Evidence Best Practices & Latest Research Presented by: Dr. Cary Heck University of Wyoming National...

Evidence Best Practices & Latest Research

Presented by:

Dr. Cary HeckUniversity of Wyoming

National Association of Drug Court Professionals

Developed by: Douglas B. Marlowe, J.D., Ph.D.

Shannon M. Carey, Ph.D.

© Douglas Marlowe, May 10, 2012

The following presentation may not be copied in whole or in part without the written permission of the author or the National Drug Court Institute.

Written permission will generally be given without cost, upon request.

“New” Findings/Issues

Recidivism Revisited

Substance Abuse Outcomes

Cost-Effectiveness Revisited

Service Delivery & Consumer Satisfaction

Best Practices Update

Sources

1. Multi-site Adult Drug Court Evaluation (MADCE)

2. Urban Institute Bayesian Cost Meta-Analysis (Downey & Roman, 2010)

3. NPC Research best-practice updates

Recidivism Revisited

URBAN INSTITUTEJustice Policy Center

Michael RempelCenter for Court Innovation([email protected])

With Shelli Rossman, John Roman, Christine Lindquist, Janine Zweig, Dana Kralstein, Mia Green, Kelli Henry, P. Mitchell Downey, and Jennifer Yahner

Presented to the Adult Drug Court Standards Core Working Group, National Drug Court Institute, Las Vegas, NV, December 11, 2010

Review of NIJ’s Multi-Site Adult Drug Court Evaluation

The views expressed are those of the authors and should not be attributed to The Urban Institute, its trustees, or its funders.


MADCE Research Design

Drug Court vs. Comparison Sites Drug Court: 23 sites in 7 regions (n = 1,156) Comparison: 6 sites in 4 regions (n = 625)

Repeated Measures Interviews at baseline, 6 months & 18 months Oral fluids drug test at 18 months Official recidivism records up to 24 months Cost-effectiveness


Official Recidivism:Re-Arrests Over 24 Months

Percent with Re-Arrest: 24 Months Post-Enrollment

52%

62%

0%

20%

40%

60%

80%

100%

Re-Arrested within 24 Months

Drug Court (n = 1,022)

Comparison (n = 512)

+ p < .10 * p < .05 ** p < .01 *** p < .001

n.s.


Criminal Behavior:Year Prior to 18-Month Interview

Percent with Criminal Activity:One Year Prior to 18-Month Interview

53% 50%

40%*36%**

0%

20%

40%

60%

80%

100%

Criminal Activity Drug-Related Activity

Drug Court (n = 951)Comparison (n = 523)

+ p < .10 * p < .05 ** p < .01 *** p < .001



Number of Criminal Acts:One Year Prior to 18-Month Interview

88.283.1

30.6***

43.0**

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Criminal Acts Drug-Related Acts

Drug Court (n = 951)Comparison (n = 523)

+ p < .10 * p < .05 ** p < .01 *** p < .001



Criminal Behavior: Year Prior to 18-Month Survey

1) Any drug use or possession 34%** 50%

2) Any drug sales 9%* 16%

3) Any other drug crimes (manufacturing, trafficking, etc.) 2% 2%

4) Any DWI/DUI 13%* 20%

5) Any violent crime/crime against people 4% 3%

6) Any weapons possession 7% 8%

7) Any property crimes 3%* 6%

8) Any public order crimes (e.g., prostitution, vagrancy) 1% 1%+p<.10, * p<.05, ** p<.01, ***p<.001.

Drug CourtComparison

GroupOutcome Measure


Saliva Test Results at 18 Months

Any Drug Any Serious Drug

Marijuana Cocaine Opiates Amphet-amines

PCP0%

10%

20%

30%

40%

50%

29%**

20%

12%+15%

6%

1% 0%**

46%

27%

21% 21%

7%

2% 2%

Drug Court (N = 764)Comparison Group (N = 383)

+ p < .10, * p < .05, ** p < .01, *** p < .001.

Cost-Effectiveness Revisited


MADCE Cost Outcomes

Hierarchical Results (over the full follow-up)

Drug Court Control Net Benefits

Social Productivity $20,355 $18,361 $1,994

Criminal Justice - $4,869 - $5,863 $994

Crime/Victimization - $6,665 - $18,231 $11,566**

Service Use - $15,326 - $7,191 - $8,135**

Financial Support - $4,579 - $3,744 - $835

Total - $11,206 - $16,886 $5,680 n.s.


