1. Evaluating the Impact of Adding the Reclaiming Futures Approach to Juvenile Treatment Drug Courts Michael L. Dennis, Ph.D., Kate Moritz, M.A., Rachel Meckley, Nora Jones, M.S., Chestnut Health Systems, Normal, IL Susan Richardson, Cora Crary, Laura Nissen, Ph.D., Reclaiming Futures National Program Office, Portland State, University, Portland, OR Mac Prichard, M.P.A., Liz Wu, Prichard Communications, Portland, OR May 8, 2012 Report to Kristin Schubert, Robert Woods Johnson Foundation, Reclaiming Futures; Robert Vincent, Substance Abuse and Mental Health Services Administration; and Gwendolyn Williams, Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs 1

2. Click to edit Master title styleAcknowledgement  Analysis for this presentation was supported by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA) contract 270-07-0191 using data provided by 27 Juvenile Treatment Drug Court (JTDC) grantees funded by SAMHSA, Office of Juvenile Justice and Delinquency Prevention (OJJDP), and/or Reclaiming Futures (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 authors thank these grantees and their participants for agreeing to share their data to support this secondary analysis as well as the following people for assistance in preparing and/or feedback on the presentation: Jimmy Carlton, Michael French, Mark Fulop, Lori Howell, Pamela Ihnes, Rachel Kohlbecker, Kathryn McCollister, Daniel Merrigan, Scott Olsen.  The opinions about this data are those of the authors and do not reflect official positions of the government or individual grantees. Please direct correspondence to Michael L. Dennis, Chestnut Health Systems, 448 Wylie Drive, Normal, IL 61701, mdennis@chestnut.org 309-451-7801.  This presentation is available at www.gaincc.org/presentationswww.gaincc.org/presentations 2

3. Click to edit Master title stylePurpose 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 3

4. Click to edit Master title style Background 4

5. Click to edit Master title style Adolescence is the Age of Onset 5 Source: 2002 NSDUH and Dennis & Scott, 2007, Neumark et al., 2000 0 10 20 30 40 50 60 70 80 90 100 12-1314-1516-1718-2021-2930-3435-4950-64 65+ Other drug or heavy alcohol use in the past year Alcohol or Drug Use (AOD) Abuse or Dependence in the past year Age Severity Category Over 90% of use and problems start between the ages of 12-20 It takes decades before most recover or die Percentage People with drug dependence die an average of 22.5 years sooner than those without a diagnosis

6. Click to edit Master title style 6 Source: Dennis & McGeary, 1999; OAS, 1995 6 Adolescence Use Related to Range of Problems

7. Click to edit Master title style Other Life Course Reasons to Focus on Adolescents  People who start using under age 15 use 60% more years than those who start over age 18  Entering treatment within the first 9 years of initial use leads to 57% fewer years of substance use than those who do not start treatment until after 20 years of use  Relapse is common and it takes an average of 3 to 4 treatment admissions over 8 to 9 years before half reach recovery  Of all people with abuse or dependence 2/3 rds do eventually reach a state of recovery  Monitoring and early re-intervention with adults has been shown to cut the time from relapse to readmission by 65%, increasing abstinence and improving long term outcomes 7 Source: Dennis et al., 2005, 2007; Scott & Dennis 2009

8. Click to edit Master title style What Is Treatment?  Motivational interviewing and other protocols to help them understand how their problems are related to their substance use and that they are solvable  Detoxification and medication to reduce pain/risk of withdrawal and relapse, including tobacco cessation  Evaluation of antecedents and consequences of use  Group, individual or family outpatient including relapse prevention planning  More systemic family approaches  Proactive urine monitoring  Motivational incentives / contingency management  Residential, intensive outpatient (IOP) and other types of structured environments to reduce short term risk of relapse  Access to communities of recovery for long term support, including 12-step, recovery coaches, recovery schools, recovery housing, workplace programs  Continuing care, phases for multiple admission 8

