1. Presented by NPC ResearchMay 2008 Informing policy, improving programs Are Family Treatment Drug Courts Effective? Results from two studies and six sites October 2008 Scott W.M. Burrus, Ph.D. Shannon Carey, Ph.D. Mike Finigan, Ph.D. Four of the study sites were funded by the Substance Abuse and Mental Health Services Administration, Grant No. 270-02--7107

2. Presented by NPC ResearchMay 2008 2  Baltimore City: System-wide reform serving families with at least one child that has never been involved with child welfare  Harford: Single, dedicated treatment provider for the entire program.  San Diego: System-wide reform with FTDC for non-compliant parents  Santa Clara: Mostly traditional FTDC model; some systems changes  Suffolk: Neglect cases only, many children not in out-of-home placements  Washoe: Traditional FTDC model Six Sites With Different FTDC Models

3. Presented by NPC ResearchMay 2008 Sample Demographics  Samples (treatment vs. comparison) were well-matched, with very few significant differences in demographic, risk, or case characteristics  California sites had larger Hispanic populations  Suffolk site had no meth users; this was the most common drug at the other 3 national sites 3

4. Presented by NPC ResearchMay 2008 Final Study Samples 4 SiteDrug Court SystemComparison Baltimore200 Harford5326 San Diego438 (104 DC, 334 SARMS, pooled for analysis) 205 Santa Clara100 553 Suffolk117 239 Washoe 84 127 Total N=9921350

5. Presented by NPC ResearchMay 2008 Data Collection Strategies  Administrative record review Treatment, court, and child welfare records  Parent interviews (National Study only) A subset of 253 parents across the 4 sites were interviewed up to 4 times during their case These data not presented here  Qualitative parent and key stakeholder interviews and court observations  Cost data from the State of Maryland and Harford County, MD. 5

6. Presented by NPC ResearchMay 2008 MAIN QUESTION: DO FTDC’S RESULT IN BETTER TREATMENT & CHILD WELFARE OUTCOMES, COMPARED TO TRADITIONAL FAMILY COURT? Part I: Outcome Analysis 6

7. Presented by NPC ResearchMay 2008 Treatment Outcome Questions 7  Compared to parent who did not participate in the program, did parents in FTDC: Enter treatment more quickly following their child welfare petition? Spend more time in treatment? Complete treatment at a higher rate?

8. Presented by NPC ResearchMay 2008 Days to Treatment Entry 8 * Statistically significant at p<.001.

9. Presented by NPC ResearchMay 2008 Days Spent in Treatment 9 * Statistically significant at p<.001.

10. Presented by NPC ResearchMay 2008 Percent Completing at Least One Treatment 10 **Statistically significant at p<.001. *Statistically significant at p<.01.

11. Presented by NPC ResearchMay 2008 Child Welfare & Court System Outcome Questions  Did children of FTDC parents spend less time in out-of-home care?  Were children of FTDC parents reunified at a higher rate?  Were FTDC parents less likely to become involved with the CWS subsequent to their case? 11

12. Presented by NPC ResearchMay 2008 Time in Out-of-Home Placement 12 * Statistically significant at p<.001. SiteDrug CourtComparison Baltimore City mean days* N=200 252 N=200 346 Harford mean days* N=53 136 N=26 443 San Diego mean days N=824 226 N=463 232 Santa Clara mean days N=194 190 N=1,112 218 Suffolk mean days N=262 114 N=496 82 Washoe mean days* N=165 199 N=245 336

13. Presented by NPC ResearchMay 2008 Permanency Outcomes Time to permanent placement Permanency decisions: % reunification % another permanency outcome About one-fourth (24%) of children had not yet reached permanency at the end of study window: Baltimore: 35% Harford: 51% San Diego: 20% Santa Clara: 12% Suffolk:57% Washoe: 13% 13

14. Presented by NPC ResearchMay 2008 Days to Permanent Placement 14 * Statistically significant at p<.05.

15. Presented by NPC ResearchMay 2008 Percent Reunified 15 * Statistically significant at p<.05. ** Statistically significant at p<.001.

