Tonawanda Drug Treatment Court Program Evaluation and Enhancements

Transcription

1 1 Tonawanda Drug Treatment Court Program Evaluation and Enhancements Consultants: Richard Washousky David Washousky Tracey Taylor This study was developed under grant #2010-DC-BX-0004 from the United States Department of Justice, Office of Justice Programs. The opinions expressed are those of the authors and do not necessarily represent the official position or views of the Bureau of Justice Assistance, Office of Justice Programs, United States Department of Justice, the New York State Unified Court System, the 8 th Judicial District, or the Tonawanda City Treatment Court

2 2 Acknowledgements The staff of Recovery Solutions would like to thank the following individuals for their help and cooperation in conducting this evaluation. Tonawanda City Treatment Court staff Honorable Joseph J. Cassata Presiding Judge Harmony Retzlaff-Hurtgam Tonawanda Treatment Court Coordinator Kelly Gotham Court Attorney Mary Strobel Tonawanda City Court Chief Clerk Michael Drmacich Gregory Fina Edwardine Havens Shelley Miller Prosecutor Assigned Counsel Attorney Registered Nurse, Reflections Senior Substance Abuse Counselor, Horizons 8 th Judicial District/NY Unified Court System staff Honorable Paula L. Feroleto Administrative Judge Jeff Smith Ann Bader Robyn Cohen Michael Magnani Project Director Division of Grants and Program Development Division of Grants and Program Development Division of Grants and Program Development

3 3 Table of Contents Executive Summary 4 Introduction to Tonawanda Drug Treatment Court 5 Tonawanda Drug Treatment Court Enhancements: Genesis, Need, and Implementation 7 Enhancement Goal 1: Counseling Services 9 Enhancement Goal 2: Transportation 11 Enhancement Goal 3: TDTC staff training 12 Enhancement Goal 4: Evaluation Study 13 Research Methodology 15 Qualitative Methods 15 Quantitative Methods 15 Key Findings and Program Outcomes 17 Qualitative Findings, Results, and Analysis TDTC and Treatment Staff Interviews 17 Participant Interviews 19 Quality of Life Self-Assessments 22 Court room observations with SCOT analysis 24 Quantitative Results, Findings, and Analysis Quantitative Key Findings 25 Limitations to Tonawanda Drug Treatment Court Evaluation 28 Final Program Recommendations 29 Directions for Future Research 30 Works Cited 31 Appendices 32 Appendix A: Tonawanda City Court Drug Court Handbook 33 Appendix B: Recovery Solutions Data Tracking Matrix 41 Appendix C: Quality of Life Self-Assessment 44 Appendix D: Tonawanda Treatment Court Bus Pass Application 46 Appendix E: Staff Interview Template 48 Appendix F: Participant Interview Template 51

4 Executive Summary The Tonawanda Drug Treatment Court (TDTC) was created from a multi-jurisdictional implementation grant initiated in 1997 by the Honorable Judge Mark Violante of Niagara Falls and the Honorable Judge Joseph Cassata of the City of Tonawanda. Though the original intent of the program was to address inadequacies with case processing between the City of Tonawanda and Niagara Falls, the program quickly became a successful rehabilitative passageway for community members who needed a second chance to rebuild their lives. The members of the TDTC team have continued to provide a consistent and positive support system, helping its participants to become drug-free, productive, and inspiring members of the community. Throughout the success of the TDTC, the program has identified additional perceived and expressed needs of its participants concerning consistent access to transportation and treatment related services. An enhancement grant was awarded in October 2010 to the TDTC for these particular higher needs participants who were struggling in the program due to the lack of transportation and/or for participants who could not afford treatment related costs. The primary goals of the enhancement grant were to provide TDTC participants an opportunity to overcome these persistent barriers with assistance from the court. Other goals included providing TDTC staff access to ongoing training in order to best serve their participants as well as conducting a program evaluation on how the enhancements have helped the TDTC. Recovery Solutions was contracted to conduct a comprehensive evaluation, utilizing both quantitative and qualitative measures, to effectively evaluate the outcomes related to these enhancements and participant needs. Operational outcomes such as the referral process, screening and assessment, case management services, and ancillary services were analyzed and the data obtained from the evaluation will be used to modify program components, procedures, and approaches, as well as to justify continuation or expansion of the TDTC. A total of 256 new participants entered the TDTC program during the grant evaluation period (10/2/10-9/31/13). 48 of these participants were identified as needing additional assistance with transportation and treatment related costs and were identified as the grant cohort. Upon conclusion of the grant evaluation period, 25 (52%) of the 48 participants had completed the program, 14 (30%) had an active status, eight (17%) failed out of the program, and one participant was transferred. Recovery Solutions was able to identify several key findings including that the enhancements provided by this grant have created an increase in accountability and overall program attendance for these higher needs participants. Key program recommendations from TDTC participants, TDTC and treatment staff, as well as the evaluation team have also been included. These include reorganizing the court calendar to separate mental health and drug court participants to assist with time management of court schedule, improving consistency between pre-court team meetings and court proceedings, increasing utilization of ancillary services, and strengthening communication of needs between TDTC participants and treatment providers. A list of Final Program Recommendations proposed by the evaluation team can be found on page 29. 4