9. Click to edit Master title style The Treatment Gap Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on Drug Use and Health, 2009. [Computer file] ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2012-02-10. doi:10.3886/ICPSR29621.v2. Retrieved from http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621/detail. Over 88% of adolescent and young adult treatment and over 50% of adult treatment is publicly funded Few Get Treatment: 1 in 20 adolescents, 1 in 18 young adults, 1 in 11 adults Much of the private funding is limited to 30 days or less and authorized day by day or week by week 9

10. Click to edit Master title styleOther Problems With the U.S. Treatment System  Less than 75% stay the 90 days recommended by NIDA (half less than 50 days)  Less than half are positively discharged  Less than 10% 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 their own performance in terms of client outcomes  Average staff education is an Associate Degree  Staff stay on the job an average of 2 years Source: Institute of Medicine (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions. National Academy Press. Retrieved from http://www.nap.edu/catalog.php?record_id=11470 http://www.nap.edu/catalog.php?record_id=11470 10

11. Click to edit Master title style Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars The Cost of Treatment Episode vs. Consequences $22,000 / year to incarcerate an adult $30,000/ child-year in foster care $70,000/year to keep a child in detention $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 SBIRT models popular due to ease of implementation and low cost 11

12. Click to edit Master title style Return on Investment (ROI) 12 Source: Bhati et al., (2008); Ettner et al., (2006), GAO (2012), Lee et al (2012) This also means that for every dollar treatment is cut, it costs society more money than was saved within the same year 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

13. Click to edit Master title style Juvenile Justice System and Substance Use  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).  By late 2004, there were 357 juvenile treatment drug courts (JTDC) and the number of courts has continued to grow at a rate of 30-50% per year. 13 Source: Dennis, White & Ives, 2009

14. Click to edit Master title style Recommended Components JTDC 1.Formal screening process for early identification and referral for substance use and other disorders/needs 2.Multidimensional standardized assessment to guide clinical decision-making related to diagnosis, treatment planning, placement and outcome monitoring 3.Interdisciplinary-treatment drug court team 4.Comprehensive non-adversarial team-developed treatment plan, including youth and family 5.Continuum of substance-abuse treatment and other rehabilitative services to address the youths needs 6.Use of evidence-based treatment practices 14

15. Click to edit Master title style 6.Monitoring progress through urine screens and weekly interdisciplinary-treatment drug court team staffings 7.Feedback to the judge followed by graduated performance- based rewards and sanctions 8.Reducing judicial involvement from weekly to monthly with evidence of favorable behavior change over a year or longer 9.Advanced agreement between parties on how on assessment information will be used to avoid self- incrimination 10.Use of information technology to connect parties and proactively monitor implementation at the client and program level 15 Source: National Association of Drug Court Professionals, 1997; Henggeler et al., 2006; Ives et al., 2010. Recommended Components JTDC (cont.)

16. Click to edit Master title styleLevel of Evidenced is Available on Drug Courts 16 Meta Analyses of Experiments/ Quasi Experiments (Summary v Predictive, Specificity,Replicated, Consistency) Dismantling/ Matching study (What worked for whom) Experimental Studies (Multi-site, Independent, Replicated, Fidelity, Consistency) Quasi-Experiments (Quality of Matching, Multi- site, Independent, Replicated, Consistency) Pre-Post (multiple waves), Expert ConsensusCorrelation and Observational studiesCase Studies, Focus GroupsPre-data Theories, Logic ModelsAnecdotes, Analogies Beyond a Reasonable Doubt Clear and Convincing Evidence Preponderance of the Evidence Probable Cause Reasonable Suspicion Law Science STRONGER Source: Marlowe 2008, Ives et al 2010

