Valerie Bryan 1 Jennifer Havens 2

Transcription

1 Blackwell Malden, FCRE Family XXX Original Bryan FAMILY Association AND Court Articles USA COURT Publishing Havens/KEY Review of Family REVIEW Incand LINKAGES Conciliation BETWEEN Courts, 2007 CHILD WELFARE LINKAGES BETWEEN CHILD WELFARE AND SUBSTANCE ABUSE TREATMENT: SOCIAL FUNCTIONING IMPROVEMENTS AND CLIENT SATISFACTION IN A FAMILY DRUG TREATMENT COURT* Valerie Bryan 1 Jennifer Havens 2 This article summarizes early findings regarding social functioning and client satisfaction from a longitudinal study of women receiving treatment in a family drug treatment court located in the Midwestern United States (N = 33). Drug treatment court participants were interviewed at program entry and when they had completed 6 months of treatment. Family drug court participants reported significant improvements in employment status and increases in earned income after 6 months of treatment. Respondents also reported improved social functioning and high overall levels of satisfaction with treatment. Findings and implications for future research are discussed. Keywords: family drug court; substance abuse treatment; family reunification; parental substance abuse; court-ordered treatment INTRODUCTION The problem-solving court model of drug court treatment has evolved over the last decade into a significant trend affecting a wide range of vulnerable groups whose problems in living involve substance abuse and dependence. Variations on the original criminal courtbased adult drug court that first began in 1989 include: juvenile drug courts, driving under the influence courts, domestic violence courts, and family drug treatment courts (Berman & Feinblatt, 2001; Hora, 2002). Although an accumulation of findings has led to a general perception that adult drug courts facilitate tangible and beneficial changes in participants lives, research pertaining to the family drug treatment court model has lagged far behind (Belenko, 2001). Efforts to evaluate the benefits of drug court for those involved with the child welfare system and family courts because of substance abuse can inform a wide range of concerned groups who seek to improve family functioning and long-term child welfare outcomes. In addition, it may inform potential clients who may become impacted by these systems. The findings from this study of family drug court participants treatment experiences and improvements in functioning are presented in the following summary to illustrate the encouraging possibilities offered by this intervention. THE TRADITIONAL DRUG COURT MODEL As a treatment model, drug courts provide a unique approach by combining long-term substance abuse treatment and criminal justice supervision, both of which have been shown Correspondence: vbryan@usouthal.edu; Jennifer.havens@uky.edu FAMILY COURT REVIEW, Vol. 46 No. 1, January Association of Family and Conciliation Courts

2 152 FAMILY COURT REVIEW to have positive effects for increasing retention of drug-involved criminal offenders in treatment and reducing recidivism and drug use among these individuals (Hiller, Knight, Leukefeld, & Simpson, 2002; Leukefeld, Tims, & Farabee, 2002; Nurco, Hanlon, Bateman, & Kinlock, 1995). Since the early 1990s, the number of jurisdictions using a drug court model has grown exponentially. Compared to 1990, when only one drug court was in operation in Miami (Huddleston, Freeman-Wilson, & Boone, 2004), national data from November 2003 indicated that there were a total of 1,093 drug courts nationwide, comprising 696 adult, 294 juvenile, 89 family, and 14 combined drug court programs. Additionally, 235 adult, 112 juvenile, 66 family, and 1 combined drug court were in the planning stages (American University, 2003). In 2001, it was estimated that 220,000 adults and 9,000 juveniles had received treatment services in drug courts since their inception in 1989 (American University, 2001). The drug court framework is reflected within the Ten Key Components, a set of general standards for drug court intervention established by the Drug Courts Program Office in 1997 (National Association of Drug Court Professionals, 1997). Briefly described, these standards suggest that drug courts should integrate alcohol and other drug treatment services with the justice process; intervene early and swiftly; take a multidisciplinary, nonadversarial team approach to case processing and treatment planning; frequently monitor participants with drug testing and judicial supervision; develop a coordinated response strategy to participant compliance (and noncompliance); forge partnerships and relationships with community agencies and networks to enhance service delivery; and seek continuing education and evaluate drug court effectiveness to improve the treatment offered in drug court programs (National Association of Drug Court Professionals, 1997). TRANSFORMATION OF THE MODEL FOR CHILD WELFARE INTERVENTION While interest in and awareness of the drug court treatment model continues to grow and develop across the nation, an understanding of the unique model of family drug treatment court remains largely unexamined. As noted above, far fewer family drug treatment court programs have been implemented compared with adult and juvenile drug courts. Although family drug treatment courts share the common missions of its adult and juvenile predecessors, important goals and objectives are pursued in family drug treatment court to intervene in child welfare, improve family functioning, and foster the development of home environments that permit reunification of drug-abusing parents and their children. Unique to the family drug court model, not only are substance abuse treatments and court systems combined in efforts to support individual recovery, but also the perspective and representation of the public child welfare system is integrated into the drug court team. This centers the direction of drug court treatment on strengthening families and promoting child health (Family court comes of age, 2001). Substance abuse research has long identified associations between substance abuse and poor parenting practices (Gregoire & Schultz, 2001; Semidei, Radel, & Nolan, 2001). Data from several national studies suggest that 40% to 80% of child abuse and maltreatment cases involve substance abuse (Wingfield, Klempner, & Pizzigati, 2000). Child welfare clients who abuse substances have been found to have greater levels of mental illness, domestic violence, economic and housing instability, and more frequently reside in dangerous living environments. Research in this area suggests that child welfare agencies must do more than make standard substance abuse assessment referrals in these cases (Semidei et al., 2001) and strategies that show promise include a shift in focus from the substance

