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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
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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
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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
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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
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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
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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
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The King County Family Treatment Court
Jill Murphy KCFTC Program Supervisor Aubrey Glines KCFTC Graduate
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KCTV Video
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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
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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
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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.
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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)
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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
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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
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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
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Evaluation of the King County Family Treatment Court
Division of Public Behavioral Health and Justice Policy University of Washington School of Medicine UWHelpingFamilies.org
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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
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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
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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)
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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
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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)
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2006: Mean= 3.4 Std. Dev= .793 2008: Mean= 3.73 Std. Dev= .693
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2006: Mean= 5 Std. Dev= 1.4 2008: Mean= 5.47 Std. Dev= 1.36
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Summary of Major Questions Means
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Summary of Process and Function Questions Means
A little bit successful Somewhat Successful Moderately successful Extremely successful
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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
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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.
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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
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Research Question 3 Do families of color have outcomes similar to families not of color? Treatment outcomes Child welfare outcomes
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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
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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%
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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
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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
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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
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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
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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
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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?
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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)
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FTC parents are more likely to enter treatment
FTC parents were 63% more likely to be admitted to treatment. Note: All differences statistically significant
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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
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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
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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
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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
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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
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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
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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?
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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
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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
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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
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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
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Note: Not statistically significant difference
Subsequent child welfare investigations: All parents At end of study window Note: Not statistically significant difference
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Subsequent child welfare investigations: Only parents with child returned home
At end of study window p=.09 p=.13
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Note: Not statistically significant difference
Subsequent child welfare investigations: All children At end of study window Note: Not statistically significant difference
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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
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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%
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Question 3: Do families of color have outcomes similar to families not of color?
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Question 3: Do families of color have outcomes similar to families not of color?
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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Please contact us with any questions
Eric Bruns Mike Pullmann Mark Wirschem Jill Murphy
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