1. The King County Family Treatment Court: What is it
The King County Family Treatment Court: What is it? What Have We Learned from our Evaluation?
University of Washington Education Series for Child Welfare Professionals
April 11, 2012
Eric Bruns
Mike Pullmann
Ericka Wiggins
University of Washington School of Medicine
Division of Public Behavioral Health and Justice Policy
Jill Murphy
Aubrey Glines
King County Family Treatment Court
King County Superior Court 1

2. Substance Abuse and Child Welfare
80% of children in foster care have a parent with a substance abuse problem
Parents with substance problems have the lowest rate of reunification with their children
Their children stay in foster care over twice as long on average
Initiation of treatment takes an average of 4-6 months after entry to CW system

3. The need for a solution Treatment completion is associated with:
Less time in foster care
Reunification rates
More rapid treatment entry and longer treatment duration is associated with:
Treatment completion
Treatment success

4. Drug Courts
Interdisciplinary, coordinated, team-based approach to avoiding future involvement in (criminal) justice system
As of 2010: 2,459 drug courts in U.S.
Number increased by 50% from 2004 – 2010
Seven meta-analyses
Rigor of studies often lacking; however, positive effects found
Positive treatment outcomes
Reduced re-arrest

5. Family Treatment Drug Courts
Apply drug court approach to cases of child abuse and neglect
Goal = enhance possibility of family reunification within legal timeframes by:
Facilitating entry and completion of treatment
Supporting parent to remain abstinent
Improving child safety/family functioning
As of 2009, NADCP reports 322 FTDCs
13% of all drug courts in U.S.
Increase of 66% from 2005

6. Today’s presentation The King County Family Treatment Court
Goals
Population of focus
Program description
Case flow process
What we have learned from an evaluation
Process evaluation
Outcome evaluation

7. The King County Family Treatment Court
Jill Murphy
KCFTC Program Supervisor
Aubrey Glines
KCFTC Graduate

8. KCTV Video

9. King County FTC Primary Goals
Children have safe and permanent homes within permanency planning guidelines;
Families of color have outcomes from dependency cases similar to families not of color;
Parents are better able to care for themselves and their children and seek resources to do so; and
The cost to society of dependency cases involving substances is reduced. 9

10. The King County Family Treatment Court
KCFTC PROCESSES AND FUNCTIONS
Comprehensive SB Assessment
High quality, appropriate CD Services
Timely/effective MH and other services
Effective care planning and management
Expanded and more frequent visitation
Consistent, timely incentives & sanctions
Random UA Screens
Effective pre-hearing case conferences
Effective judicial interaction
SHORT-TERM OUTCOMES
Eligibility/enrollment completed quickly
Enrollment in appropriate CD services
Parents compliant with/complete treatment
Parents ultimately able to remain sober
Parents/children more fully engaged in svcs
Parents/children receive needed services
Decreased placement disruptions
Parents compliant with court orders
Less negative effect on child well-being
Less disruption of child-parent bonds
Increased family reunification rates
Earlier determination. of alternate placement options
NATIONAL BEST PRACTICES
Communication bw Court and providers
Judge plays active role in Tx process
Judge responds to positive & noncompliant beh.
Mechanisms for shared decision making
Accountability for Tx services
Strategy for responding to noncompliance
MIS allow data to be assembled/reviewed
Enhancement of due process
Team members provided adeq resources 10

11. Population Focus Up to 60 children at a time, whose parent(s):
Admit to the court that his/her child is dependent or have an existing dependency finding
Are chemically dependent and willing to go to treatment;
Are at least 18 years of age;
Sign a Consent to Release Confidential Information Form so that the team may share information with other team members and outside community providers;
Have no felony child abuse or sexual abuse guilty findings; and
Applications/referrals to FTC must be received no later than six months from the date of dependency petition.

12. KCFTC Program Model
Parents agree to enter a more intensive court process
Expectation = 12 mos – 2 years duration
Case management to ensure connection to appropriate chemical dependency treatment
Cross-disciplinary pre-hearing staffings to present a unified approach at hearings
Case review hearings every other week until frequency can be stepped down
Treatment Liaison who monitors parent’s progress in CD and MH treatment and provides case management
Formal Wraparound Process for approx 1/3 of families (15 at a time)
Social Workers dedicated to the FTC with reduced caseloads (12:1)

13. KCFTC Team Members Judge Assistant Attorney General
Parent’s Defense Attorney
Child’s Attorney
Treatment specialist/ Treatment liaison
Treatment provider
Court Appointed Special Advocate (CASA)
Wraparound coordinator
DCFS Social Workers
FTC Program Supervisor
FTC Program Court Specialist
Family members/friends
Family support providers

