improving outcomes presentation co final final · reported in this presentation regional...

4/10/2012

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National Family Drug Court Technical Assistance and Training Program

Taking Your Problem Solving Court to Scale:g

Increasing and Expanding

the Families Served

April 10, 2012

P t d b

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This project is supported by Award No. 2009-DC-BX-K069 awarded by the Office of Juvenile Justice and Delinquency

Prevention, Office of Justice Programs

Presented byPhil Breitenbucher, MSW

Children and Family FuturesThe Mission – to improve the lives of children and families,

particularly those affected by substance use disorders.

C l i h i d i id

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• Consults with government agencies and service providers to ensure that effective services are provided to families

• Advises Federal, State, and local government and community-based agencies, and conducts research on the best ways to prevent and address the problem

• Provides comprehensive and innovative solutions to policy makers and practitioners

National Center for Substance Abuse and

Child Welfare

National Center for Substance Abuse and

Child Welfare

Children In-depth

Children and Family

Futures

Affected by Meth

Technical Assistance

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FuturesOffice of Juvenile

Justice and Delinquency Prevention

Office of Juvenile

Justice and Delinquency Prevention

Regional Partnership

Grants

Regional Partnership

Grants

TitleNCSACW In-Depth Technical Assistance Sites (IDTA)Children Affected by Methamphetamine Sites (CAM)

Children’s Bureau Regional Partnership Grants (RPG)OJJDP Family Drug Courts (OJJDP)

NCSACW IDTA(20 Sites)

NCSACW CAM (12 Sites )OJJDP Grantees

(30 Sites)

Array of Services (11)

Child Focused (8)

Drug Courts (10)

System-Wide Collaboration (9)

Treatment Focused (9)

Tribal (6)

RPG Sites (53 Sites)

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The Past

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How did the FDC movement get here? Why the rapid growth? What happened?

The Birth of the FDTC Movement

• First FDTCs convened in Reno, Nevada and Florida in 1994 1995Florida in 1994 -1995– Judges Charles McGee (NV) & John Parnham (FL)

– Judges Pach (NY), Edwards (CA), Milliken (CA), Cohen (FL), Ray (OH), Thomas Merrigan (MA) and Commissioner Molly Merrigan (MO)

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• First FDCs took concepts developed in criminal and then juvenile drug courtscriminal and then juvenile drug courts applying a collaborative approach to therapeutic jurisprudenceThe “study of the role of the law as a therapeutic agent.” It focuses on the law’s impact on emotional life and on the psychological well-being of the individual – the impact on the “whole person.”

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David Wexler – Therapeutic Jurisprudence: An overview. Paper delivered to the National Institute of Mental Health in 1987. Along with Professor Bruce Winick, University of Miami School of Law, who originated the concept with Wexler.


“The family drug court although similar to theThe family drug court, although similar to the adult drug court in terms of services and protocols, usually focuses on the "best interests of the child”…and this focus is the court's paramount consideration in responding to the progress -- or lack thereof -- of the p gparent.”

Caroline S. Cooper, Coordinator, 1995 SJI National Symposium on the Implementation & Operation of Drug Courts; and Director, OJP Drug Court Clearinghouse and Technical Assistance Project School of Public Affairs/American University June 2000 8

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• Focused on early intervention and treatment based on a comprehensive needsbased on a comprehensive needs assessment and case plan

• Client and system accountability for compliance through frequent court appearances

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The FDTC Movement

# of FDCs

153

321

150

200

250

300

350

1040

0

50

100

1999 2001 2005 2010

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Family Drug Courts ‐ NationwideNew York ‐ 55

California ‐ 56

Florida ‐ 22

1‐5 6‐10 11‐19

Zero DDCs reported

20 +Source: National Drug Court Institute (NDCI) Survey, 2010

Total – 322 FDCs

Common VisionExtraordinary Effort

Three SystemsThree Systems with multiple:• Mandates• Training • Values• Timing

Drug Treatment

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Timing • Methods

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New Partnerships, Creative Approaches

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The need for immediate and efficient intervention became overwhelming important in the face of implementing the Adoption and Safe Families Act

Implications of ASFA (1997)

• Adoption and Safe Families Act, enacted in 1997 sought to address:1997 sought to address:- Cases lingering in the court system as

parents cycled in and out of treatment- Children left in foster care for months or

even years – (aka foster care drift)E h i t bli hi ithi• Emphasis on establishing permanency within federally mandated timeframes