5 5 Introduction to Tonawanda City Treatment Court The Tonawanda Drug Treatment Court (TDTC) was created from a multi-jurisdictional implementation grant initiated in 1997 by the Honorable Judge Mark Violante of Niagara Falls and the Honorable Judge Joseph Cassata of the City of Tonawanda. In addition to addressing similar patterns of drug related behaviors they were seeing, both judges wanted to improve on the inadequacies in case processing due to an influx of defendants who were being charged in both jurisdictions. A Federal Planning Grant from the Office of Justice Programs had assisted Judge Violante in beginning a pilot drug court in Niagara Falls and within 8 months the city had started to see the positive impact the pilot program was generating. After observing this success, Judge Cassata wanted to simulate similar reductions in recidivism and the number of individuals arrested for drug-related offenses, as well as promote the cost effectiveness to the City of Tonawanda. From its inception in 1998, TDTC s overall goals were to provide consistent interventions involving treatment, education, case management, and judicial supervision. With a reported overall 65% graduation rate, the program has demonstrated its ability to achieve these goals and has continued to improve treatment outcomes for the chemically dependent, nonviolent individual, reduce criminality, improve allocation of scarce criminal justice resources, and increase public safety. Today, TDTC has evolved into a hub drug court that accepts the transfer of drug court eligible cases from nine other Erie County town and village courts when the initial court does not have a drug treatment court program. The TDTC has helped to interrupt the drug abuse and drug related crime the city was experiencing by substituting effective treatment and rehabilitation methods. TDTC has

6 6 continued to provide defendants with opportunities to break this crime cycle by providing alternatives to incarceration involving intensive case management, community supervision, and linkages to ancillary services. However, despite ongoing success, access to transportation and a gap in available treatment for individuals who are not considered eligible for Medicaid, do not have health insurance, and cannot afford copays or sliding scale fees for counseling sessions have proven to be persistent barriers to successful treatment and rehabilitation. In accordance with Drug Court Key Component #8: Monitoring and evaluation measures the achievement of program goals and gauges effectiveness, TDTC has attempted to address these ongoing needs by submitting an enhancement grant to help add additional services for its participants and make modifications as needed. The following is a discussion of the proposed enhancements including goals, objectives, and measures for completion and sustainability.

7 7 Tonawanda Drug Treatment Court Enhancements: Genesis, Need, and Implementation After evaluating the perceived and expressed needs of its participants, the TDTC wanted to better serve individuals who often fall through the cracks and who are unable to successfully complete treatment or the requirements of the court due to their economic and/or geographical constraints. These particular individuals do not qualify for Medicaid because they make more than the poverty guidelines allow for and do not have alternative health insurance. These individuals are struggling to pay for the necessities to live which often times puts treatment on the bottom of their list, because they cannot afford crucial counseling sessions for ongoing mental health issues and/or to help during the early stages of recovery. At the time of the grant application for enhancements, TDTC court staff reported 30% of its participants were ineligible for Medicaid, did not have health coverage, and/or were not able to afford the sliding scale costs of treatment if they did have health insurance. Additionally, these same individuals struggle with obtaining reliable and consistent transportation due to financial constraints, or they do not have a valid driver s license. These participants have to rely on public transportation, family, and or friends, which allows an individual lacking the intrinsic motivation and external supports to continue to fail in completing treatment and being successful in recovery. At the time of the enhancement grant application it was estimated by TDTC staff that 12.5% of the participant population presented with persistent difficulties with securing daily transportation to complete daily activities including attending court and treatment sessions. The following goals, objectives, and measures were proposed by TDTC to address the ongoing geographical and economic constraints of its participants.

8 8 Goal Objective Measure Provide additional counseling/treatment service options to TDTC participants who are not eligible for Medicaid, not covered by private insurance, and who do not have the means to pay sliding scale fees (Key Components: 1, 4, 6, 10) Provide transportation to TDTC participants to treatment court related appointments where transportation issues have caused an absence or will cause an absence for a mandatory appointment (Key Components: 6, 10) Contract with Horizon Health Services, Inc. to provide counseling services Form partnership with local area colleges and universities with masters programs in counseling and/or social work to create internship opportunity Develop a system for identifying transportation need and assigning passes/tokens # of counseling sessions held # of participants referred for counseling # of sessions attended by participants Creation of internship opportunity # of bus passes and tokens given to participants Purchase 10 bus passes on monthly basis Supplement additional transportation needs with bus tokens reduced rates for eligible participants Provide training for the TDTC team (Key Component: 9) Complete Process measures and program outcome evaluation (Key Component: 8) Ongoing training for TDTC team and stakeholders Determine program s effectiveness in: Program implementation Influencing criminal recidivism Rearrests while active, within 6 months, 1 year Participant completion of program # and type of service referrals Retention in chemical dependency and related treatment Operational outcomes related to community partnerships and programs # of trainings attended Recommendations for improving key components Referral Screening and assessment Case management services Training activities