16. Presented by NPC ResearchMay 2008 Summary: Outcomes for FTDCs  Strong treatment outcomes: FTDC parents more likely to enter treatment, spend more time in treatment, and complete treatment  Longer time to permanent placement for FTDC parents could be explained by the longer treatment stays  Less time in Out of Home Placements: FTDC children spent more of this time with their parents 16

17. Presented by NPC ResearchMay 2008 Outcomes for FTDCs, cont’d 17  FTDC children were more likely to be reunified with their parents at the end of the case

18. Presented by NPC ResearchMay 2008 Part II: Black Box Analysis (National Study) How do FTDCs work? What factors influence program outcomes ? 18

19. Presented by NPC ResearchMay 2008 Unpacking the “Black Box” of Family Treatment Drug Court  Outcome analysis tells us whether FTDCs work  Analysis of parent characteristics and experiences with services can begin to tell us about how, why, and for whom FTDCs work  A preliminary look within the FTDC sample 19

20. Presented by NPC ResearchMay 2008 Conceptual Model for Understanding How FTDC Works 20 FTDC Treatment Child Welfare Outcomes Parent Characteristics Parent Characteristics

21. Presented by NPC ResearchMay 2008 Key Questions About FTDC  Key FTDC Variables: Time to enter FTDC Time spent in FTDC Number of FTDC hearings FTDC graduation  Selected Outcomes: Days in treatment, Treatment completion Reunification 21

22. Presented by NPC ResearchMay 2008 FTDC Processing Variables 22 San Diego Santa Clara SuffolkWashoe Days from petition to drug court entry 227 A 101N.A.105 Days spent in drug court 209 C 355449 B 353 Number of drug court appearances 17 (approx. 2 per month) 15 (approx. 1 per month) 31 (approx. 2 per month) 25 (approx. 2 per month) A San Diego is significantly different from Santa Clara and Washoe. B Suffolk is significantly higher than all other sites. C San Diego is significantly lower than all other sites.

23. Presented by NPC ResearchMay 2008 23 Drug Court Graduation

24. Presented by NPC ResearchMay 2008 24 VariableStatistically Significant? Nature of Relationship to Treatment Outcomes Time to FTDC entry (petition to entry) NoNo relationship Longer time spent in FTDC YesLonger stays in tx More tx completion More FTDC appearances YesLonger stays in tx More tx completion FTDC graduationYesLonger stays in tx More tx completion FTDC Experiences and Substance Abuse Treatment Outcomes

25. Presented by NPC ResearchMay 2008 FTDC Experiences and Reunification 25 VariableStatistically Significant? Nature of Relationship to Reunification Faster time to FTDC entry NoNo relationship More time spent in FTDC YesMore reunification More FTDC appearances YesMore reunification FTDC graduationYesMore reunification

26. Presented by NPC ResearchMay 2008 Key Questions  Does time to treatment entry relate to outcomes: Time spent in treatment Treatment completion Reunification  Does time spent in treatment relate to : Treatment completion Reunification?  Does treatment completion relate to reunification? 26

27. Presented by NPC ResearchMay 2008 27 Treatment Experiences and Treatment Completion VariableStatistically Significant? Nature of Relationship to Treatment Outcomes Faster time to treatment entry YesLonger treatment stays Higher rates of treatment completion Longer time in treatment YesHigher rates of treatment completion

28. Presented by NPC ResearchMay 2008 Treatment Experiences and Reunification 28 VariableStatistically Significant? Nature of Relationship to Reunification More time to treatment NoNo relationship More time spent in treatment NoNo relationship At least one treatment completion YesMore likely to be reunified

29. Presented by NPC ResearchMay 2008 Do Parent Characteristics Influence Outcomes?  Parent characteristics examined: Demographic variables History of substance abuse, mental health Child welfare history Maternal risk factors Child risk factors Psychosocial characteristics (perceived stress, perceptions of control, social support) 29

30. Presented by NPC ResearchMay 2008 Summary: Influences of Parent Characteristics 30 No strong, consistent pattern of differences for different “types” of parents

31. Presented by NPC ResearchMay 2008 How Do FTDCs Work? Summary of Findings from Quantitative Data 31 FTDCTreatment Child Welfare Outcomes Parent Characteristics Parent Characteristics Speed of Tx entry Duration of Tx Speed of Tx entry Duration of Tx

32. Presented by NPC ResearchMay 2008 Does FTDC Influence Reunification “Above and Beyond” its Effect on Treatment Completion? 32 FTDC (TX vs Control) Treatment Completion Reunification Parent Characteristics.14***.28***

33. Presented by NPC ResearchMay 2008 Part III: Qualitative Parent Interviews 33 WHAT FEATURES OF DRUG COURT MOST INFLUENCE PARENTS’ RECOVERY AND ABILITY TO MAKE PROGRESS ON THE CASE PLAN?