• Created a need to find effective responses to substance abuse and child maltreatment within families 14

Blending Perspectives and Building Common Ground

• Report to Congress in response to the Adoption and Safe Families Act (AFSA) 1999Adoption and Safe Families Act (AFSA) 1999

• Five National Goals established1. Building collaborative relationships2. Assuring timely access to comprehensive

substance abuse treatment servicesI i bilit t d t i3. Improving our ability to engage and retain clients in care and to support ongoing recovery

4. Enhancing children’s services5. Filling information gaps

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Five National Reports

1. Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (Child Welfare League of America,1998)America,1998)

2. Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Abusers (U.S. General Accounting Office, September 1998)

3. No Safe Haven: Children of Substance-Abusing Parents (The National Center on Addiction and Substance Abuse at Columbia University, 1999)

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y, )4. Healing the Whole Family: A Look at Family

Care Programs (Children’s Defense Fund, 1998)5. Blending Perspectives and Building Common

Ground: A Report to Congress on Substance Abuse and Child Protection (Dept. of Health and Human Services, 1999.)

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Common Ingredients of FDTCs in 2002 Process Evaluation

System of identifying familiesSystem of identifying familiesy y gy y g

Earlier access to assessment and treatment servicesEarlier access to assessment and treatment services

Increased management of recovery services and complianceIncreased management of recovery services and compliance

Responses to participant behaviors (sanctions & incentives)Responses to participant behaviors (sanctions & incentives)

Increased judicial oversightIncreased judicial oversight

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What is Success in FDC?Key Outcomes

Safety (CWS)

Permanency (Court)

Recovery (AODS)( )

• Reduce re-entry into foster care

• Decrease recurrence of abuse/neglect

( )• Reduce time to

reunification• Reduce time to

permanency• Reduce days in

care

( )• Increase

engagement and retention in treatment

• Increase number of clean UA’s

• Increase number of graduates

• Decrease Recidivism

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The Present

What do we know now? Where are we? What’s being done? What are the needs?

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Family Drug Court Outcomes

P

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• Parents enter treatment sooner• Parents stay in treatment longer• Parents complete treatment more often• More reunifications• Fewer incidents of non-compliance• Cost Savings

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FDC Local Evaluations

Jackson County OR (N=329 340)

Marion County, OR (N=39, 49)

Maine (3) (N=49, 38*)

Jackson County, OR (N=329, 340)

Washoe, NV (N=84,127)

Santa Clara, CA (N=100, 370)

Sacramento, CA (N=4,858, 111)Baltimore, MD (N=200, 200)

San Diego, CA (N=438, 388)

Suffolk, NY (N=117, 239)

London, England (N=55, 31)

Pima County AZ (N=33 45)

Data complied by CFF; references provided on Slide #

Pima County, AZ (N=33, 45)

11 FDC Sites(N= FDC, Comparison)

*Maine = only 1 of 2 comparison groups are reported in this presentation

Regional Partnership GrantsFamily Drug Courts

24 Grantee Sites

RPG FDC• 5,200 children• 8,000 adults

40

60

80

pletion Ra

te

Treatment Completions

Up to 20-30% higher 40

60

80

100

FR Rates

Reunification Rates

Up to 20-40% higher

0

20

Com

0

20

F

FDC vs ComparisonDays in Foster Care New CPS Petition after FR

Data complied by CFF; references provided on Slide #

0

200

400

600

800

# of Days

Several Fewer Months

0

5

10

15

20

25

New

Petition

Infrequent, In all conditions

FDC Outcomes - Summary

• Higher treatment completion rates• Shorter time in foster care• Higher family reunification rates• Higher family reunification rates• Lower termination of parental rights• Fewer new CPS petitions after

