1.  Juvenile Drug Courts (Part II): Incentives and Sanctions Sandra J. Altshuler, Ph.D., L.I.C.S.W. Spokane County Behavioral Health Therapeutic Courts With thanks to Jacqueline van Wormer, Ph.D. Washington State University and NATIONAL COUNCIL OF JUVENILE AND FAMILY COURT JUDGES

2. Learning Objectives  Participants will review briefly the need for diversion programs for juveniles and the research on Juvenile Drug Courts (JDCs).  Participants will review and discuss proper phase structures in JDCs.  Participants will learn about JDC Incentives and Sanctions that DO and DO NOT work to promote positive behavior change in youth.  Participants will learn about contingency management (CM) and its use in JDCs for adolescent’s substance abuse and use.  Participants will learn how to develop behavior and activity contracts.

3. Can We Strengthen Our Court Sessions to Bring About Stronger Behavior Change?  What is the purpose of using sanctions in your JDC?  What is the purpose of using incentives?

4. Goal-Oriented Incentives and Sanctions  Strategy Fifteen: “Respond to compliance and noncompliance with incentives and sanctions that are designed to reinforce or modify the behavior of youth and their families”  Research:  Gendreau (1999)  NPC (2006, 2010)  Henggeler et al., (2006, 2012 (a) (b))  Salvatore et al., (2010)

5. Incentives & Sanctions, Continued  Historical CJ responses vs. modification of behavior through a coordinated and thoughtful (research informed) process  Punishment for a “wrong” is not the goal – behavior change is the goal  The JDC should use a balance of incentives, sanctions and treatment responses

6. Incentives and Sanctions, continued  Key components:  Immediate, certain, fair and of appropriate intensity  Do not rely solely on standardized “lists”  Should be proportional and balanced  Punishment alone is least effective way to change behavior  Be comfortable in combining incentives and sanctions  Be cognizant of time  Perceptions of fairness – it all begins with individualization  Make sure youth understand their positive and negative reinforcers

7. Contingency Management What is Contingency Management (CM)? And How do we strengthen the use of CM in our treatment settings, and utilize the same methods within our Juvenile Drug Courts?

8. Contingency Management “Contingency management or systematic use of reinforcement is a type of treatment used in the mental health or substance abuse fields. Patients' behaviors are rewarded (or, less often, punished); generally, adherence to or failure to adhere to program rules and regulations or their treatment plan.” (Wikipedia)

9. Reasons Why JDCs Should Implement CM  Theories are based on cognitive behavioral therapy, which has been proven to work with adolescents, and is vastly used in outpatient settings  It can be easily adapted within the JDC  In their study of six juvenile drug courts, Henggeler et al (2006) found stronger outcomes for those youth who received MST AND CM then standard process

10. Point & Level “Reward” Systems  Behavior Contract  Most Valued Privilege  Checkbook System  Reward Menu

11. Behavior Contracts  “Rewards for Responsible Behavior in Other Domains” (Henggeler et al, p. 131)  How to target specific behaviors (i.e., school attendance)  How to add a step-by-step process for the youth to follow  How to get youth working towards “things” they are interested in  How to engage families/guardians in the process  How to increase communication between the youth and judge  And …how to implement these components in your program

12. The Four Steps in Addressing Problem Behaviors  Identify (define) the targeted behavior  Identify (define) the current behavior  Identify (define) the desired behavior  Use small, achievable increments

13. Decision Matrix – Phase I Phase I IncentivesSanctions Behavior*ResponseResponse Attend school at least ?? out of 20 days Teacher signs attendance card each day present and acknowledges Small prize or coupon for each week with no absences After school study hall for each day absent over the limit to make up all missed work

14. Decision Matrix – Phase II BehaviorIncentivesSanctions *Expectation*Response Attend regularly Complete all assignments Select a book, notebook, pen after two weeks of success Praise from teacher, family, court Grades improve After school study hall to complete assignments (with help as needed)