17. Click to edit Master title style 17 Meta Analyses of Experiments/ Quasi Experiments (Summary v Predictive, Specificity,Replicated, Consistency) Dismantling/ Matching study (What worked for whom) Experimental Studies (Multi-site, Independent, Replicated, Fidelity, Consistency) Quasi-Experiments (Quality of Matching, Multi- site, Independent, Replicated, Consistency) Pre-Post (multiple waves), Expert ConsensusCorrelation and Observational studiesCase Studies, Focus GroupsPre-data Theories, Logic ModelsAnecdotes, Analogies Beyond a Reasonable Doubt Clear and Convincing Evidence Preponderance of the Evidence Probable Cause Reasonable Suspicion Law Science STRONGER Source: Marlowe 2008, Ives et al 2010 Adult Drug Treatment Courts: 5 meta analyses of 76 studies found crime reduced 7-26% with $1.74 to $6.32 return on investment Juvenile Drug Treatment Courts – one 2006 experiment, one 2010 large multisite quasi- experiment, & several small studies with similar or better effects than regular adolescent outpatient treatment DWI Treatment Courts: one quasi experiment and five observational studies positive findings Family Drug Treatment Courts: one multisite quasi experiment with positive findings for parent and child Level of Evidenced is Available on Drug Courts

18. Click to edit Master title style Juvenile Treatment Drug Court Effectiveness  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 18

19. Click to edit Master title style Methods 19

20. Click to edit Master title style Juvenile Treatment Drug Court (JTDC) Grants (n=1,934)  Juvenile Treatment Drug Court (DC) – Original cohort of 11 CSAT grantee sites using the GAIN in Laredo, TX; San Antonio, TX; Belmont, CA; Tarzana, CA; Pontiac, MI; San Jose, CA; Austin, TX; Peabody, MA; Providence, RI; Detroit, MI; and Philadelphia, PA – Intake data collected from these sites on N=1,771 adolescents between January 2006 through March 2009 with 1+ follow-up at 3, 6, and 12-months post intake  Juvenile Treatment Drug Court (JTDC) – Cohort of 6 CSAT grantee sites using the GAIN in San Antonio, TX; Seattle, WA; San Rafael, CA; Buffalo, NY; Box Elder, MT; and Viera, FL – Intake data collected from these sites on N=163 Adolescents between January and November 2011 with 1+ follow-up at 3, 6, and 12-months post intake 20

21. Click to edit Master title style Reclaiming Futures JTDC (RF-JTDC) Grants (n=811)  Reclaiming Futures – Office of Juvenile Justice and Delinquency Prevention (RF-OJJDP) – Cohort of 3 grantee sites using the GAIN in Greene County, MO; Hocking County, OH; and Nassau County, NY – Intake data collected from these sites on N=457 adolescents between January 2008 through December 2011 with 1+ follow-up at 3, 6, and 12-months post intake  Reclaiming Futures – Juvenile Drug Court (RF-JDC) – Cohort of 6 grantee sites using the GAIN in Hardin County, OH; Snohomish County, WA; Travis County, TX; Ventura County, CA; Cherokee Nation, OK; and Denver, CO – Intake data collected from these sites on N=354 adolescents between January 2010 through December 2011 with 1+ follow-up at 3, 6, and 12-months post intake 21

22. Click to edit Master title style GAIN Initial (GAIN-I)  Administration Time: Core version 60-90 minutes; full version 110- 140 minutes (depending on severity)  Training Requirements: 3.5 days (train the trainer) plus recommend formal certification program (Administration certification within 3 months of training; Local Trainer certification within 6 months of training); advanced clinical interpretation recommended for clinical supervisors and lead clinicians  Mode: Generally staff-administered on computer (can be done on paper or self-administered with proctor)  Purpose: Designed to provide a standardized biopsychosocial for people presenting to a substance abuse treatment using DSM-IV for diagnosis and ASAM for placement and needing to meet common requirements (CARF, COA, JCAHO, insurance, CDS/TEDS, Medicaid, CSAT, NIDA) for assessment, diagnosis, placement, treatment planning, accreditation, performance/outcome monitoring, economic analysis, program planning, and supporting referral/communications with other systems 22