3 Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 153 abusing parent to the whole family and family environment (Gregoire & Schultz, 2001). However, in order to comply with the Adoption and Safe Families Act of 1997 (ASFA) guidelines requiring termination of parental rights to be pursued when a child has been in foster care for 15 of the prior 22 months, substance abuse interventions for child welfare clients must be swift, intensive, and effective (Karoll & Poertner, 2002; Semidei et al., 2001). Family drug treatment court programs are interventions which emphasize this holistic focus upon strengthening families by offering extensive and comprehensive wraparound services that are individualized to the needs of the substance-abusing parent and affected children, as well as relatives and partners. The model encourages the development of cohesive linkages among stakeholders in the child welfare, substance abuse treatment, and judicial systems. Because child welfare is an active and central focus of the family drug treatment court team, the ability to accommodate and adhere to the demands of the ASFA timeline may also be substantially improved. In order to help participants regain control of their lives, an intensive component of this holistic approach involves addressing employment problems and assisting participants with acquiring and maintaining employment; in fact, diligent efforts to find employment and remain employed are requirements for retention in many drug court programs (Leukefeld, McDonald, Staton, & Mateyoke-Scrivner, 2004). Research shows that rates of substance abuse are highest among those who are unemployed (Townsend, Lane, Dewa, Brittingham, & Pergamit, 1999; Wilkinson, Leigh, Cordingley, Martin, & Lei, 1987). Furthermore, treatment retention and long-term recovery outcomes have also been found to be positively associated with employment status in drug court and other treatment programs (Butzin, Saum, & Scarpitti, 2002; Mateyoke-Scrivner, Webster, Staton, & Leukefeld, 2004; McLellan et al., 1994; Miller & Shutt, 2001; Peters, Haas, & Hunt, 2001; Truitt et al., 2002). Therefore, it appears important to examine the capabilities of treatment programs to facilitate occupational improvements. Within the treatment framework utilized in family drug treatment court programs, social functioning improvements are another set of intended program outcomes worthwhile to evaluate (Huddleston et al., 2004). Additionally, as client satisfaction with treatment has been shown in recent substance abuse research to be associated with improved longterm recovery outcomes (Dearing, Barrick, Dermen, & Walitzer, 2005), it may be useful to examine client levels of satisfaction with treatment received in family drug treatment court. Prior studies of the traditional drug court model have reported problems with client engagement in this form of treatment (Peyton & Gossweiler, 2001), and measures of client satisfaction have been identified as a correlate of treatment engagement (Dearing et al., 2005). Although a growing body of research indicates that adult drug court participants are retained longer in treatment, are more likely to complete treatment, and are less likely to criminally recidivate than those in traditional treatment programs (Belenko, 2001; Peters & Murrin, 2000; Roman, Townsend, & Bhati, 2003), the development of empirical knowledge about the effectiveness of family treatment drug court programs remains in its infancy (Belenko, 2001). At the time of this study, no findings pertaining to family treatment drug court outcomes of any kind could be located within the substance abuse and drug court literature. Therefore, the purpose of this analysis was to explore and describe early treatment experiences among participants from an urban family drug treatment court located in the Midwestern United States in order to begin to address the gap in the literature about this unique treatment model.

