, evaluation models etc. Since October, we have met 5 times and call on a wide range of expertise from:Department of Justice: Director, Courts Policy; President, Childrens Court of Victoria, CEO CCV, Principal Registrar, CCV, Magistrate Levine, CCV; Victoria Legal Aid Child Protection PractitionerAOD/Mental Health Experts : CEO Odyssey House; CEO Youth Support and Advocacy Services; Associate Professor Addiction Studies, Monash University and Turning Point; Policy Advisor, Department of Health Child Protection Experts: Principal Child Protection Practitioner, Department of Human Services; Director Take Two, Berry Street (non-government children and family support services) Program development and evaluation: Emeritus Professor Barbara Kamler

Positive signs: Secondment of an FDTC Coordinator one day per weekOn November 26, 2012, we received support from the Department of Justice via this email from the CEO of the Childrens Court:Dear Greg Arrangements are being made for X, Program Manager Drug Court, to dedicate one day per week to supporting the FDTC work. X will be sitting either in Courts Policy or here with us (as required) to develop a project plan and eventual program model.

Positive signs. ABC Radio National Interview January 28, 2013GREG LEVINE: ... All of the significant evaluations of courts in the United States have demonstrated that both socially and economically there's absolutely no reason why it can't work here. In my view it's of the highest priority for governments to be able to introduce this court process. ALISON CALDWELL: Magistrate Greg Levine says a dedicated family drug treatment court would meet two of the recommendations from Victoria's Cummins inquiry, including that child protection move away from an adversarial system. He has floated the idea with the Justice Department and Victoria's Department of Human Services. Mary Wooldridge is the Minister for Community Services and Mental Health. She welcomes the initiative. MARY WOOLDRIDGE: The Coalition Government is very interested in that idea and we're definitely having a look at the model and seeing if that's something that would fit well into the Victorian justice system. fIn conclusionFamily Drug Treatment Courts offer a proven structure and set of processes for interrupting the intergenerational harm caused by substance abuse and for giving parents the very best chance to rehabilitate and be reunited with their children. [Levine, G. (2012) Report to the Winston Churchill Memorial Trust of Australia, p. 5.]