1. A Team Member’s Guide to Effective DWI Court Treatment:
National Highway Traffic Safety Administration
National Center for DWI Courts
DWI Court Training
A Team Member’s Guide to Effective DWI Court Treatment:
The 7-Point Checklist
Developed by
Terrence D. Walton, MSW, CSAC
Based on the NADCP Adult Drug Court Best Practice Standards Volume 1~ Substance Abuse Treatment
NCDC: A Professional Services Division of NADCP

2. A Team Member’s Guide to Effective DWI Court Treatment
Process
Practice
Treatment
Effective

3. The Big Picture
Assess
Place
Treat

4. The Big Picture
Participants receive substance related treatment based on a standardized assessment of their treatment need. Treatment is not provided to reward, punish, or to serve other non-clinical goals. Treatment providers are trained and supervised to deliver a continuum of evidence-based interventions that are documented in treatment manuals.

5. Be Careful
Treating high-risk offenders and lower-risk offenders together is harmful
Treating non-addicts together with addicts, as well as requiring non-addicts to attend 12-step groups is likely to reduce treatment effectiveness
Treating alcohol-only users with illicit drug users may reduce treatment effectiveness

6. 7 Point Diagnostic Check
Does your program provide the full continuum of treatment services and avoid using incarceration to accomplish clinical or social service objectives?
Do participants receive a dosage and duration of treatment sufficient to achieve long term sobriety and recovery?
Review the 7 diagnostic check questions that will populate the balance of the presentation.
Read the 7 questions one-by-one, but don’t elaborate.
A “Yes” response to each of the questions is what programs should work towards.
Participants need to ask these questions of themselves regarding their treatment programs as this will give guidance as to what improvements are needed. Don’t seek answers to the questions. They are for the participants to consider and discuss in breakout or upon return.

7. 7 Point Diagnostic Check
Do participants receive regular individual clinical sessions and are they screened to determine suitability for group interventions?
Are providers proficient in delivering appropriate evidence-based treatment interventions?
Is DWI Court treatment provided by one or two treatment agencies whose practitioners are licensed/certified and who are represented in DWI Court team meetings and status hearings?

8. 7 Point Diagnostic Check
Do participants regularly attend structured peer support groups and are they prepared for those groups using an evidence-based preparatory intervention?
Do participants complete a final DWI Court phase focusing on relapse prevention/ continuing care and is there post-discharge program contact?

9. Diagnostic Check Point 1
Does your program provide the full continuum of treatment services and avoid using incarceration to accomplish clinical or social service objectives?

10. Continuum Of
Care

11. ASAM Continuum of Care Level 0.5 or I Level II Level III or IV
Early Intervention
Outpatient
Level II
Intensive OP
Day Treatment
Level III or IV
Residential
Inpatient

12. ASAM Residential Options
Level III.1
Low Intensity
Clinically Managed
Level III.3
Medium Intensity
Level lll.5
High Intensity

13. ASAM Medically-Related Options
Level III.7 (residential)
High Intensity
Medically Monitored
Level IV (inpatient)
Medically Managed
Opioid Maintenance Therapy
Methadone
Buprenorphine

14. ASAM Medically-Related Options
Participants do not receive punitive sanctions or augmented sentence if they fail to respond when treated at a level substantially below the level they are assessed to need.

15. Incarceration
Is Not A
Level of Care

16. Participants are not incarcerated to achieve clinical or social service objectives such as obtaining access to detoxification services or sober living quarters.

17. In Custody Treatment Cost effectiveness is reduced by as much as 45%
Most studies report minimal gains from in custody treatment
In custody treatment will rarely serve the goals of treatment effectiveness or cost effectiveness
Cost study- Carey 2012

18. Diagnostic Check Point 2
Do participants receive a dosage and duration of treatment sufficient to achieve long term sobriety and recovery?

19. Treatment Dosage and Duration
Best results if treatment last at least 9 to 12 months (with at least 200 hours of counseling)
6 to 10 hours of counseling weekly in the initial phase
DWI Courts publish anticipated treatment dosage and duration. Be flexible and allow for differences in treatment response
Cost study- Carey 2012

20. Diagnostic Check Point 3
Do participants receive regular individual clinical sessions and are they screened to determine suitability for group interventions?

21. Treatment Modalities
At least one individual session per week in first phase
Participants screened for group intervention suitability
Evidence-based group assignment criteria utilized, such as gender, trauma histories, co-occurring psychiatric symptoms
Treatment groups have no more than twelve participants and two facilitators
Cost study- Carey 2012

22. Diagnostic Check Point 4
Are providers proficient in delivering appropriate evidence-based treatment interventions?

23. Evidence-Based
Treatment

24. Outcomes Improve When…
Participants receive behavioral or cognitive-behavioral interventions
Interventions are carefully documented in treatment manuals
Providers are trained to deliver the intervention consistent with the manual
Fidelity to the treatment model is maintained through continual clinical oversight

25. Skill Building & Practice
Effective Practices
Incentives
and Sanctions
Manuals
Relapse
Prevention
Skill Building & Practice
Treatment
Behavioral
Cognitive

26. Effective Practices
Cognitive
Behavioral
Treatment

27. Effective Practices RPT= Relapse Prevention Therapy
MRT
R & R
T4C
Matrix
RPT= Relapse Prevention Therapy
R&R= Reasoning and Rehabilitation
MRT= Moral Reconation Therapy
T4C= Thinking For a Change
Matrix= The Matrix Model (for stimulant treatment)

28. Sources of Information
Good
Treatment
Drug
Alcohol
Better
Drug/DWI Courts
Offender

29. Sources of Information
Lots
Treatment
Drug
Alcohol
Some
Drug/DWI Courts
Offender

30. A Big Resource
National Registry of Evidence-Based Programs and Practices
Teacher should go to this site at this point and walk participants through how to use it. Teacher should familiarize him or herself with the site in advance so that they navigate it smoothly for the participants.
Includes hundreds of approaches that were submitted for expert review and each was rated and determined whether it could be registered as an evidence based practice. Information regarding the intervention, as well as the nature and strength of the evidence supporting it is outlined.
Not all evidence-based practices are included in this registry, but it is appropriate starting point when looking for EBP.
The best way to know if you are using evidenced-based approaches is if you find them in NREPP and see that that intervention achieved the outcomes in which you are interested on a population demographically similar to yours.