15. Decision Matrix – Phase III Behavior IncentivesSanctions *Expectation*Response Attend regularly Complete all assignments Improve grades Praise from teacher, family, court for improvement Certificate of achievement Select school related gift: tuition, book Determine if tutor is needed Attend extra class or session for help Tighten curfew

16. Behavioral Contract Example GoalBehaviors Steps needed (Expectations) Responses if steps done Responses if steps not done Support Services Enroll in GED program Call or visit GED center by xxxxx date Praise Recognition from Team Appointment Calendar XXXXXX Increased reporting to PO Increase in curfew EM Find GED center phone number Bus pass and route Youth’s Signature of Agreement: Caregiver(s) Signature of Agreement: Case Manager’s Signature of Agreement:

17. Behavior Contract: School Work with your partner to develop a fictional behavior contract Example of a “behavioral contract” Goal Behaviors/ Tasks IncentivesNon-complianceSanctionSupport Services Improve school grades - Attend school daily - Keep a planner or homework log - Organize books/school supplies - Complete all assignments Praise Recognition Add 3 points for each day youth attends school *Recognition from teachers/team/family *Grades improve Failure to attend school/classes Failure to get a planner Failure to complete assignments Limit free time After school study hall Limit TV time/video game time *Failing/poor grade Transportation assistance Tutoring Alarm clock Health assessment Eye exam Youth’s Signature of Agreement: Caregiver(s) Signature of Agreement: Case Manager’s Signature of Agreement:

18. Most Valued Privilege  This is a privilege that the youth values and will work hard to earn  Work with the youth and family to determine what the MVP is, preferably a family-based reward (i.e., video games, cell phone use, time w/ friends)  The MVP is given or taken away with each drug screen  IMPORTANT – youth does not earn points if there is a positive drug screen but points that have already been earned are not taken away (Henggeler et al, p. 107-108)

19. Make it Transparent MVP Sally – Use of cell phone John – Curfew extension on Saturday night Mary – Allowed to use Mom’s car on Friday afternoon Jack – Ride to school, rather than walk

20. Checkbook System  Basic checkbook set up – date; transaction description; debit/credit; and balance  Basic personal checks that the youth can draft and use to purchase items on the reward menu  Make this very visual and tangible for the youth  Consider working with a local bank to provide life skills training on how to keep a checking account and write checks or to provide free checkbooks and/or personalized checks (Henggeler et al, p. 126-127)

21. Recommended Reading  Contingency Management for Adolescent Substance Abuse: A Practitioner’s Guide, by: Scott W. Henggeler, Phillippe B. Cunningham, Melisa D. Rowland, Sonja K. Schoenwald and Associates  Contingency Management in Addiction Treatment. by: Nancy L. Petry. Psychiatric Times: http://www.psychiatrictimes.com/addiction/contingency- management-addiction-treatment-0  Making Sense of Incentives and Sanctions in working with the Substance-Abusing Youth: Answers to Frequently Asked Questions (Juvenile & Family Justice TODAY. 2012, Volume 21, Number 2)  Enhancing the Effectiveness of Juvenile Drug Courts by Integrating Evidence- Based Practices (Journal of Consulting and Clinical Psychology. 2012, Vol. 80, No. 2, 264-275)

22.  Part III Themes of Effective Programs

23.  Team Approach – Good communication  Well specified target population, theory of change (targeting risk and protective factors), interventions, and training  Ongoing quality assurance (fidelity checks)  Empower caregivers to support favorable outcomes (involve the family)

24. Themes of Effective Programs  Individualized to youth/family strengths and weaknesses (not one size fits all)  Comprehensive services (individual, family, peer, school, community) provided  Use of behavioral tracking and intervention techniques such as CBT (problem solving skills, drug refusal skills) and implementation of reward/punishment contingencies  Treatment delivered in natural environment (not in out-of- home placements)

25. Contact Information Sandra J. Altshuler, Ph.D., L.I.C.S.W. Spokane County Superior Court 1116 W. Broadway Spokane WA 99203 (509) 477 6355 saltshuler@spokanecounty.org sandyaltshuler@gmail.com Ncjfcj.org