9 9 Recovery Solutions was contracted to provide an analysis of the above enhancements in addition to providing recommendations and directions for future improvements. The following discussion involves an overview and analysis of the enhancements proposed by the TDTC including key findings, an evaluation of how the enhancement goals and objectives were implemented, and how each has been or is continuing to be measured for program sustainability, including recommendations by the evaluation team. Enhancement Goal #1: Provide additional counseling/treatment service options to TDTC participants who are not eligible for Medicaid, not covered by private insurance, and who do not have the means to pay sliding scale fees A contract was created with Horizon Health Services, Inc. to provide no fee counseling services to the TDTC participants who could not afford initial intake assessments and/or the recommended number of individual and/or group therapeutic sessions. After this arrangement was developed, it was proposed to contract with local colleges and universities who have Master level programs in counseling and social work. An internship opportunity would be created where the intern would be supervised by a counselor with Horizon Health Services and then work on site at the TDTC to assist in administering assessments and/or evaluations, and/or help to connect participants to needed services. Based upon discussion with Horizon Health Services and the project director, it was decided that on-site services were not feasible at this time and an internship opportunity was not developed. Upon first distribution of the grant monies, TDTC reported using funding for any additional assessments participants may have needed and also to help off-set costs for those participants who were struggling to pay their existing co-pays. TDTC staff reported that the amount of funding ($12,480) allocated for the contract with Horizon Health Services was not enough to cover all of these costs plus initial intake assessments ($120) and subsequent individual/group counseling fees ($70/session) for all of the participants who were not able to pay throughout the proposed grant periods (year 1: 10/1/10-

10 10 9/31/11; year 2: 10/2/11-9/31/12). TDTC staff reported that funding for these services was not available after April 2012 and there were challenges and delays with connecting participants with treatment due to a lack of grant funding after April 2012 and also due to trying to set up pay scales for the participants who could not pay for treatment without assistance from the court. Currently, it appears that Horizon Health Services and TDTC have been attempting to negotiate and work out pay schedules for participants who are determined in need of financial support. Due to continuing referrals and interactions between the TDTC and Horizon Health Services, the evaluation team would recommend that Horizon Health Services and TDTC staff discuss and establish a plan to help establish consistency with payment schedules for participants, regardless of grant funding. Please see Final Program Recommendation #11 on page 29. Horizons Health Services also utilizes a Resource Advocate who meets with participants who do not currently have insurance. If a participant is eligible for Medicaid, they will attend a hearing to determine eligibility and terms. If the participant is not eligible for Medicaid, they are placed on a C plan which is based on their income. These participants will be asked to pay a $25.00 to $75.00 co-pay for services. Initially, TDTC reported there was a lapse between when a participant could start treatment due to the participant having to meet with the Resource Advocate first and then await a pending status in order to secure funding for the initial assessment and counseling fees. There may also have been a delay due to participants having to travel to Horizon Health Services Boulevard location in order to meet with the Resource Advocate. At this time, it is being reported that the Resource Advocate at Horizon Health Services will label a participant as Medicaid pending in order for him or her to see a counselor as soon as possible instead of waiting until Medicaid is actually awarded. The amount of time between a participant meeting with the Resource Advocate and the start of treatment has been reduced from 1-2 months to 2-3 weeks and communication is improving between TDTC and Horizon Health Services. The evaluation team would

11 11 recommend that Horizons Health Services send the Resource Advocate directly to TDTC at scheduled days and or times when treatment court is being held as well as continue to communicate cost per participant needs with TDTC staff. Please see Final Program Recommendation #12 on page 29. Key Findings for Enhancement Goal #1 (n=48) 75% of participants reported earning no income Approximately 42% of participants were found to not have been receiving Medicaid at the time of entry in TDTC, with 79% of those participants being eligible to receive Medicaid Over half of the participants (58%) were found to not be able to afford co-pays for treatment related costs Approximately 85% of participants were recommended and sent for outpatient treatment 79% of participants utilizing the enhancement grant received substance abuse treatment; one participant received mental health treatment only; and approximately 20% received both substance abuse and mental health treatment Approximately 35% of the participants utilized free counseling offered by Horizons; one of these participants failed out of the program and was transferred to DWI court and another participant was transferred to the Niagara Falls Treatment Court Enhancement Goal #2: Provide transportation to TDTC participants to treatment court related appointments where transportation issues have caused an absence or will cause an absence for a mandatory appointment Ten bus passes were to be purchased on a monthly basis for those participants who needed to attend appointments related to their treatment and/or treatment court requirements. Supplemental bus tokens were also purchased for participants who were in need of transportation on a limited basis. It was estimated that approximately 10 participants may request the utilization of a bus pass on a monthly basis. In order to determine whether or not a participant was in need and/or could benefit from assistance with transportation, TDTC staff created a bus pass application for participants to complete upon entry into treatment court. A copy of this application can be found in Appendix D on page 46.