31. Medications

32. Medications
Medically assisted treatment improves outcomes, including buprenorphine, methadone, naltrexone/Vivitrol
Participants are prescribed psychotropic or addiction medications based on medical necessity by a treating physician with related expertise
DWI Court discourage participants from obtaining mood altering medications from general practitioners
Cost study- Carey 2012

33. PROFICIENCY

34. Establishing Proficiency
Even an otherwise experienced and qualified practitioner may not be proficient in delivering a specific evidence-based intervention

35. Establishing Proficiency
Developing proficiency in an EBI requires:
Ready and ongoing access to the intervention manual
A minimum of three days of pre-implementation training
Periodic booster sessions
Monthly individualized supervision and feedback

36. Diagnostic Check Point 5
Is DWI Court treatment provided by one or two treatment agencies whose practitioners are licensed/certified and who are represented in DWI Court team meetings and at status hearings?

37. TrEATMENT
PROVIDER
INVOLVEMENT

38. Team Representation
One or two treatment agencies are responsible for delivering services
Clinically trained representatives of these agencies attend staffings and hearings
Cost study- Carey 2012

39. Why is Few Better
Than Many?

40. Courts That Used One or Two Primary Treatment Agencies Had 76% Reductions in Recidivism
Note: Difference is significant at p<.05

41. Courts That Used a Single Treatment Agency had 10 Times Greater Savings
Note: Difference is significant at p<.05

42. Team Representation
If more than two agencies provide services, cross-agency communication protocols must be established
Cost study- Carey 2012

43. Qualified
practitioners

44. Treatment Providers are licensed or certified to deliver treatment services, have substantial experience with CJ populations, are supervised to ensure fidelity to evidence-based practice

45. Diagnostic Check Point 6
Do participants regularly attend structured peer support groups and are they prepared for those groups using an evidence-based preparatory intervention?

46. Peer support/
Self help
groups

47. Peer Support Participants regularly attend peer support groups
The peer support groups utilize a structured format, such as 12-step or SMART Recovery
Before beginning peer support groups, providers use an evidence-based preparatory intervention, such as Twelve Step Facilitation Therapy
Cost study- Carey 2012

48. What about coerced AA participation?
There are two critical reasons to be careful when mandating 12 step group participation
Legal precedent indicates clearly that if participants or potential participants object to 12 step participation because of it’s religious content, secular alternatives must be made available. (This is discussed in an earlier presentation during the Operational Tune up Training). It is only objections made on religious grounds that must be accommodated.
While mandated support group attendance can be effective in introducing clients to these groups, with out active involvement, these groups are unlikely to be effective. It is more difficult to mandates active involvement (e.g., listening to a sponsor, doing service work, getting honest during groups, etc.) Programs should seek ways to incentivize active involvement.

49. “Simply attending self-help groups is not sufficient to achieve successful outcomes. Sustained benefits are more likely to be attained if participants engage in recovery-relevant activities such as developing a sober-support social network, engaging in spiritual practices and learning effective coping skills from fellow group members. Because it is very difficult for DWI Courts to mandate and monitor compliance with these types of recovery activities, they must find other means of encouraging and reinforcing participant engagement in recovery-related exercises.”
Insert statement is quoted from the Drug Court Standards page 45.

50. Provide secular alternatives when mandating 12-Step groups
There is solid legal precedent establishing that programs must not penalize or deny participation to individuals who refuse to attend 12-step groups because of religious content (e.g. prayers, references to “God” in 12 steps). For such individuals, comparable secular alternatives must be offered. Smart recovery is a secular alternative that has a few in-person meetings and many telephone:

51. Diagnostic Check Point 7
Do participants complete a final DWI Court phase focusing on relapse prevention/continuing care and is there post-discharge program contact?

52. Continuing Care
Participants complete final phase focusing on relapse prevention and continuing care
Participants complete a continuing care plan with counselor
For at least 90 days post discharge, treatment providers or clinical case managers attempt to contact the participant to check on progress, offer brief advice or encouragement, and provide referrals for additional services
Cost study- Carey 2012

53. Treatment Oversight Seek objective, non-biased clinical expertise
Establish performance standards and measures (process & outcome)
Review clinical documentation
Conduct on-site observation
Talk (and listen) to counselors directly delivering the treatment services
Conduct client interviews or focus groups
Seek additional training and technical assistance when needed

54. A Team Member’s Guide to Effective DWI Court Treatment:
National Highway Traffic Safety Administration
National Center for DWI Courts
DWI Court Training
A Team Member’s Guide to Effective DWI Court Treatment:
The 7-Point Checklist
Developed by
Terrence D. Walton, MSW, CSAC
Based on the NADCP Adult Drug Court Best Practice Standards Volume 1~ Substance Abuse Treatment
Use the analogy of the promise the CarMax makes in describing what it takes to become a CarMax used car. They all undergo a rigorous inspection. They boast that only 1 in 3 used cars can become a CarMax car. We should make no less of a commitment to drug court treatment.
NCDC: A Professional Services Division of NADCP