W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 1 OCTOBER 17, 2014 Drug Court Evaluation: The Impact of Recovery Support Services Washington State Association of Drug Court Professionals 17 th Annual Conference OCTOBER 17, 2014 Jim Mayfield and Paula Ditton Henzel DSHS Research and Data Analysis Division Getty Images, iStock

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 2 OCTOBER 17, 2014 Our topic today Review social service and criminal justice data integration in Washington State 2.Demonstrate the use of integrated data to evaluate drug courts 3.Present evaluation of recovery support services provided to drug court participants 3xHIGHER Getty Images, iStock

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 3 OCTOBER 17, 2014 Washington is one of a few states in the nation with an integrated social service client database

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 4 OCTOBER 17, and at an individual or family level That means we can identify costs, risks and outcomes at the state or community level...

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 5 OCTOBER 17, 2014 Nursing Facilities In-home Services Community Residential Functional Assessments Case Management Community Residential Services Personal Care Support Residential Habilitation Centers and Nursing Facilities Medical and Psychological Services Training, Education, Supplies Case Management Vocational Assessments Job Skills Child Protective Services Child Welfare Services Adoption Adoption Support Child Care Out of Home Placement Voluntary Services Family Reconciliation Services Institutions Dispositional Alternative Community Placement Parole Food Stamps TANF and State Family Assistance General Assistance Child Support Services Working Connections Child Care Juvenile Rehabilitation Economic Services Aging and Long- Term Support Developmental Disabilities Vocational Rehabilitation Children’s Services Child Study Treatment Center Children’s Long- term Inpatient Program Community Inpatient Evaluation/ Treatment Community Services State Hospitals State Institutions Assessments Detoxification Opiate Substitution Treatment Outpatient Treatment Residential Treatment Mental Health Substance Abuse Services DSHS Client Services Database External School Outcomes Preschool – College Arrests Charges Convictions Incarcerations Community Supervision Dental Services Medical Eligibility Medicaid, State Only Hospital Inpatient/ Outpatient Managed Care Physician Services Prescription Drugs Hours Wages Housing Assistance Emergency Shelter Transitional Housing Homeless Prevention and Rapid Re-housing Permanent Supportive Housing Public Housing Housing Choice Vouchers Multi-Family Project-Based Vouchers Internal Administrative Office of the Courts Employment Security Department Department of Corrections Washington State Patrol Department of Commerce Health Care Authority Housing and Urban Development Public Housing Authority WASHINGTON STATE Department of Social and Health Services Integrated Client Databases WASHINGTON STATE Department of Social and Health Services Integrated Client Databases Education Research Data Center De-identified Births Deaths Department of Health Integrated Client Databases (ICDB)

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 6 OCTOBER 17, 2014 (Includes dropouts) Drug court participants and study sample June 2007 through July 2009 Reported admissions (unduplicated) * 2,537 Opt outs  582 Did not link with the ICDB  121 Missing critical data  163 Final Drug Court Sample 1,671 *SOURCE: Administrative Office of the Courts, individual drug courts, and DCCM.

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 7 OCTOBER 17, years -9 years -8 years -7 years -6 years -5 years -4 years -3 years -2 years -1 year +1 year +2 years +3 years INDEX Date felony was filed Baseline characteristics up to 10 years prior 3 years after filing date Age, gender Race and ethnicity Employment history Location Arrest rate Incarceration rate Days incarcerated Received AOD treatment Days of AOD treatment AOD treatment cost Most serious felony charge Criminal history AOD treatment need Previous AOD treatment BASELINE PERIODFOLLOW-UP PERIOD STUDY TIMELINE: Admissions from June 2007 through July 2009

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 8 OCTOBER 17, 2014 Nursing Facilities In-home Services Community Residential Functional Assessments Case Management Community Residential Services Personal Care Support Residential Habilitation Centers and Nursing Facilities Medical and Psychological Services Training, Education, Supplies Case Management Vocational Assessments Job Skills Child Protective Services Child Welfare Services Adoption Adoption Support Child Care Out of Home Placement Voluntary Services Family Reconciliation Services Institutions Dispositional Alternative Community Placement Parole Food Stamps TANF and State Family Assistance General Assistance Child Support Services Working Connections Child Care Juvenile Rehabilitation Economic Services Aging and Long- Term Support Developmental Disabilities Vocational Rehabilitation Children’s Services Child Study Treatment Center Children’s Long- term Inpatient Program Community Inpatient Evaluation/ Treatment Community Services State Hospitals State Institutions Assessments Detoxification Opiate Substitution Treatment Outpatient Treatment Residential Treatment Mental Health Substance Abuse Services DSHS Client Services Database External School Outcomes Preschool – College Arrests Charges Convictions Incarcerations Community Supervision Dental Services Medical Eligibility Medicaid, State Only Hospital Inpatient/ Outpatient Managed Care Physician Services Prescription Drugs Hours Wages Housing Assistance Emergency Shelter Transitional Housing Homeless Prevention and Rapid Re-housing Permanent Supportive Housing Public Housing Housing Choice Vouchers Multi-Family Project-Based Vouchers Internal Administrative Office of the Courts Employment Security Department Department of Corrections Washington State Patrol Department of Commerce Health Care Authority Housing and Urban Development Public Housing Authority WASHINGTON STATE Department of Social and Health Services Integrated Client Databases WASHINGTON STATE Department of Social and Health Services Integrated Client Databases Education Research Data Center De-identified Births Deaths Department of Health Routinely updated ICDB data sources