12 12 In accordance with the grant budget, TDTC staff reported purchasing 8-10 bus passes per month, which was dependent on need(s) of participants. TDTC staff also reported purchasing approximately 2 rolls of bus tokens per month (50 tokens in each roll) that are given to participants who may have additional needs. Both TDTC participants and staff who were interviewed have reported an increase in overall program participation and improved accountability. The evaluation team would recommend seeking future funding opportunities to research the benefits of forming a partnership with public transportation and the court system to continue providing transportation assistance for treatment court participants. Please see Directions for Future Research on page 30. Key Findings for Enhancement Goal #2 (n=48) 73% of participants reported utilizing public transportation as their main form of transportation 75% of the participants were determine eligible for assistance with transportation and were given bus passes; 38% of these participants were also given supplemental bus tokens Of the 35% who utilized the free counseling service, 5 of these participants were provided bus passes and/or supplemental tokens All TDTC staff, who were interviewed, reported an increase in accountability and attendance among those participants who were utilizing assistance with transportation All participants, who were interviewed, reported that the bus passes and tokens have helped them to be more successful throughout duration of treatment court. Enhancement Goal #3: Provide training for the TDTC team The total budget written in to the enhancement grant for staff training, including travel, lodging, and registration costs was $48,108. Travel expenses were built into the enhancement grant for year 1 (10/1/10-9/31/11) and year 2 (10/1/11-9/31/12) for 10 members of the TDTC team (1 of 2 judges, resource coordinator, chief clerk or deputy chief clerk, defense attorney, assistant district attorney, one probation officer, court attorney, counseling provider, police officer, evaluator) to attend four trainings. TDTC staff reported attending only two of the four trainings, with only 3-4 treatment team

13 13 members in attendance at each training. Due to the significance of ongoing training, the evaluation team would recommend that a yearly training schedule be established and followed for TDTC team members in order to continue maintaining a successful drug court, stay up to date on emerging trends in the treatment court field, and continue developing best practice approaches to address a variety of participants needs. It may also be beneficial to create a schedule for treatment court coordinators within the 8 th Judicial District to meet and discuss ongoing challenges, any changes within the district, and/or strengths between the various treatment courts. Please see Final Program Recommendation #13 on page 29. The following chart is a description of what the proposed trainings were, the trainings that were attended, and the TDTC members who attended. All information presented was reported by TDTC staff. Proposed training Training attended TDTC members attending NYS Association of Drug Court Professionals Conference* in Rochester, NY *(training cancelled due to state budget) 2 BJA sponsored trainings in Washington, D.C. National Association of Drug Court Professionals (NADCP) Conference NYS Association of Drug Court Professionals Conference in Saratoga, NY TDTC coordinator (2012) Judge (2012, 2013) Treatment provider (2012) - Trainings were not attended by TDTC staff Judge 2012 NADCP Conference TDTC coordinator in Nashville, TN Court Attorney Human Resource Employee Enhancement Goal #4: Complete process measures and program outcome evaluation Recovery Solutions Consulting and Training was contracted to complete a performance based outcome evaluation focusing on the enhancements discussed above. A program outcome evaluation was completed by Recovery Solutions in order to justify how the enhancement grant was used to supplement needed services and whether or not these additional services were utilized by the program participants. Qualitative and quantitative data was collected over a 2 year grant period (10/1/10-9/31/12) as well as an extension, from 10/1/12-9/31/13, and analyzed in order to

14 14 modify program components, procedures, and approaches to justify continuation or expansion of the program. A list of Final Program Recommendations can be found on page 29.

15 15 Research Methodology The process evaluation on the TDTC was created using a multi-faceted approach that aimed to gather both quantitative and qualitative outcomes in order to assess the success of the TDTC enhancement projects. The following sections describe the interpretative and measurable data collected from TDTC participants (n=48), who utilized ether the bus passes/tokens or free counseling, which was collected throughout the 2 year grant cycle (10/1/10-9/31/12, with 1 year extension from 10/1/12-9/31/13) and will be discussed in further detail on pages Qualitative Methods Qualitative data was gathered via court observations, quality of life surveys, analysis of Strengths, Challenges, Opportunities, and Threats of the program (SCOT analysis), semistructured staff interviews, and participant interviews. The information collected assisted in providing thematic indicators of program strengths and challenges as well as creating a foundation for grant validation and recommendations. Data was used to answer the following questions: What are the overall strengths and challenges of the TDTC? What gaps, if any, exist in service delivery? What type of ancillary services are being utilized? What opportunities exist for future enhancement and/or expansion of the TDTC? Quantitative Methods Recovery Solutions created a data matrix for TDTC staff to utilize in the collection of data throughout the two year grant cycle, which can be found in Appendix B on page 41. This information allowed the evaluators to extrapolate themes and outcomes that characterized