reunification• Cost savings per family

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Cost Savings Per Family

$5,022 Baltimore, MD$5,593 Jackson County, OR$13,104 Marion County, OR

Burrus, et al, 2011

Carey , et al, 2010

Carey , et al, 2010

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73

62 66 69

5561 64

5557 57607080

Treatment Completion Rates

31

48

33

4437

3240

3123

32 36

01020304050

FDC Comparison*p <.05**p <.01

***p <.001+p value not reported

80

91

7670

83

63708090

100

Reunification Rates

5145

56

21

57

394045 45

27

44 45

25

5545

21

0102030405060



477

589

466504 477

688

502.6500

600

700

800

Days in Foster Care

307 301352

437477

312252

327407

466

369

477

310346

0

100

200

300

400

500

0



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8

17

23

20

25

New CPS Petitions after Family Reunification

2

17

2

7 75

12

2

69

7

0

13

0

5

10

15

FDC Comparison

*p <.05**p <.01


80

70

80

90

Children Remain Home

61.1

20

30

40

50

60

70

0

10

RPG FDC Comparison **p < .001

28

25

30

Access to Treatment

ion

20

5

10

15

20

25

an #

of d

ays

to a

dmis

s

0

5

RPG FDC Comparison

**p < .001

Med

i

122.6140

Length of Stay in Treatment

97.2

40

60

80

100

120

Med

ian

# of

day

s

0

20

RPG FDC Comparison***p <.001

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• Ashford, J. (2004). Treating substance abusing parents: A study of the Pima County Family Drug Court approach. Juvenile & Family Court Journal, 55, 27-37.

• Boles, S., & Young, N. K. (2010, July). Sacramento County Dependency

References

Drug Court year seven outcome and process evaluation findings. Irvine, CA: Children and Family Futures.

• Boles, S., & Carpenter, L. (December 16, 2011). “Regional Partnership Grant Program: Improving Outcomes for Families Affected by Substance Abuse. 2011 Beyond the Bench Conference. California Administrative Office of the Courts.

• Burrus, S. W. M., Mackin, J. R., & Finigan, M. W. (Summer 2011). Show Me the Money: Child Welfare Cost Savings of a Family Drug CourtMe the Money: Child Welfare Cost Savings of a Family Drug Court. Juvenile and Family Court Journal, 62 (3), 1-14.

• Burrus, S. W. M., Mackin, J. R., & Aborn, J. A. (Aug. 2008). Baltimore City Family Recovery Program (FRC) independent evaluation: Outcome and cost report. Portland, OR: NPC Research.

• Carey, S. M., Sanders, M. B., Waller, M. S., Burrus, S. W. M., & Aborn, J. A. (March 2010). Jackson County Community Family Court – Outcome and Cost Evaluation: Final Report. Submitted to the Oregon Criminal Justice Commission. Portland, OR: NPC Research

• Carey S M Sanders M B Waller M S Burrus S W M & Aborn J

References

• Carey, S. M., Sanders, M. B., Waller, M. S., Burrus, S. W. M., & Aborn, J. A. (March 2010). Marion County Fostering Attachment Treatment Court – Process, Outcome and Cost Evaluation: Final Report.Submitted to the Oregon Criminal Justice Commission. Portland, OR: NPC Research

• Harwin, J., Ryan, M., Tunnard, J., Pokhrel, S., Alrouh, B., Matias, C., & Momenian-Shneider, S. (2011, May). The Family Drug and Alcohol Court (FDAC) evaluation project final report. London: Brunel University. y

• Worcel, S. D., Green, B. L., Furrer, C. J., Burrus, S. W. M., Finigan, M. W. (March 2007). Family Treatment Drug Court Evaluation: Final Report.NPC Research: Portland, OR.

• Zeller, D., Hornby, H., & Ferguson, A. (2007, Jan.). Evaluation of Maine’s Family Treatment Drug Courts: A preliminary analysis of short and long-term outcomes. Portland, ME: Hornby Zeller Associates.

How are these outcomes being achieved?

Strategies Most Likely to Be Selected by RPG/FDCs

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Strategies Most Likely to Be Selected by RPG/FDCs

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Strategies Least Likely to be Selected by RPG/FDCs

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Common Challenges and Barriers for FDCs

• Collaboration challenges• Screening and assessment – referral

processes• Engaging and retaining clients• Comprehensive programs – children’s

servicesservices• Performance measures/data collection• Budget/sustainability – scale and scope

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Collaboration Challenges –Defining Your FDC

• Dependency matters

• Recovery

• Dependency matters

• Specialized court • Dependency matters

• Dependency matters• Recovery

management• Same court,

same judicial officer during initial phase

• Non-compliant case transferred to specialized judicial officer

pservices offered before noncompliance occurs

• Compliance reviews and recovery management heard by

i li d t

matters• Recovery

management• Same court, same

judicial officer

a e s• Recovery

management• Same court,

same judicial officer

• Non-compliant case transferred to Presiding Judge or another

DUAL TRACK

j

PARALLEL

specialized court officer

INTEGRATED HOME COURT INTENSIVE

court

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ASAM Definition of Addiction

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing

d d/ li f b b

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reward and/or relief by substance use and other behaviors.”