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 9 OCTOBER 17, years -9 years -8 years -7 years -6 years -5 years -4 years -3 years -2 years -1 year +1 year +2 years +3 years INDEX Date felony was filed ADMITTED to Drug Court BASELINE PERIODFOLLOW-UP PERIOD NOT Admitted to Drug Court BUT statistically similar STUDY TIMELINE and Comparison Group

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 10 OCTOBER 17, 2014 Study population characteristics Adults admitted to Drug Courts and a matched comparison group are statistically identical across multiple dimensions “Index” Felony: The most serious charge associated with admission to drug court Demographics Age Gender Race/Ethnicity Criminal History Felony Convictions by Type Misdemeanor Convictions by Type Arrests Juvenile Crime Other Characteristics AOD Treatment Need AOD Treatment & Detox History Employment History Geography

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 11 OCTOBER 17, xHIGHER Getty Images, iStock Study questions How do drug courts influence incarceration (prison only)? 2.What is the impact of drug court on subsequent arrest rates? 3.How do drug courts influence treatment participation?

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 12 OCTOBER 17, 2014 Drug Court participants were less likely to be incarcerated Cumulative incarceration rate over the three-year follow-up period Drug Court and comparison group clients—DOC facilities only MONTHS AFTER INDEX FELONY CHARGE Drug Court group Comparison group 23% 17%

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 13 OCTOBER 17, 2014 Drug Court participants in the community were less likely to be re-arrested Cumulative arrest rate over the three-year follow-up period for individuals in the community Drug Court and comparison group clients MONTHS AFTER INDEX FELONY CHARGE Drug Court group Comparison group 85% 71% Graduates 61%

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 14 OCTOBER 17, 2014 Drug Court participants were more likely to remain free of arrest *Based on a multivariate predictive model. Arrest-free during follow-up period * Adjusted Drug Court Group Comparison Group 2x HIGHER n = 1,290n = 1,384 *

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 15 OCTOBER 17, 2014 Chemical dependency treatment experiences differed significantly Any AOD Treatment received during follow-up DRUG COURT GROUPCOMPARISON GROUP 3% No Treatment n = 53 97% Received Treatment n = 1,618 54% No Treatment n = % Received Treatment n = 775

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 16 OCTOBER 17, 2014 Drug Court participants entered treatment more quickly TIME TO TREATMENT Drug Court Group Comparison Group 64 DAYS EARLIER TO TREATMENT n = 775n = 1,618 Drug Court Group Comparison Group 3x HIGHER n = 775n = 1,618 Number of days before entering treatment Percent entering treatment within 90 days

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 17 OCTOBER 17, 2014 Drug Court participants entering treatment stayed longer DAYS IN TREATMENT Drug Court Group Comparison Group 128 MORE DAYS IN TREATMENT n = 775n = 1,618 Drug Court Group Comparison Group 4x HIGHER n = 775n = 1,618 Number of days spent in treatment Percent spending 90 days or more in treatment

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 18 OCTOBER 17, Updated drug court participation data: 2008 through The Administrative Office of the Courts will update drug court participation data annually legislation granted specific agencies (including DSHS) access to jail bookings and releases, statewide 3xHIGHER Getty Images, iStock Next steps....

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 19 OCTOBER 17, xHIGHER Getty Images, iStock Drug Court and Recovery Support Services OUTCOME EVALUATION Preliminary Findings OCTOBER 17, 2014 Paula Ditton Henzel Washington State Department of Social and Health Services Research and Data Analysis Division wa cares

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 20 OCTOBER 17, 2014 Overview WA-CARES and Recovery Support Services Study Design Outcomes Do recovery support services have an impact on: Substance use disorder treatment? Employment? Re-Arrest and Incarceration? Conclusions

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 21 OCTOBER 17, 2014 The WA CARES Project WA-CARES is a collaborative project between... DSHS Division of Behavioral Health and Recovery The Administrative Office of the Courts Nine independent, county-level drug courts WA-CARES addresses... Implementation of an automated drug court case management system Recovery support services (RSS) provided to drug court participants in select drug courts Preliminary report identifies... WA-CARES participant characteristics and preliminary outcomes for RSS and Non-RSS (Drug Court Case Management, or DCCM) sites Full report available from DSHS Research and Data Analysis Division at: WA-CARES was funded by... Grant funds from the Substance Abuse and Mental Health Services Administration (SAMHSA) Bureau of Justice Assistance (BJA)

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 22 OCTOBER 17, 2014 Recovery Support Services (RSS)  Identify and address potential barriers to recovery and drug court success  Include funds for services to address needs around employment and job training, transportation, clothing, medical and legal problems, child care, and parenting education, among other basic needs Participating Sites San Juan Clallam Skagit Okanogan Snohomish Lewis Yakima Cowlitz Whatcom King Pierce Thurston Jefferson Island Kitsap Mason Grays Harbor Pacific Wahkiakum Clark Skamania Klickitat Kittitas Chelan Douglas Grant Benton Franklin Walla Columbia Garfield Asotin Adams Lincoln Whitman Spokane Pend Oreille Stevens Ferry Recovery Support Service Sites Other WACARES Sites New WACARES site, Fall 2013 NOTE: Clallam, Skagit, Okanogan began providing RSS services in June 2011, Snohomish in January 2012, and Cowlitz October Mason became an active WA-CARES site in 2013.