23. Click to edit Master title style GAIN Initial (GAIN-I) (continued)  Scales: The GAIN-I has 9 sections (access to care, substance use, physical health, risk and protective behaviors, mental health, recovery environment, legal, vocational, and staff ratings) that include 103 long (alpha over.9) and short (alpha over.7) scales, summative indices, and over 3,000 created variables to support clinical decision-making and evaluation. It is also modularized to support customization.  Response Set: Breadth (past-year symptom counts for behavior and lifetime for utilization), recency (48 hours, 3-7 days, 1-4 weeks, 2-3 months, 4-12 months, 1+ years, never), and prevalence (past 90 days); patient and staff ratings  Interpretation: – Items can be used individually or to create specific diagnostic or treatment planning statements – Items can be summed into scales or indices for each behavior problem or type of service utilization – All scales, indices, and selected individual items have interpretative cut points to facilitate clinical interpretation and decision making 23

24. Click to edit Master title style Cost to Society  Costs of Service Utilization (conservative) – The frequency of using tangible services (e.g., health care utilization, days in detention, probation, parole, days of missed school) 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) – 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 24

25. Click to edit Master title style Service Utilization Unit Costs (conservative) DescriptionUnit Cost in 2010$ Inpatient hospital dayDays $1,432.81 Emergency room visitVisits $ 269.87 Outpatient clinic/doctor’s office visitVisits $ 76.83 Nights spent in hospitalNights $1,432.81 Times gone to emergency roomTimes $ 269.87 Times seen MD in office or clinicTimes $ 76.83 Days bothered by any health problemsDays $ 25.63 Days bothered by psychological problemsDays $ 9.90 How many days in detoxDays $ 259.00 Nights in residential for AOD useNights $ 151.66 Days in Intensive outpatient program for AOD useDays $ 104.19 Times did you go to regular outpatient programTimes $ 280.70 Days missed school or training for any reasonDays $ 18.38 How many times arrestedTimes $2,125.81 Days on probationDays $ 5.76 Days on paroleDays $ 18.59 Days in jail/prison/detentionDays $ 81.06 Days detention/jailDays $ 113.60 25

26. Click to edit Master title style Cost of Crime (tangible & intangible) 26 OffenseTangible\aIntangible\bTotal Cost 2010$ Murder $1,294,788 $8,550,058 $9,844,845 Rape/sexual assault $41,775 $202,197 $243,972 Aggravated assault $19,787 $96,239 $116,026 Robbery $21,672 $22,864 $44,536 Motor vehicle theft $10,669 $ 265 $10,934 Arson $16,638 $ 5,199 $21,837 Household burglary $ 6,249 $ 325 $ 6,574 Larceny/theft $ 3,568 $ 10 $ 3,578 Stolen property $ 8,076 $ - $ 8,076 Vandalism $ 4,922$ - $ 4,922 Forgery and counterfeiting $ 5,332$ - $ 5,332 Embezzlement $ 5,550$ - $ 5,550 Fraud $ 5,096$ - $ 5,096 \a Including the cost to the victim, justice system, and criminal career \b Including the cost of pain & suffering, prorated risk of homicide

27. Click to edit Master title style Results: Baseline Needs 27

28. Click to edit Master title style 28 Count of Major Clinical Problems at Intake: RF JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups *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

29. Click to edit Master title styleNumber of Clinical Problems: JTDC vs. RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 29

30. Click to edit Master title style General Victimization Scale: RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups *Mean of 15 items 30

31. Click to edit Master title style 31 Major Clinical Problems* by Victimization: RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups *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

32. Click to edit Master title styleSeverity of Victimization: JTDC vs. RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 32

33. Click to edit Master title styleAge of Onset: JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 33

34. Click to edit Master title styleAge of Onset: RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups RF JTDC Early Onset and Higher Prevalence of Mental Health and Victimization 34