14. Juvenile Dependency Case Flow (noting FTC)
Placement in
Shelter Care
Dependency
Petition Filed
Shelter Care Hearing ( w / in 72
hours of place -
ment or filing ,
whichever
occurs first )
Pre
Trial
Conference 21
days prior to
fact
finding
Fact
Finding
Hearing 75
days
of filing
Disposition
same day as or w 14
days of dep finding
Review Hearing
the sooner of 90
from Dispo . or 6
mos
from date of placement
Permanency
Planning Hearing 12
months from date of
placement
&
every
months thereafter
months after
permanency planning
hearing
Petition
Approved
Continued
Exit System
Yes
Goal Achieved ?
Petition for
Parental Rights
Termination No
Termination of
Filed
Dismissed 30
Day Shelter
Care Review
days of
Case Conf
Dept
supervision
continues for
Child
returned
home
Review
Dependency Stipulated
Enter FTC*
(See separate flow chart)
Exit FTC w/o Permanency Goal Achieved
Original Chart prepared by Michael Curtis on January 12, 2006
*There can be entry into FTC anytime after dependency is established as long as a referral is made to FTC within 6 months of the filed petition date. 14

15. FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART
Other FTC Hearings:
Check In Hearing: Set for following week after positive/missed UA or noncompliance w/ tx
Compliance Clock Hearing: Can be applied after 5th response and set 60 days out from current hearing
Motion Hearing: Can be set anytime there is a contested issue. Not heard during regular FTC calendar
Box Color Legend:
Red: Not a hearing
Green: Beginning and end of FTC Process
Blue: FTC Review Hearings
Graduated Blue: Does not occur on every case
Orange: Not unique to FTC
Purple: Unique to FTC and can occur throughout FTC process
Discharge/Opt Out Hearing: Dependency dismissed or discharged to regular dependency
FAMILY TREATMENT COURT CASE PROCESSING FLOW CHART 15

18. Evaluation of the King County Family Treatment Court
Division of Public Behavioral Health and Justice Policy
University of Washington School of Medicine
UWHelpingFamilies.org

19. Needs for the Evaluation
Provide information needed by the KCFTC and its stakeholders
Expand the research base on FTDCs
Do FTDCs achieve their stated goals and outcomes?
Do they contribute positively to federal priorities for CW systems?
Do common criticisms of drug courts apply to FTDCs?
Widening the net of involvement in justice system
Mandate longer involvement in justice system
Limit access to or completion of treatments
Not cost effective

20. Summary of the FTDC Literature
Four studies of FTC model (Boles et al., 2007; Edwards et al., 2005; Green et al., 2007, 2009; Worcel et al., 2008;)
All four studies show positive outcomes:
Parents enrolled in treatment more quickly
Parents received treatment services for a longer mean duration
Parents were more likely to successfully complete treatment
Children placed in permanent living situations more quickly
Children more likely to be reunified (e.g., 42% vs. 27% at 2 years; 70% vs. 45% at 3-4 years)
No study found between-group differences in future abuse/neglect reports

21. Summary of the FTDC Literature
NPC Research, the most active evaluators of FTCs and drug treatment courts, has completed several cost-benefit analyses at sites across the nation. The table below summarizes their findings:
Location
Cost savings per participant
Return on investment
Areas of savings
Harford Co., MD
$12,000 over 1 year
350%
Foster care days, Criminal justice, Court Cases
Jackson Co., OR
$5,593 over 4 years
106%
Foster care days, Probation/Parole, Court Cases
CA "Court 1"
$1,657 over 4 years
130%
Not provided
CA "Court 2"
$2,141 over 5 years
Baltimore, MD
$5,022 over 1 year
Foster care days (did not examine other areas)

22. Components of the KCFTC Evaluation
Process evaluation
Interviews with team members and stakeholders, 2006 and 2008
Parent interviews,
Outcomes evaluation
Analysis of child placement data from Children’s Administration and adult treatment data from the Division of Behavioral Health and Recovery
Cost-benefit analysis
Currently underway 22 22