Cost Details #1:Program Investments

Hierarchical Results (over full follow-up)

Drug Court Control Net Costs

Time with probation officer 4.7 hours 5 hours $6

Drug tests 65.4 tests 12.3 tests - $410***

Electronic monitoring 3 days 1.6 days - $6

Status hearings 20.6 hearings 1.5 hearings - $288***

Time with case manager 12.9 hours 1.1 hours - $306***

Months in program 12.2 months 1.2 months - $800***

Residential drug treatment 37.8 days 14.4 days - $4,431

Medicinal treatment 6.5 sessions 3.3 sessions - $73

Individual counseling 15.6 sessions 2.4 sessions - $1,070***

Group counseling 63.1 sessions 13.5 session - $514***

Bayesian Meta-Analysis Data from Shaffer (2006) doctoral dissertation

> 80% of Drug Courts reduced crime

Avg. reduction in crime = 8% to 14%

85% of Drug Courts were cost-effective (i.e., had positive cost outcomes)

Only 14% of Drug Courts were cost-beneficial (i.e., cost outcomes exceeded expenditures)

60% of avoided crimes were “insignificant in nature” (i.e., drug, theft, trespassing and traffic offenses)

Best Drug Courts netted $23,000 per participant

(Downey & Roman, 2010)

Service Delivery & Participant Satisfaction


Nature of the Intervention:Drug Court vs. Comparison Sites

Interventions Received in Six Months After Baseline

Percent of offenders with any treatment 83%*** 36% Average days in treatment 59*** 23

Percent with any judicial status hearings 93%*** 14% Average number of status hearings 10.3*** 1.2

Percent with supervision officer contact 96%** 71% Average number of contacts 17.2*** 6.4

Percent with any drug test 95%*** 61% Average number of drug tests 30.9*** 4.3

Percent receiving any judicial sanction 50%*** 15% Percent receiving praise from the judge 76%*** 10%+p<.10, * p<.05, ** p<.01, ***p<.001.

Drug Court (n = 1,009)

Comparison (n = 524)


18-Month Retention Rates:All 23 Sites in MADCE Study

18-Month Retention Rates By Site (n = 951)

39%48%

55%58%

62%65%

67%68%

70%71%71%72%72%

76%77%77%77%78%79%79%

84%93%93%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Court 1

Court 3

Court 5

Court 7

Court 9

Court 11

Court 13

Court 15

Court 17

Court 19

Court 21

Court 23

Median Drug Court

= 72%


Procedural and Distributive Justice:Six-Month Interview Results

Offender Perceptions of Fairness

2.86

3.24

3.86

3.21

3.26*

3.78***

4.26**

4.11***

1.00 2.00 3.00 4.00 5.00

Perceptions ofDistributive Justice

Perceptions of CourtProcedural Justice

Perceptions ofSupervision Officer

Perceptions of Judge

Comparison (N = 524) Drug Court (N = 1,009)

* p < .05 ** p < .01 *** p < .001

Note: Distributive justice questions were on a 1-4 scale.


Perceptions of Interim Sanctions:Six-Month Interview Results

Offender Perceptions of Interim Sanctions

6.22

2.25

2.87

2.36

2.96

7.06*

0 1 2 3 4 5 6 7 8

Deterrence Score(combined certainty

& undesirability, 1-12scale, n = 1383)

Perceptions ofSanction

Undesirability (1-3scale, n = 1521)

Perceptions ofSanction Certainty

(1-4 scale, n = 1390)Drug Court

Comparison

+ p < .10 * p < .05 ** p < .01 *** p < .001


Explanatory Model: Reduced Days of Drug Use (N = 1,297)