35. Click to edit Master title style Results: Services 35

36. Click to edit Master title style Services Received *Days of Substance Abuse (SA), Mental Health (MH), Physical Health (PH) treatment and Juvenile Justice System Involvement \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 36

37. Click to edit Master title styleIncrease in Average Cost of Service Utilization \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 37

38. Click to edit Master title styleTreatment Initiation*: JTDC vs. RF-JTDC 38 *Initial GAIN interview was administered within 14 days before to seven days after admission to Treatment \c Other JTDC has significantly higher rate than RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

39. Click to edit Master title styleEngagement*: JTDC vs. RF-JTDC 39 *In initial Treatment 30+ days and reported 3+ days of Treatment \d RF-JTDC has significantly higher rate than Other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

40. Click to edit Master title styleContinuing Care*: JTDC vs. RF-JTDC 40 *Received Treatment 90-180 days post intake Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

41. Click to edit Master title styleLevel of Care*: JTDC vs. RF-JTDC 41 *OP: Outpatient, IOP: Intensive Outpatient; STR: Short Term Residential; M-LTR: Medium to Long Term Residential; CC-OP Continuing Care Outpatient.. Distribution of clients by Level of Care is significantly different between JTDC and RF-JTDC. Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

42. Click to edit Master title styleType of Treatment*: JTDC vs. RF-JTDC 42 *A-CRA: Adolescent Community Reinforcement Approach; ACC: Assertive Continuing Care; MET/CBT: Motivational Enhancement Therapy/ Cognitive Behavior Therapy; EBTx: Other evidenced based treatment approaches with outcome data.. Distribution of clients by Type of Treatment is significantly different between JTDC and RF-JTDC. Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

43. Click to edit Master title styleLength of Stay*: JTDC vs. RF-JTDC 43 *Distribution of clients by Length of Stay is significantly different between JTDC and RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

44. Click to edit Master title styleAny Self Help Activity: JTDC vs. RF-JTDC 44 \c Other JTDC has significantly higher rate than RF-JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups

45. Click to edit Master title style Results: Outcomes 45

46. Click to edit Master title styleChange in Days of Abstinence* * Days of abstinence from alcohol and other drugs while living in the community; If coming from detention at intake, based on the 90 days before detention. \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 46

47. Click to edit Master title styleChange in Being in Early Recovery* * No past month use, abuse or dependence symptoms while living in the community \a p<.05 that post minus pre change is statistically significant Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 47

48. Click to edit Master title styleChange in Emotional Problems Scale* *Proportional average of recency and days of emotional problems (bothered, kept from responsibilities, disturbed by memories, paying attention, self-control) in past 90 \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 48

49. Click to edit Master title styleChange in Days of Victimization* *Number of days victimized (physically, sexually, or emotionally ) in past 90 \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 49

50. Click to edit Master title styleChange in Illegal Activities Scale* *Recency and days (during the past 90) of illegal activity and supporting oneself financially with illegal activity \a p<.05 that post minus pre change is statistically significant Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 50

51. Click to edit Master title styleChange in Average Number of Crimes Reported \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 51

52. Click to edit Master title style Change in Average Number of Crimes Reported by Type* *Sum of all crimes reported by type \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC Source: CSAT 2010 SA Data Set subset to 1+ Follow ups 52

53. Click to edit Master title style Change in Cost of Crime to Society* *Based on the frequency of crime times the average cost to society of that crime estimated by McCollister et al (2010) in 2010 dollars; distribution capped at 99 th percentile to minimize the impact of outliers... \a p<.05 that post minus pre change is statistically significant \b p<.05 that change for Reclaiming Futures JTDC is better than the average for other JTDC CSAT 2010 SA Data Set subset to 1+ Follow ups 53