23. Respondents Advisory Group Member 8 21% 5 14%
Respondent Type N %
Advisory Group Member 8
21% 5
14%
DSHS Social Worker/Social Worker Supervisor
13%
Court Appointed Special Advocate (CASA)/CASA Manager or Supervisor 7
18% 4
11%
Attorney (Parent or Child) 6
15%
16%
Judge 2 5% 3 8%
UW PCAP Representative 1 3%
AAG /AAG Supervisor
Treatment Provider/Treatment Provider Superv.
10%
FTC Coordinators/Specialists
Wraparound staff/supervisors
Other (e.g., Bailiff, Alumni)

24. 2006: Mean= 3.4 Std. Dev= .793
2008: Mean= 3.73 Std. Dev= .693

25. 2006: Mean= 5 Std. Dev= 1.4
2008: Mean= 5.47 Std. Dev= 1.36

26. Summary of Major Questions Means

27. Summary of Process and Function Questions Means
A little bit
successful
Somewhat
Successful
Moderately
successful
Extremely
successful

28. What we learned from process evaluation
Strengths
Strong opinions about the positive impact of KCFTC
Most processes and functions viewed as successfully being accomplished by 2008
Relative Weaknesses
Respondents less confident that goal of serving a representative population was being met
Respondents believed client load was less than optimal (serving too few families)
Mixed opinions on the amount of shared vision among team members
Certain processes and functions:
Efficiency of eligibility determination and intake
Consistency and effectiveness of incentives and sanctions
Resources and training for KCFTC staff and team members 28 28

29. Outcome Evaluation: Research Question 1
When compared to comparable non-FTDC participants, do FTDC participants differ in terms of their experience with the court and treatment system?
Hypotheses – FTDC participants would:
Have more court hearings;
Enter treatment more often;
Enter treatment more quickly;
Attend treatment sessions more consistently;
Receive more treatment events;
Receive a broader treatment array;
Remain in treatment longer; and
Successfully discharge from treatment more often.

30. Research Question 2
When compared to children of non-FTDC participants, do children of FTDC participants demonstrate more positive child welfare outcomes?
Hypotheses – KCFTC children would:
Spend less time in out-of-home placements;
Reunify with their parents more often;
Get placed in permanent living situations more quickly; and
Have fewer subsequent child welfare investigations and founded investigations

31. Research Question 3
Do families of color have outcomes similar to families not of color?
Treatment outcomes
Child welfare outcomes

32. Outcome Evaluation Administrative data: Family Treatment Court group:
Treatment data from Division of Behavioral Health and Recovery
Child welfare data from Children’s Administration
Hearing data from King County Superior Court
Data collected September 2010
Family Treatment Court group:
Selected all parents admitted to the FTC between March 2006 and October 2009
Comparison group:
Eligible parents referred but not admitted to the Family Treatment Court
Randomly selected a reasonable number
Statistically matched (propensity score methods) on caregiver age and race, number of prior child welfare investigations, whether parent was in treatment at petition, number of prior treatment episodes, and primary drug of choice

33. Reasons why parent is in comparison group
Percent
Attorney not responding
42%
Over 6 months without referral
18%
Chose not to participate 8%
No known address/can’t locate/on run 7%
Other
Reason missing
17%

34. Parent demographics Total # of parents = 268 Parent mean age
Comparison = 182
KCFTC = 76
Parent mean age
Comparison = 31
KCFTC = 31
Mean # of children per participant
Comparison=1.39
KCFTC = 1.46
Detail: specific race/ethnicity
Note: no significant differences

35. Prior Investigations Comparison % or Mean (SD) KCFTC %
Any investigation completed prior to petition
83%
79%
Type of Allegation (index petition)
Neglect
77%
Abuse
36%
Prenatal Injury 8% 9%
Medical Neglect 7%
Abandonment 2% 3%
Number of investigations prior to petition
2.1 (2.1)
1.8 (2.3)
Note: No statistically significant differences

36. Note: Statistically significant difference for Native American
Child demographics
Number of children
Comparison = 235
KCFTC = 89
Child Mean Age
Comparison = 4.2
KCFTC = 3.5
Note: Statistically significant difference for Native American

37. Status of FTC parent at time of data collection
Discharged
33%
Graduated
26%
Currently enrolled
22%
Opted out of program
11%
Certificate of participation 7%
Dismissed 1% 37

38. Note on Analytic Approach…
1). “Intent to treat”
All parents who were admitted to FTC were included in all analyses, even if they opted out or had an unsuccessful outcome.
No parent who was ever in FTC was ever included in the comparison group
2). Index Petition Date
“Time Zero” or comparable start point for both groups was the petition date, not date of entry into FTC (comparison group had no date of entry)
These decisions likely result in more conservative findings

39. Question 1: Do FTC participants have different treatment and court experiences than comparable non-FTC parents?
Do they experience more court hearings?
Are they more likely to enter treatment?
Do they enter treatment more quickly?
Are they more likely to attend treatment?
Do they remain in treatment longer?
Are they more likely to be successfully discharged from treatment?