Adopted by the ASAM Board of Directors 4/12/2011

ASAM Definition of Addiction

• Addiction is characterized by inability to consistently abstain, impairment in behavioral

t l i di i i h d iti fcontrol, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response

• Like other chronic diseases, addiction often involves cycles of relapse and remission

42Adopted by the ASAM Board of Directors 4/12/2011

• Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death

Collaboration Challenges –Policies and Procedures

• Lack of or inconsistent participation or buy-in from one or more critical partners: child welfare, substanceone or more critical partners: child welfare, substance abuse treatment, judges, attorneys

• Confidentiality issues not resolved; information and data sharing problems

• Competing timeframes, lack of coordinated case planningTime to meet as team• Time to meet as team

• Lack of appropriate community resources• Issues of collaboration among agencies in

understanding and working toward shared outcomes

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Screening and Assessment –Referral Processes

• Target population and process for identifying FDC clients is often unclear or inconsistentlyFDC clients is often unclear or inconsistently applied

• No standardized screening for substance use disorders prior to referral to FDC

• Sites are not at capacity and/or it is unclear how capacity rates have been establishedhow capacity rates have been established

• Sites have exclusion criteria for serious mental health issues, felonies, and domestic violence; others deal with these as co-occurring issues 44

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What percentage of families with substance abuse issues are currently

served in the FDTC? Most FDTCs typically

serve 5-10% of the t Th l t

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3

2

0

0

10-20%

20-40%

40-60%

60-80%

80-100%parents. The largest FDTCs serve up to

30-35% parents.

2

0 2 4 6 8 10 12 14 16 18

0-10%

Responses (n=23)

*Based on estimated child entries to out of home care45

What is the ideal percentage of families with substance abuse issues served in

the FDTC?

60% would be approximately

2

5

8

4

4

10-20%

20-40%

40-60%

60-80%

80-100%2,813 parents per

year

0 1 2 3 4 5 6 7 8 9

10 20%

Responses (n=23)

* Divided by 11 (the number of FDCs in Colorado) this would be an average of 256 parents served a year in each FDC.

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Defining the Scale of Your FDC

Defining The Scale of Your FDTC

# of children with substantiated allegations: 11,166

# of children entering foster care: 2,275

# of children of substance users: 1,365 (60% estimate)

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# of potential children

served in FDCYour defined

target population

* Numbers based on Colorado state child welfare data

Engaging and Retaining Clients

• Clients are given phone numbers or list of resources and instructed to call for assessmentand instructed to call for assessment

• Clients report lack of understanding with FDC requirements and expectations - especially in the beginning

• Lack of consistency in responses to client behavior• No clear incentives for client participation

f (• Time of groups; competing priorities (e.g. work vs. FDC requirements)

• Issues of treatment availability and quality

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Defining Your Drop off Points

4,689 cases referredfor SA assessment

3,563 received SA assessment 24% drop off = 1,126

Number referred to SA treatment 80% =2,850

Number made it to SA treatment = 1 425treatment = 1,425

50% drop off

427 successfully completed SA tx*

Payoff49

* 30% completed

Comprehensive Programs –Children’s Services

• Very little mention of services to children, though serving the family is one of primary differencesserving the family is one of primary differences between adult and family drug courts

• A few sites focus on 0-3, 0-5 and Substance Exposed Newborns with partnerships that focus on parent/child interaction and developmental/health programs for young children

• Utilizing CAPTA and Part C partners• Utilizing CAPTA and Part C partners

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Performance Measures and Data Collection

• Lack of prevalence data demonstrating the extent of substance abuse among child welfare populationsubstance abuse among child welfare population

• No uniform data collection; inability to measure effectiveness of program

• Lack of long-term data on child welfare and recovery outcomes; only while client is enrolled in DDC

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Budget and Sustainability

• Need for ongoing champions; challenge with turnover of judgesof judges

• Some FDTCs operate as “projects” or “boutique courts”

• Inherent limitations on scale and scope in some FDTC models

• No standardized cost analysis of total program cost or cost savingsor cost savings

• Lack of sufficient data on program effectiveness• Resource problems worsened by State and local

fiscal crises

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Are FDC results able to “move the needle” in the larger child welfare system?