54. Click to edit Master title style Discussion 54

55. Click to edit Master title styleLimitations  This analysis is based on self-reported data  The conditions were defined by grant mechanism, it would be better to classify one JTDC site using the RF model (King County) with RF JTDC and drop youth served by other (non JTDC) diversion program tracks from both sets of grants  There were some baseline differences between JTDC and RF-JTDC that have only been controlled for by looking at change (vs. more elaborate matching) and is observational  There was data missing due to attrition (26% to 37%), so outcomes had to be estimated based on the average of the observed waves  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 55

56. Click to edit Master title styleReprise  The Reclaiming Futures JTDC reached more clinically severe youth, provided them with more services and did as well or better as the average JTDC  The Reclaiming Futures did better than the average JTDC model in terms of – increasing the alcohol and drug abstinence (26% vs. 42%) – reducing emotional problems (-16% vs. -24%) – reducing days of victimization (+37% vs. -97%) – reducing the number of crimes overall (-50% vs. -66%), property crimes (-53% vs. -62%), violent crimes (-33% vs. - 67%) and substance related (i.e., DUI, drug, gambling, prostitution, probation violation) crimes (- 54% vs. -72%) 56

57. Click to edit Master title styleReprise (continued)  Reclaiming Futures JTDC costs more than average JTDC in terms of the change in services provided (+$1,673 vs. +$4,022)  However, Reclaiming Futures JTDC was also associated with greater saving than average JTDC in terms of reductions in the tangible and intangible costs of crime – in raw dollars (-$86,202 vs. -$192,552 per youth) – and as a percent of baseline costs (-41% vs. -76%) 57

58. Click to edit Master title styleNext Steps  Doing several double checks and sensitivity analyses, and running by site to verify and better understand the findings.  Will work to publish these findings and to do more comprehensive analyses in terms of case mix adjustment and costs  OJJDP is expected to solicit and fund another round of Reclaiming Futures JTDC  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 58

59. Click to edit Master title style Resources you can use now  Cost-Effective evidence-based practices A-CRA & MET/CBT tracks here, more at www.chestnut.org/li/apss or http://www.nrepp.samhsa.gov/www.chestnut.org/li/apss http://www.nrepp.samhsa.gov/  Most withdrawal symptoms appeared more appropriate for ambulatory/outpatient detoxification, see http://www.aafp.org/afp/2005/0201/p495.html http://www.aafp.org/afp/2005/0201/p495.html  Trauma informed therapy and sucide prevention at http://www.nctsn.org/nccts and http://www.sprc.org/ http://www.nctsn.org/ncctshttp://www.sprc.org/  Externalizing disorders medication & practices http://systemsofcare.samhsa.gov/ResourceGuide/ebp.html http://systemsofcare.samhsa.gov/ResourceGuide/ebp.html  Tobacco cessation protocols for youth http://www.cdc.gov/tobacco/quit_smoking/cessation/youth_tobacc o_cessation/index.htm http://www.cdc.gov/tobacco/quit_smoking/cessation/youth_tobacc o_cessation/index.htm  HIV prevention with more focus on sexual risk and interpersonal victimization at http://www.who.int/gender/violence/en/ or http://www.effectiveinterventions.org/en/home.aspxhttp://www.who.int/gender/violence/en/ http://www.effectiveinterventions.org/en/home.aspx  For individual level strengths see http://www.chestnut.org/li/apss/CSAT/protocols/index.html http://www.chestnut.org/li/apss/CSAT/protocols/index.html  For improving customer services http://www.niatx.nethttp://www.niatx.net 59