16 16 different trends within the TDTC population. The following are a list of domains and variables that were collected and analyzed. Age Gender Race Income Education Age of 1 st Arrest # of Rearrests Age of 1 st Drug Use Drug of Choice # of Relapses History of chemical dependency Diagnosis Medicaid status Utilization of Bus Passes and/or Tokens Overall program status (active, completed, fail) Information regarding past and current treatment A more in depth discussion of the findings and interpretation of the above data can be found under the Quantitative Results, Findings, and Analysis section on page 25.

17 17 Key Findings and Program Outcomes The following sections are a discussion of the qualitative and quantitative data including key findings, common themes, strengths, challenges, and perceived needs of the TDTC. Qualitative Findings, Results, and Analysis Key results and findings were identified from information gathered and assessed from TDTC court staff and its participants that was collected via semi-structured staff and participant interviews, quality of life-assessments, and court room observations, including an analysis of Strengths, Challenges, Opportunities, and Threats of the program (SCOT analysis). TDTC and Treatment Staff Interviews The evaluation team conducted semi-structured interviews with the following TDTC and treatment staff: o Honorable Judge Joseph Cassata, Presiding Judge o Harmony Retzaff Hurtgam, TDTC Coordinator o Kelly Gotham, Court Attorney o Edwardine Havens, Registered Nurse with Reflections o Joe Bush, Counselor at the Beacon Center o Shelley Miller, Senior Substance Abuse Counselor Horizons Health at Services o Shari Greenwood, Erie County Community College s Education 2 Recovery Program liaison Key Findings and Staff Recommendations 1. Universal praise for TDTC Coordinator All TDTC and treatment staff who were interviewed by the evaluation team reported that the TDTC Coordinator, Harmony Retzaff-Hurtgam, encouraged consistent communication between stakeholders, demonstrated dedication to the TDTC participants, and promotes the organization and structure that is needed to run a successful treatment program.

18 18 2. Positive communication between stakeholders TDTC and treatment staff reported receiving positive communication and feedback between stakeholders, including TDTC staff, treatment providers, community liaisons, and community supervision agents. Staff reported they have a good rapport with Police and Probation Departments aiding in community supervision of the TDTC participants stating, they are respectful, cooperative, and caring, and they continue to have a good line of communication with them. TDTC staff report receiving feedback and weekly reports from treatment providers in a timely manner and treatment providers are making themselves available for any additional information that may help the participant to be successful. Overall, all staff report consistent feedback among all case management team members. 3. TDTC provides a positive support system for its participants Treatment providers reported that the TDTC participants were well supported throughout treatment court process and as the needs of the participant changed, TDTC staff made themselves available and made accommodations as needed to promote participant success. Treatment staff reported that everything the TDTC staff are doing meshes into what a successful program can be, including participant accountability, evaluating and addressing participant needs in a timely manner, 4. Improve consistency and time management of treatment court proceedings TDTC and treatment court staff reported that although overall communication between stakeholders has been positive, the consistency between what is discussed at the treatment team meetings prior to TDTC proceedings and what is actually done during the TDTC proceedings could be improved. Staff wanted to see more consistency with what sanctions are recommended by treatment staff and what the judge utilizes, improved consistency from the judge with the interaction of all participants, and to separate the mental health and drug courts to improve specific participant interaction. Staff also reported wanting to see improvement made on the overall time management of treatment court proceedings, including

19 19 starting on the intended and scheduled time of treatment court. Please see Final Program Recommendations #1, #2, and #3 on page Increase utilization of GED classes and strengthen communication with educational and vocational services within the community TDTC and treatment staff reported wanting to increase the utilization of GED classes offered by either the community or by Erie County Community College (ECC) in addition to the communication between both community resources. TDTC staff reported contacting local treatment providers and community stakeholders to invite members of the community to attend GED classes that were being held at the court in Tonawanda. GED classes started at the court on 2/1/13 but stopped on 6/25/13 due to low enrollment numbers. At this time, ECC does have a community liaison present in the courtroom to help connect participants with the necessary resources to obtain a GED and to utilize the Education 2 Recovery Program, however it has been reported that participants are not being mandated by the judge to obtain their GED as part of their recovery plan. The evaluation team is recommending that the court mandate participants to obtain their GED and then encourage and support participants to seek further vocational training and/or enrollment into an academic program. Please see Final Program Recommendation #8 on page 29. Participant Interviews Of the 48 participants who were reportedly utilizing assistance with transportation, Recovery Solutions staff was able to interview 11 of these participants. The semistructured interviews included questions about the participant perception of the judge and/or treatment staff, how the participant feels the bus passes and tokens have been helping them, current enrollment in treatment, current employment and/or vocational training, and any recommendations he or she may have for the treatment court staff. The participants who were interviewed were also given a Quality of Life Self-Assessment to complete. The following themes were extrapolated from the information that was gathered from treatment court participants.