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 23 OCTOBER 17, 2014 Recovery Support Services NOTE: Includes only RSS services provided to the 175 clients identified for this study. Total Services Provided  Number of Clients Served  Basic Needs Transportation Dental 5826 Legal 3013 RSS Assessment Financial 5628 Recovery Coordination Employment 2918 Education 2716 Medical 177 Vision 116 Pharmacy 53 Home Safety 31 Alcohol and Drug Free Activities 55 Mental Health Treatment 71 Child Care 11 Spiritual Support 22 Other  6 month Incentive 33 Average Number of Services Provided 13 Average Expenditure $1,392

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 24 OCTOBER 17, 2014 Study Design  RSS Group: 175 clients admitted to drug court during the first 2 years of WA-CARES (January 2011 – December 2012) who received recovery support services  Matched Comparison Group: 175 drug court participants admitted to drug court during the same time period who did not receive recovery support through WA-CARES Pre-Period 24 months INDEX Drug Court admission date Post-Period 12 months Demographics (Age, Gender, Race/Ethnicity) Most serious felony charge Criminal history Previous substance use disorder treatment Urban/rural county Treatment Employment Arrests and DOC Incarceration Mental Health Employment history Medicaid eligibility Basic Food Homelessness County arrest rate County unemployment rate RSS and Non-RSS similar histories and characteristics Matched based on:

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 25 OCTOBER 17, 2014 RSS recipients entered treatment sooner and spent more time in treatment  72 percent of RSS recipients entered substance use disorder treatment within 7 days, compared to 58 percent of those without RSS (p <.01)  RSS clients participated in about 133 days of treatment, compared to 95 days for those without RSS (p <.0001) Entry within 7 Days Among clients who received treatment * Days in Treatment Among clients who received treatment * 0 58% 72% p <.01 n = 123 of 172n = 87 of 151 RSS No RSS 0 n = 172n = days 95 days p <.0001 RSS No RSS *Unadjusted PRELIMINARY

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 26 OCTOBER 17, 2014 RSS recipients are more likely to become employed  Despite having similar rates of employment prior to entering drug court, RSS recipients had much higher rates of employment in the fourth quarter following admission than those without RSS (46% versus 29%) Pre-period  Post-period Quarters before and after Drug Court admission date RSS No RSS Employment Outcomes Percent with earnings by quarter  4 quarters pre- and post- Drug Court admission date PRELIMINARY

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 27 OCTOBER 17, 2014 RSS recipients were less likely to be arrested  Over the course of the 12-month follow-up period 34% of the RSS group were arrested, compared to 46% of those without RSS (p <.05)  The felony arrest rate was also lower among RSS recipients, although the difference between the two groups did not reach statistical significance Any Re-Arrest Percent with any re-arrest during follow-up * Felony Re-Arrest Percent with felony re-arrest during follow-up * n = 60 of 175n = 80 of % 34% p <.05 RSS No RSS n = 42 of 175n = 51 of % 24% n.s. RSS No RSS 00 PRELIMINARY *Unadjusted

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 28 OCTOBER 17, 2014 RSS appears to reduce the rate of incarceration  Just 5 percent of RSS recipients were incarcerated during the follow-up period, versus 19 percent of those without RSS (p <.0001)  38 percent of the RSS group were arrested or incarcerated in a Department of Corrections facility, compared to just over half (53 percent) of those without RSS (p <.01) State Prison Incarceration Rate Percent incarcerated at any time during follow-up * Any Re-Arrest or State Prison Incarceration Percent at any time during follow-up * 0 19% 5% p <.0001 n = 8 of 175n = 33 of 175 RSS No RSS 0 n = 66 of 175n = 93 of % 38% p < 0.01 RSS No RSS PRELIMINARY *Unadjusted

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 29 OCTOBER 17, 2014 In Conclusion Compared to similar drug court clients over a 12-month follow-up period we found that :  Clients who received recovery support services spent more time in substance use disorder treatment  Recovery support recipients had higher rates of employment  Rates of arrest and incarceration in a Department of Corrections facility were significantly lower for RSS recipients Findings related to WA  CARES can be found at:

W ASHINGTON S TATE D EPARTMENT OF S OCIAL AND H EALTH S ERVICES DSHS Research and Data Analysis DSHS | Research and Data Analysis 30 OCTOBER 17, 2014 Questions? FOR MORE INFORMATION Washington State Department of Social and Health Services Research and Data Analysis Division 