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“We do thirty families—that’s all we do, and that’s all we want to do”

Changing the Larger System

But given the size of the problem…….54

Why do the Small FDCs Stay Small?

Lack of referrals Exclusionary criteria Limited partnerships;

limited services Lack of recovery case

management Non-standardized

communication protocol

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communication protocol Non-specialized docket

So How Did the Big Ones Get so Big?• Judicial leadership in convening

interagency players and tracking t tioutcomes over time

• Child welfare and treatment agency buy-in based on recognition that FDCs could directly improve their own outcomes

• Data systems and case management tracking that focused g gon both FDC project and larger system

• Annual evaluations that included cost offset data powerful enough to convince policy leaders to expand FDCs 56

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Getting Better at Getting Along: Four Stages of Collaboration

ChangingThe System

ChangingThe Rules

y

Universal Screening

Shared Case Plans

FDC Project

Better Outcomes for Children and

Families

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InformationExchange

JointProjects

Sid Gardner, 1996Beyond Collaboration to Results

Shared Case PlansShared Data

Focusing on Institutional Change

While many FDCs are able to “collaborate” at the level of FDC “project,” the ingredients for real systemsof FDC project, the ingredients for real systems change may not yet be present:

• Universal substance abuse screening for all parents involved with child welfare

• Universal child maltreatment screening for parents involved in substance abuse treatmentJoint (SA/CW) case planning and monitoring• Joint (SA/CW) case planning and monitoring

• Shared data systems• Shared outcomes

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Negotiate with Stakeholders“What would they buy?”

Outcomes• Document effectivenessC f i i

Resources• Inventory of staff, volunteers and

• Cost of innovation• Collect and share stories

redirected funding

current funds• Identify potential sources for future funding

• Select priority options for new funding

• Select priority options for redirected funding

Institutionalize innovation through practice and policy changes 59

Marketing to stakeholders and community

Checkpoints

An annual review of outcomes and dropouts?

Resources for a serious evaluation of agency performance?

Resources shifted from least to most effective programs?

In-depth assessment of children’s needs?

Missing partners brought to the table?

Results measured against the entire community’s needs—or just the project? 60

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Questions & Discussion

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RResourcesChildren and Family Futures, National Center on Substance Abuse and Child

Welfare, & Office of Juvenile Justice and Delinquency Prevention

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FDC Learning Academy 2010-2011

15 webinars

30 hours of content

15 expert presenters

1048 attendees

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43 states

Thank you for your participation!

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Selected Peer Learning Courts will host visiting FDC professionals to view their FDC in action, receive national recognition for their program and receive travel scholarships to the 2012 National FDC Symposium.

T o part application (1) formal application s bmission (2) onsite re ie

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FOR MORE INFORMATION :Visit: http://www.cffutures.org/projects/family-drug-courtsEmail: [email protected]

Two-part application: (1) formal application submission; (2) onsite review

Applications due: April 30th

September 5 – 7, 2012 Anaheim Marriot in Anaheim, CA

Family Drug Courts A National Symposium to Improve

Family Recovery, Safety and Stability

For more information please visit:

Presented by SAMHSA in collaboration with OJJD

For more information, please visit: http://www.cffutures.org/fdc_symposium

Presented by SAMHSA in collaboration with OJJDP

Visit the FDC Learning

Academy Blog

• Webinar updates• Presenter info• Learning resources

www.familydrugcourts.blogspot.com

Learning resources• Post a follow-up questionAsk our presenters!

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Training and Staff Development

NCSACW Online Tutorials1. Understanding Substance Abuse and Facilitating Recovery: A

Guide for Child Welfare Workers

2 U d t di Child W lf d th D d C t A2. Understanding Child Welfare and the Dependency Court: A Guide for Substance Abuse Treatment Professionals

3. Understanding Substance Use Disorders, Treatment and Family Recovery: A Guide for Legal Professionals

Please visit: http://www.ncsacw.samhsa.gov/68

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Phil Breitenbucher, MSWFDC TTA Program Director

Children and Family Futures9 0 S 202

Contact Information

4940 Irvine Blvd., Suite 202Irvine, CA 92620(714) 505-3525

[email protected]

RESOURCES

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RESOURCESPlease visit our website:

http://www.cffutures.org/projects/ family-drug-courts

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