20 20 Universal praise for Honorable Judge Cassata in regards to participants feeling respected, feeling the judge was concerned about them, being treated fairly, and that the judicial process was reasonable and helped them to stay sober. Universal praise for TDTC and treatment staff in regards to participants feeling respected and as if treatment staff were concerned about them, participants being treated fairly, and the treatment process was reasonable and helped participants to attend court on a regular basis. The following are quotes taken from interviewed participants about TDTC and treatment staff: If you want the help, it is a great program ; It has helped me stay sober ; They are a great team of people ; I really like my mental health counselor ; Court is understanding, accepting, and gives a second chance ; It has been a positive experience ; Court was very fair, listened when I had problems, and gave me chances. Universal praise for transportation assistance. All participants who were interviewed reported that they are benefiting from the bus passes and tokens the court is providing them. These benefits include the ability to attend court sessions, substance abuse and/or mental health treatment, and other court related appointments. The following are quotes taken from participants in regards to the transportation enhancement: I wouldn t be as successful without the bus pass ; I would have to go back to jail ; It has helped a lot ; I don t have to sit in jail ; I am actually making it to treatment now ; The bus passes have been very helpful and has helped to attend meetings, appointments, and court. Participants reported that visits with treatment staff and the judge did not necessarily help them to stay sober. Seven of the participants who were interviewed identified having at least 1 relapse throughout their involvement with treatment court. (77% participants who utilized the enhancement grant reported having at least one relapse throughout their involvement in treatment court). The participants who were interviewed did not have any specific recommendations on how the program could help them stay sober but did

21 21 acknowledge that they knew using or not using comes down to their own choices. The evaluation team would suggest increasing the number of urine screenings for higher risk offenders for continued drug use, utilization of SCRAM bracelets for monitoring the consumption of alcohol, review motivation of treatment and interactions between counselor and participant and modify treatment accordingly, increase the use of more severe sanctions, and/or increase the amount of community supervision that is being provided to participants with higher chances of relapse. Please see Final Program Recommendation #7 on page 29. Recommendations from participants: 1. Start on time. Participants expressed concerns about court starting on the contracted time. Participants reported having to wait an hour or more at times for the judge to start court proceedings and voiced concerns about how this increases frustration for those who make it on time every week as directed or who are working. 2. Sign-in Sheet. Participants recommended the use of a sign-in sheet to help the order of which cases are called and to reward those who are either early and on time on a weekly basis. 3. Take the good people 1 st. Participants also recommended taking the good people first (those who have continued to make progress and follow the rules) as a reward so they do not have to sit and wait for all mental health, juvenile, and/or drug court participants to talk to the judge. 4. More help with obtaining GED, school enrollment, and vocational training. Only one of the participants, who were interviewed, was currently employed. The other participants, who were interviewed, stated the need for more assistance with either obtaining their GED, information and guidance about school and classes, and one-on-one help with enrollment into school, vocational, and training programs.

22 22 Quality of Life Surveys Of the 48 participants who were utilizing assistance from the enhancement grant, 12 of these participants completed a Quality of Life Self-Assessment. A copy of the assessment can be found in Appendix C on page 44. The participants who were given the assessment had been involved in the program for various time periods ranging from 3-4 months, to 2 years. The assessment asks participants to evaluate their perception of different areas of their life including housing, employment, access to transportation, level of independence and self-esteem, social life and personal relationships, and physical health. Participants rank each item either poor (1 point), fair (2 points), good (3 points), or excellent (4 points), and whether or not drugs and or mental health symptoms are having a severe (1 point), moderate (2 points), minimal (3 points), or no impact (4 points) on their lives. The highest score a participant could obtain, if the participant answered either excellent or no impact for each question is 64. The lowest score a participant could obtain, if the participant answered either poor or severe for each question is 16. The average score obtained by participants was 37; the highest was 52, the lowest was 30. The top 3 areas that appeared to be rated fair or poor by participants are: the amount of money participants have to buy what is needed, involvement with work/employment, and access to transportation (without the assistance of a bus pass and/or tokens). The following is description of how participants answered for each domain within the self-assessment. 80% of participants rated housing as either good or excellent 92% of participants rated the amount of money they have to buy what they need as poor (42%) or fair (50%) 58% of participants rated their involvement in work/employment as poor (41%) or fair (17%). 58% of participants viewed their level of education as good, 25% rated as fair, and 17% rated as poor. Approximately 67% of participants rated their access to transportation as either being poor (33%) or fair (33%) without the use of bus pass/tokens