34. Presented by NPC ResearchMay 2008 Qualitative Parent Interviews  Brief, open-ended questions asked of 219 parents, and in-depth qualitative interviews with 30 parents  Interviews provide contextual data to facilitate the interpretation of the quantitative data  Parents’ perspective of what facilitates the drug court process 34

35. Presented by NPC ResearchMay 2008 Emotional Support  Parents talked about how the drug court team, and in particular the judge and the drug court- dedicated case workers, provide a support system. “The drug court team and the drug court case worker have helped me a lot. My first case worker, that wasn’t the drug court one, didn’t spend much time with me, but my drug court case worker always knew what was going on with me, and helped me get what I needed to get my kids back 35

36. Presented by NPC ResearchMay 2008 Accountability and Collaboration  Parents also explained how frequent hearings and attendance in drug court provided accountability for their behavior because: “the team knows what’s going on with you and you get immediate support for whatever is going on as soon as you need it.” “it’s helpful going every two weeks because things can come up during that time, and in drug court these problems are addressed quickly.” 36

37. Presented by NPC ResearchMay 2008 Accountability and Collaboration, cont’d  Frequent court attendance means that the judge and others are well informed about the parents’ cases and able to provide appropriate support for recovery and other issues facing the parent. “(attending drug court regularly) helps you feel less alone, that someone knows what’s going on in your life and the all the issues that you face, they know how to support you and what you need.” 37

38. Presented by NPC ResearchMay 2008 Practical Support Participants in drug court receive practical assistance. Parents talked about: how the drug court helped get them housing and employment, helped with life improvement needs such as tattoo removal, dentures and obtaining birth control. These practical and external supports helped to increase parents’ sense of confidence and ability to make improvements in their lives. 38

39. Presented by NPC ResearchMay 2008 Sense of Accomplishment  Parents who graduated from drug court spoke eloquently about the significance of graduation. Parents discussed how graduation from drug court gave them a sense of accomplishment, some for the first time in their life. “It (graduation) was great. Everyone applauded for me, I got a hug from the Judge, and they gave me flowers. I felt like a beauty queen. I also felt that my graduated meant that I finished something I started, and this is the first time I ever accomplished something like this in my life. Now I feel like I can succeed in life.” 39

40. Presented by NPC ResearchMay 2008 Part IV: Cost Study DO POTENTIAL SOCIETAL COST SAVINGS RESULT FROM FTDC PARTICIPATION? 40

41. Presented by NPC ResearchMay 2008 Part IV: Harford Cost Study Results 41

42. Presented by NPC ResearchMay 2008 42 Cost Study Findings

43. Presented by NPC ResearchMay 2008 Cost Study Findings 43

44. Presented by NPC ResearchMay 2008 Harford Cost Study Conclusions  Because FRC families utilized less foster care and were more likely to achieve reunification, FRC cases were less costly to the child welfare system than other CINA cases.  The total potential societal cost savings per year of Harford County FRC operation was nearly $317,000, or approximately $12,000 per served family. 44

45. Presented by NPC ResearchMay 2008 Baltimore City Cost Study Findings 45

46. Presented by NPC ResearchMay 2008 Baltimore City Cost Findings, Cont. After taking into account FRP program costs and State of Maryland alcohol and drug treatment costs:  The total net cost saving of the FRP for 200 cases is $1,004,456 or $5,002 per served family 46

47. Presented by NPC ResearchMay 2008 Putting It All Together— What Have We Learned?  FTDC’s work — Families have more positive treatment and child welfare outcomes  How FTDC’s work – Support for treatment entry, retention, and completion Combination of emotional support, accountability, and service coordination – but how these work is largely unknown  Retention of families in FTDC programs is important to success  FTDC influence on child welfare recidivism needs additional data and research  Reduced time in foster care during and after the child welfare case may result in potential cost savings of FTDC. 47

48. Presented by NPC ResearchMay 2008 For More Information: 48  The final report is posted on NPC’s website: www.npcresearch.comwww.npcresearch.com  E-mail Scott Burrus burrus@npcresearch.com  Article on an earlier phase of the FTDC study: Green, Furrer, Worcel, Burrus & Finigan (2007). How Effective Are Family Treatment Drug Courts? Outcomes from a Four-Site National Study, Child Maltreatment 12(1), 43-50.

49. Presented by NPC ResearchMay 2008 Discussion Questions 49  What are the ways that you use data as a part of your work in drug court?  Hand out of data used for FDC evaluation  How does this data overlap with what you use regularly?  What are the challenges to collecting data? Which data is most difficult for you to collect?  What are some ideas for overcoming these challenges?