60. Click to edit Master title style  Applegate, B. K., & Santana, S. (2000). Intervening with youthful substance abusers: A preliminary analysis of a juvenile drug court. The Justice System Journal, 21(3), 281-300.  Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders. Washington, DC: Urban Institute.  Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids. Accessed on 6/3/09 from http://www.connectforkids.org/node/571  Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. Journal American Medical Association, 301(2), 183-190  Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice, 4(1), 45-55.  Dennis, M. L., Scott, C. K., Funk, R. R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment. Journal of Substance Abuse Treatment, 28(2 Suppl), S51-S62.  Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL: Chestnut Health Systems. Retrieved from www.gaincc.org. www.gaincc.org  Dennis, M.L., White, M., Ives, M.I (2009). Individual characteristics and needs associated with substance misuse of adolescents and young adults in addiction treatment. In Carl Leukefeld, Tom Gullotta and Michele Staton Tindall (Ed.), Handbook on Adolescent Substance Abuse Prevention and Treatment: Evidence-Based Practice. New London, CT: Child and Family Agency Press.  Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services Research, 41(1), 192-213.  French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35, 462-469  General Account Office (GAO, 2011). Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts. Washington, DC: Author. Retrieved from http://www.gao.gov/Products/GAO-12-53 on April 18, 2012.  Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., Chapman, J. E. (2006). Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42-54.  Institute of Medicine (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions. National Academy Press. Retrieved from http://www.nap.edu/catalog.php?record_id=11470http://www.nap.edu/catalog.php?record_id=11470 60 References

61. Click to edit Master title style  Ives, M.L., Chan, Y.F., Modisette, K.C., & Dennis, M.L. (2010). Characteristics, needs, services, and outcomes of youths in juvenile treatment drug courts as compared to adolescent outpatient treatment. Drug Court Review, 7(1), 10-56.  Lee, S., Aos, S., Drake, E., Pennucci, A., Miller, M., & Anderson, L. (2012). Return on investment: Evidence-based options to improve statewide outcomes, April 2012 (Document No. 12-04-1201). Olympia: Washington State Institute for Public Policy. Retrieved from http://www.wsipp.wa.gov/pub.asp?docid=12-04-1201 on 5/4/12.  Marlowe, D. (2008). Recent studies of drug courts and DWI courts: Crime reduction and cost savings.  Miller, M. L., Scocas, E. A., & O’Connell, J. P. (1998). Evaluation of the juvenile drug court diversion program. Dover DE: Delaware Statistical Analysis Center, USA.  National Association of Drug Court Professionals (1997). Defining Drug Courts: The Key Components. Washington, DC: U.S. Department of Justice Office of Justice Programs. Retrieved from https://www.ncjrs.gov/pdffiles1/bja/205621.pdf.https://www.ncjrs.gov/pdffiles1/bja/205621.pdf  National Institute on Drug Abuse (2000). Principles of Drug Addiction Treatment: A Research-Based Guide. Rockville, MD: Author. NIH Publication No.00-4180. On line at http://www.drugabuse.gov/PODAT/PODATIndex.html  National Institute on Drug Abuse (2006). Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide. Rockville, MD: Author. NIH Publication No. 06-5316. On line at http://www.drugabuse.gov/PODAT_CJ/  Office of Applies Studies. (1995). National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration.  Office of Juvenile Justice and Delinquency Prevention (OJJDP). (May 2001). Juvenile Drug Court Program. Department of Justice, OJJDP, Washington, DC. NCJ 184744  Rodriguez, N., & Webb, V. J. (2004). Multiple measures of juvenile drug court effectiveness: Results of a quasi-experimental design. Crime & Delinquency, 50(2), 292-314.  Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on Drug Use and Health, 2009. [Computer file] ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2012-02-10. doi:10.3886/ICPSR29621.v2. Retrieved from http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621/detail.  Scott, C.K. & Dennis, M.L. (2009). Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction, 104, 959-971.  Sloan, J. J., Smykla, J. O., & Rush, J. P. (2004). Do juvenile drug courts educe recidivism? Outcomes of drug court and an adolescent substance abuse program. American Journal of Criminal Justice, 29(1), 95-116.  Teplin, L.A., Elkington, K.S., McClelland, G.M., Abram, K.M., Mericle, A.A., and Washburn, J.J. (2001). Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees. Psychiatric Services, 56(7), 823–828. 61 References