40. FTC parents have more court hearings
11 months post petition (mean follow up time for overall sample):
FTC: mean 16.1 (SD = 4.8) hearings
Comp: 5.9 (2.4)
(p<.001)
Review hearings were 4.5 times more frequent for FTC (accounted for 75% of all FTC hearings)

41. FTC parents are more likely to enter treatment
FTC parents were 63% more likely to be admitted to treatment.
Note: All differences statistically significant

42. FTC parents enter treatment three times as fast
Of those parents entering treatment who were not already in treatment at the index petition, the median days until treatment entry were:
Comparison: 120
KCFTC: 36
Proportion not admitted
Note: Statistically significant difference, p < .001

43. FTC parents received broader service array
Of those admitted to any treatment
Comparison
(n=52)
KCFTC
(n=68)
Long term Residential*
46%
65%
Intensive Outpatient
40%
56%
Outpatient
50%
Intensive Inpatient
44%
35%
Methadone
23%
27%
Recovery House* 2% 9%
Housing Support 8% 3%
* Statistically significant difference, p < .05

44. FTC parents received broader service array
Of those who received any treatment
Comparison
(n=44)
KCFTC
(n=64)
Individual therapy*
89%
100%
Group therapy
90%
97%
Case management
81%
Urinalysis
43%
52%
Methadone/opiate subst.
15%
25%
Childcare*
11%
* Statistically significant difference, p < .05

45. FTC parents received more treatment but were not significantly more likely to attend treatment
Avg. # of treatment events per person who received treatment:
KCFTC = 116 (SD=97)
Comparison = 51 (SD=57)
Note: Statistically significant difference, p < .05
Comparison
n=6,188
FTC
n=8,357
Attended treatment episode
88%
90%
Excused by provider 6% 4%
No show, unexcused 8%
Note: Not statistically significant difference, p =.40

46. FTC parents remain in treatment longer (Of those entering treatment; N=110)
Of those parents who entered treatment, the median days in treatment were:
Comparison: 44
FTC: 109
Note: Statistically significant difference at beginning and middle, p < .05

47. Note: Statistically significant differences, p < .05
Success in treatment
FTC parents remained in treatment twice as long (median of 109 days compared to 44)
FTC parents 37% more likely to be successfully discharged from treatment (72% compared to 54%)
Note: Statistically significant differences, p < .05

48. Question 2: Do FTC families, compared to similar families who did not receive FTC services, have more positive child welfare outcomes? Specifically:
Do the children of FTC participants spend less time in out of home placement?
Are the children of FTC participants placed in permanent living situations more quickly overall?
Are FTC children more likely to have a permanent placement?
Are FTC participants less likely to have subsequent CPS investigations?

49. FTC children spend less time in out-of-home placements
Median days in out of home placement:
Comparison: 689
FTC: 476
Note: Statistically significant difference, p < .05

50. Note: Statistically significant difference, p < .05
FTC children end involvement with the child welfare system more quickly
Median days until permanent placement:
Comparison: 813
FTC: 718
Note: Statistically significant difference, p < .05

51. Child Welfare Outcomes At end of study window
FTC children spent 30% less time in out-of-home placements
median of 476 days, compared to 689
FTC children spent 20% less time in the child welfare system
median of 718 days, compared to 813
FTC children 43% more likely to have a permanent placement
61% compared to 43%
Note: Statistically significant differences, p < .05

52. Placement types/Reunification At end of study window
FTC children 2.5 times more likely to return to the custody of their parent (27% compared to 11%)
FTC children half as likely to be in an out of home placement (24% compared to 46%)
FTC children 1.9 times more likely to be returned home (in parental custody, reunified, trial home visit; 55% compared to 29%)
Note: Statistically significant differences, p < .05

53. Note: Not statistically significant difference
Subsequent child welfare investigations: All parents At end of study window
Note: Not statistically significant difference

54. Subsequent child welfare investigations: Only parents with child returned home
At end of study window
p=.09
p=.13

55. Note: Not statistically significant difference
Subsequent child welfare investigations: All children At end of study window
Note: Not statistically significant difference

56. Subsequent child welfare investigations: Only children who returned home
At end of study window
Subsequent removals: 3% for FTC group (n=1) vs. 13% for Comparison (n=3); p=.13