23 23 50% of participants viewed their social life as being fair, while 50% viewed their social life as being good or excellent Over 50% of participants viewed their participation in community activities as either good or excellent Almost 70% of participants rated their ability to have fun and relax as either good (50%) or excellent Approximately 67% of participants rated their physical health as being good (58%) while 33% rated it as being fair 33% of participants rated their level of independence as fair Over 80% of participants rated their ability to take care of themselves as either good (42%) or excellent Only 17% of participants rated their self-esteem as poor, while most participants rated it as good (50%) or excellent (25%) 75% of participants rated their personal relationships as good (58%) or excellent. The majority of participants (92%) felt that overall, things were going good (67%) or excellent (25%). Only 2 participants reported that drugs and alcohol were having a severe effect on their lives. Only 1 participant reported they felt their mental health symptoms were having severe effect on their life. SCOT Analysis The following SCOT analysis has been created by the evaluation team from courtroom observations and interactions with TDTC staff. The list includes various strengths and opportunities that exist at the TDTC.

24 24 Tonawanda Court Observations Strengths, Challenges, Opportunities, Threats Analysis (SCOT) Strengths Court Coordinator is organized and fully knowledgeable of each court participant s status Defense Attorney appears committed to process and mission of drug court key components While awaiting the Judge s appearance on the bench, participants were interacting with each other Pre-court session case conference with Judge and staff focused on participant compliance and progress Judge s philosophy of fostering participant accountability they sanction themselves Strong adherence to characteristics of teaching honesty, trust, respect, empowerment, and involvement Treatment providers present in courtroom-erie County Medical Center, Horizon, and Reflections Judge s philosophy that the court is one of love and education Judge holds bi-weekly group interactive sessions with all court participants prior to the start of case processing on topics for recovery why is your drug friend not your friend, why do I like/not like my treatment provider (models a group therapy type process with participants) Judge s affirmations appear real and are encouraging to participants with a firm, but warm sensitivity you have matured, you have done well, you have to believe and have faith, I want you in my court Judge attempts to get all participants involved in cases, creating laughter and continuous interaction Judge utilizes Certificates of Outstanding Achievement Sign on the Judge s Bench Drug Court Works exemplifies the tone of the court process, let s be successful Most participants had family members with them in court and the Judge always asked them to the bench with the participant. Opportunities Stronger linkages (including on-site services within the courtroom) with educational systems for GED classes, pre-collegiate studies, and college enrollment for career aspirations and skill building (some of these services could be provided on-site) Erie County DSS Worker on-site Resource Advocate from Horizon Health Services to help participants apply for Medicaid Internship program through local college for supervised on-site case management services for additional assistance with participants Challenges There are cases with co-occurring mental health disorders and juveniles are mixed with adults Participants with limited education and lack of vocational/career skills Continued funding for training of TDTC staff on updates for best practices Consistent communication between pre-court case conference and court proceedings Threats Participants are unable to afford treatment and/or transportation Limited number of treatment providers Lack of services to address and support ongoing challenges with transportation and housing

25 25 Quantitative Findings, Results, and Analysis Quantitative data was collected from participants (n=48) who were utilizing the supplementary services (counseling services and transportation) that were added via the enhancement grant. Key Findings concerning demographic and psychosocial characteristics, program completion rates, recidivism, and the types of treatment will be presented and discussed in the following sections. 1, 2% Program Status 8, 17% 14, 29% 25, 52% Active Completed Failed Out Transfer Of the eight participants who failed out of the program, one participant received a new charge and was transferred to DWI court in the City of Buffalo and another participant was transferred to the Niagara Falls Treatment Court due to living arrangements. Participant Income 6, 13% 3, 6% 3, 6% 36, 75% None SSI/SSD $15,000-$20,000 $25,000-$30,000 75% of participants reported no income

26 26 Participant Education 14, 29% 3, 6% 3, 6% 9, 19% 19, 40% 8th-9th grade 10th-11th grade High School Diploma GED COLLEGE 17 of the participants reportedly did not earn a GED or a High School Diploma, accounting for 35% of the total number of participants utilizing the enhancement grant. This information can be compared to data input into the Universal Treatment Application from the start of the grant period (10/1/2010 to 12/31/13), in which 76 (n=208) participants reported not having earned their high school diploma and 23 (n=208) participants reported not earning their GED. Of the 11 TDTC participants who began GED classes, only one completed their high school equivalency. Please see Final Program Recommendation #8 on page 29. Participant Recidivism Rates while in Treatment Court 15, 31% 33, 69% Y N 31% of participants utilizing the enhancement grant had rearrests while participating in treatment court. Over half of the participants reported they had their first arrest at the age of 15 or before and 33% were arrested at the age of 16. Please see Limitations to Program evaluation on page 28 concerning recidivism data.