LegendBetween Courts EffectsWithin Courts Effects

Days of Drug Useb

Attitude Toward Judgea

Drug Court

Age

Drug Tests

Sanctions

Antisocial Personality

Court Appearances

Drug Treatment in Weeks

18-month InterviewBaseline

Controls

-1.685**-0.608**

0.941***

-0.016*

0.494***

0.027***

-0.018***0.00

4*

0.017***

0.076**

9.23

0***

24.861***

8.684***

1.237***

6-month Interview



Days of Drug UsebDays of Drug Useb



Drug CourtDrug Court

AgeAge

Drug TestsDrug Tests

SanctionsSanctions

Antisocial PersonalityAntisocial

Personality

Court Appearances

Court Appearances



18-month InterviewBaseline

Controls

-1.685**-0.608**

0.941***

-0.016*

0.494***

0.027***

-0.018***0.00

4*

0.017***

0.076**

9.23

0***

24.861***

8.684***

1.237***

6-month Interview

Found over 50 practices that were related to significantly lower recidivism, lower costs, or both

• Evaluated 101 Drug Courts around the nation (detailed process studies/10 KC)

• 69 included recidivism and cost evaluations

• What are the best Drug Courts doing?

Best Practices

• Trying to make the 10KC understandable in a much more specific way – through specific practices

Drug Court Top 10*Recidivism*

10. The results of program evaluations have led to modifications in Drug Court operations



9. Law enforcement is a member of the Drug Court team




8. Drug Court allows non-drug charges

Note 1: Difference is significant at p<.05

8. Drug Courts That Allow Non-Drug Charges had roughly twice the reductions in recidivism

YesN=42

NoN=24

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.450.41

0.21

Program Allows Non-Drug Charges (e.g., Theft, Forgery)

% r

ed

uc

tio

n in

# o

f re

arr

es

ts





7. A representative from treatment attends court sessions






6. Review of the data/program stats has led to modifications in Drug Court operations


5. A representative from treatment attends Drug Court team meetings (staffings)



4. Treatment communicates with court via email




3. Judge spends an average of 3 minutes or greater per participant during status review hearings


Drug Courts Where the Judge Spends an Average of 3 Minutes or Greater per Participant During Court Hearings had 153%

reductions in recidivism





2. Participants are expected to have greater than 90 days clean (negative drug tests) before graduation





2. Participants are expected to have greater than 90 days clean (negative drug tests) before graduation

1. Program caseload (number of active participants) is less than 125


1. Drug Courts with a Program Caseload (Number of Active Participants) of less than 125 had

567% reductions in recidivism


Drug Courts with a Program Caseload (Number of Active

Participants) of less than 125 had

greater reductions in recidivism

Drug Court Top 10*Cost Savings*

10. In the first phase of Drug Court, drug tests are collected at least two times per week


9. Law enforcement attends court sessions




8. Drug test results are back in 48 hours or less





7. Team members are given a copy of the guidelines for sanctions



5. In order to graduate, participants must have a job or be in school


5. Drug Courts Where in Order to Graduate Participants Must Have a Job or be in School had

a 83% Increase in Cost Savings


4. The defense attorney attends Drug Court team meetings (staffings)




3. Sanctions are imposed immediately after non-compliant behavior (e.g., in advance of a client's regularly scheduled court hearing)






1. Review of the data and stats has led to modifications in Drug Court operations


Drug Court Top 10Significant for both recidivism and cost

• Review of the data and stats has led to modifications in Drug Court operations

• The results of program evaluations have led to modifications in Drug Court operations

• A representative from treatment attends Drug Court appearances

*On both top 10 lists*

*Other practices of particular interest

Courts that typically impose jail longer than 6 days have worse (higher) recidivism


Drug Courts That Used One or Two Primary Treatment Agencies Had 76% Reductions in Recidivism

Note: Difference is significant at p<.05

1 2 3 4 4 - 10 > 10 0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Fewer treatment providers are related to greater reductions in recidivism

% reduction in recidiv...

Number of agencies

Conclusions Target high-risk / high-need cases

(including non-drug offenses)

Evaluate, Evaluate, Evaluate (including participant perceptions)

Centrality of the judge

Integration of treatment in court

Involvement of law enforcement

Drug testing & structured consequences

Ramp up services as you go to scale

Sponsor’s Note

This project was supported by Grant No. 2012-DC-BX-K004 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the SMART

Office, and the Office for Victims of Crime. Points of view or opinions in this document are those of the author and do not represent

the official position or policies of the United States Department of Justice

Evidence Best Practices & Latest Research Presented by: Dr. Cary Heck University of Wyoming National...

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