57. Findings similar to other FTDC studies
Current Study
Ashford, 20041
Boles et al., 2007
Green et al., 2007
Worcel et al., 2008
Burrus et al., 2011
% Enrolled in treatment
FTDC
Comp.
84%
57%
97%
67%
56%2
89%
69%
82%
59%
Mean days until treatment entry 63 99 73
182 84
122 57 88
Mean days in first treatment
142 96
893
1143
303
184
306
148
138 82
% completed treatment
72%
54%
48%
31%
64%2
44%
34%
65%
33%
64%
36%
% children reaching permanency
61%
43%
35%
38%
Mean days until permanency
475
502
251
341
359
435
288
228
249
325
% children reunified
55%
29%
52%
42%
27%
32%
39%
70%
Subsequent founded investigation4
28%
23%
15%
Subsequent removal from home5 3%
13%
46%
50%
11%

58. Question 3: Do families of color have outcomes similar to families not of color?

59. Question 3: Do families of color have outcomes similar to families not of color?

60. Admitted to treatment through DBHR after petition All parents
Parent white
Parent of color
Parents of color did not differ from white parents in their likelihood to:
Be in treatment when petition was filed
Be admitted to treatment after petition
Schedule treatment episode after petition is filed
Note: No statistically significant differences 60

61. Note: White-white, p < .05
Median days until treatment entry Of those not in treatment at petition
Parent white
Parent of color
Parent white
Parent of color
Note: White-white, p < .05
POC-POC, p < .10 61

62. Median days in first treatment
Parent white
Parent white
Parent of color
Note: White-white, p < .05
POC-POC, p < .10
FTC: POC-White mixed
Parent of color 62

63. Length of time in first treatment episode
Of those parents entering treatment, the median days in first treatment episode:
Comparison, parent of color: 43
Comparison, white: 53
KCFTC, parent of color: 77
KCFTC, white: 151
Note: No statistically significant differences 63

64. No other significant differences
Percentage successfully completing a treatment episode Of those receiving treatment
Parent of color
Parent white
Parent of color
Parent white
Note: POC-POC p < .05
No other significant differences 64

65. Percentage of children with permanent placements
Child white
Child of color
Child white
Child of color
Note:
All: Comp-FTC p < .05
No other significant differences 65

66. Percentage of children remaining in out of home placement
Child white
Child of color
Note:
All: Comp-FTC p < .05
FTC: COC – Child white, p < .10
No other significant differences
Child white
Child of color 66

67. Comparing FTC to regular court for families of color
Generally indicate that families of color in FTC had more positive outcomes than families of color in the comparison group
61% more likely to enter treatment
Enter treatment 63% faster
Remain in treatment nearly twice as long
49% more likely to complete treatment
Children 39% more likely to be permanently placed
Children 54% more likely to be returned home

68. Comparisons by race in FTC
Parents of color in the FTC were not significantly different than white parents on:
Percentage admitted to treatment
Speed of admission to treatment
Percentage successfully completing treatment
Parents of color spent less time than white parents in treatment
Children of color might be more likely to remain in out-of-home placements (borderline significance)

69. Outcome Study Summary
The King County Family Treatment Court is one of a variety of problem-solving courts
Staff from several disciplines and agencies collaborate on supervision and support
Stakeholders generally have positive opinions about the development and functioning of the court
Parents have more successful substance use treatment outcomes
Children are more likely to exit the child welfare system and be returned to the care of their parents
Other research with similar findings to our research also found significant long-term cost savings

70. Internal vs. External costs and benefits
Overall costs/benefits to society
County government
State government
Federal government
Participants
Citizens and communities
Family Treatment Court
Child Welfare
DSHS (treatment)
External benefits  underproduction of the service (i.e. too little Family Treatment Court)
External costs  overproduction of the service

71. Substance Use and Mental Health treatment
Justice System
Dependency court hearings
Adult contacts with law: prison, jail, criminal hearings, probation, etc.
Child contacts with law: prison, jail, criminal hearings, probation, etc.
Damages to victims
Others
Employment
Education
Physical health care
Public assistance
Child Welfare
Placements
Caseworker time
Caregiver-child visitations
Costs and Benefits
Substance Use and Mental Health treatment
DSHS-provided treatment services
Private pay or insurance treatment services
Non-monetary costs
Emotional pain from loss of child/parent
Broken communities
Emotional pain to victims 71

72. Please contact us with any questions
Eric Bruns
Mike Pullmann
Mark Wirschem
Jill Murphy