27 27 History of Chemical Dependency 18, 38% 30, 62% Y N Approximately 62% of participants utilizing the enhancement grant reported having a history of chemical dependence, with the top 3 drugs of choice being marijuana, alcohol, and opiates and over one third (37%) of these were diagnosed as having a dependence to at least 2 substances. Over half (52%) of the participants reported being between the ages of 10 and 15 and 33% reportedly first used a substance at the age of % of participants reported having at least one relapse while involved with treatment court. Treatment Provided 1, 2% 9, 19% 38, 79% Substance Abuse Mental Health Both Almost 80% of participants are currently engaged in outpatient treatment for substance abuse, 19% are engaged in both mental health and substance abuse treatment. Almost all of the participants reported attending either substance abuse or mental health treatment in the past including inpatient, outpatient, and residential services; one participant reported no prior involvement in treatment.

28 28 Limitations to Program Evaluation The evaluation team encountered a few challenges when conducting the program evaluation. Due to the limited number of participants (n=48) who were utilizing the enhancement grant, and the use of self-report assessments our statistical findings were based on inferential trends rather than statistically significant conclusions. Accessibility to the Universal Treatment Application and/or the utilization of a centralized data management system for program outcomes would have created more opportunities to report on more specific participant data, including statistically significant cross-referencing between users of the grant and the general court population in the TDTC. Additionally, tracking of recidivism in both the TDTC and the greater 8 th Judicial District can be a challenge. Centralized data collection across the 8 th JD, including in-intakes completed in jail, could help identify both active and inactive problem solving court participants. Examples of these data systems are HIPAA compliant and can be modified to restrict access and permissions of clients outside of the TDTC s direct supervision. However, the TDTC and other problem solving courts would be able to easily and quickly identify participants that have recidivated. This would also aid in allowing evaluators to monitor participant progress at 1 year, 2 year, and 3 year intervals after either successful completion or failure of the TDTC program. This data could be extremely significant in identifying trends that lead to long term success as well as failure in the problem solving court environment.

29 29 Final Program Recommendations 1. Improve consistency between what is discussed during pre-court treatment team meetings and what is done by the presiding judge during Treatment Court proceedings. 2. Improve time management of court schedule by starting at the scheduled time. 3. As a team, discuss the benefits of separating drug court and mental health court per court and participant needs and develop a plan to do so accordingly. 4. Mandate that participants utilize and prove participation in self-help groups, during treatment court involvement, as proof of participation in an ancillary service. 5. Mandate community service for participants to promote the development of pro-social interactions and involvement within the community 6. Continue seeking funding for bus passes/tokens. Future opportunities may become available between public transportation and judicial systems to assist with consistent transportation for treatment court participants. 7. Utilize SCRAM as an incentive or sanction for appropriate participants by seeking assistance and consultation about what participants would best benefit from using a SCRAM bracelet. 8. Strengthen on-site GED services and utilization of vocational services and programming. o Continue linkage with Erie County Community College s Education 2 Recovery Program for intensive academic and vocational case management services. o Encourage partnership, including on-site visitation with New York State Adult Vocation and Rehabilitation Services. 9. Improve pre-release and aftercare planning for participants and create follow-up procedures for participants who graduate from the program for longitudinal data tracking for program outcomes. 10. Create linkages and/or on-site accessibility for co-dependency support groups and programs for parents and family members of participants. 11. Improve communication with treatment providers about the fees and pay schedule for initial intake and counseling fees for participants who are determined unable to pay for these services or who have limited ability to pay. 12. Improve communication with Resource Advocate at Horizon Health Services by developing an on-site visitation schedule. 13. Increase training attendance by TDTC staff by creating a yearly training schedule for team members to attend to stay up to date on best practices.

30 30 Directions for Future Research There is a continuous need for post grant research that identifies participant and program outcomes in addition to rates of recidivism at 1 year, 2 years, 5 years, and 10 years to support the long term effects a treatment court program has on its participants. A two year timeline does not allow for longitudinal evaluation of the program due to the length of time it may take a participant to successfully complete the program. A study of this type would involve conducting phone and in-person interviews as well as review of crime databases for recidivism and predicative statistical analysis within the judicial system. This type of post-grant evaluation would yield valuable information for modifying best management practices, demonstrating long-term success, and evaluating predictive variables for participant success. TDTC staff and the 8 th Judicial District will be encourage to seek future funding for the following opportunities that may help to support existing projects within the TDTC as well as expanding on supports for current and future participants. 1. Creating a partnership between public transportation and the court system in order to provide a sustainable assistance program for treatment court participants who may be in need of transportation. 2. Creating support programs or expanding on existing programs for treatment of court participants who may be homeless or who are in need of transitional housing 3. Expanding support for pre-release and aftercare planning for participants with follow-up procedures for participants who graduate from the program for longitudinal data tracking for program outcomes 4. Create linkages and/or on-site accessibility for co-dependency support groups and programs for parents and family members of participants