4 154 FAMILY COURT REVIEW DESCRIPTION OF THE FAMILY DRUG TREATMENT COURT PROGRAM The intervention under study is a family drug treatment court which enrolls participants who had been referred from the family court division of civil court due to an identifiable substance misuse problem, which the court believes to have contributed to child dependency, abuse, or neglect. Upon referral to the program, the potential participant is assessed by social work clinicians with certification in substance abuse counseling for program eligibility. The program is voluntary, and clients who do not choose to participate continue family court case proceedings in the family court which initiated the referral. The program is based on a 12-month minimum treatment timeline; however, many who have successfully completed this program have required up to 18 months or more of treatment. This drug court follows the model presented in the Ten Key Components and the guidelines set forth by traditional drug court programs by using a phase system, which treats the participant most intensively in the first phase. All participants meet with clinicians and case managers to develop a treatment plan, which contains both standard expectations for all clients and goals identified for each individual s particular circumstances. Substance abuse treatment is provided through mandatory individual and group counseling sessions and mandatory attendance at support groups, which is gradually stepped down as participants successfully complete phases one, two, and three. Participants are regularly drug tested throughout the program with urine screens, though the frequency of testing is also reduced according to the phase of treatment. Regular drug court sessions before the family drug court judge are also required, when case progress is reviewed and participants are encouraged for achieving successes and sanctioned for noncompliance with their program plan. When participants are not compliant with their treatment plan, which may include missing scheduled appointments with drug court staff or linked resources (such as a mental health screening or job interview), missing drug tests, or failing to show for drug court, they receive sanctions that are graduated in severity. The list of possible sanctions is made clear to participants before they agree to participate. Sanctions the court has used include 48 hours to 7 days in jail, increased support group attendance, fines, and demotions to a lower phase of treatment. As the intensity of substance abuse treatment lessens, increased attention is directed toward strengthening social supports, social and occupational functioning, and identifying needed linkages to community resources applicable to the participants situations. Drug court case managers work with clients to seek sources of financial support, including pursuing and obtaining child support; finishing high school or enrolling in higher educational programs; and enrolling in prevocational workshops, job training courses, obtaining employment, or pursuing a preferred career path. Participants also complete a 16-week parenting course offered on-site once they have achieved early recovery, which is usually recognized as completing the first phase. Emphasis is also placed upon the need to improve physical health and to tend to any medical or mental health concerns that may have been overlooked or ignored while participants were in an active phase of addiction. Consequently, as the individual succeeds in early recovery, more responsibility is placed upon them to achieve an overall improved level of life functioning and autonomy. The program s treatment philosophy is to provide a standard, wraparound set of supportive and therapeutic services, while identifying and addressing unique issues of each participant. The intended goal for participants is that, by the completion of the third phase, program graduates will have experienced a prolonged period of recovery from substance abuse or dependence and will have achieved a level of physical, psychological, and behavioral functioning that fosters the development of healthy relationships with their children and reduces the likelihood of system

5 Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 155 reentry. As a participant approaches program completion, drug court staff, including the drug court judge, work closely with the referring family court to advocate for family reunification if desired by the client, often providing written or verbal testimony on the client s behalf. STUDY DESCRIPTION The data presented in this report were collected by researchers from August 2003 through June 2005 during a larger, ongoing process/outcome evaluation of the family drug treatment court program. Data collection procedures were approved through both the drug court site and the affiliated university s Institutional Review Board. To protect the drug court participants privacy, researchers requested and received a Certificate of Confidentiality from the U.S. Department of Health and Human Services in October INSTRUMENTATION The data described in the current report were collected during subject interviews using the Center for Substance Abuse Treatment/Government Performance and Results Act Client Outcome Measures for Discretionary Programs (CSAT-GPRA), the Behavior and Symptom Identification Scale (BASIS-32), and the Mental Health Statistics Improvement Program Consumer Survey (MHSIP). Administration of the CSAT-GPRA was completed in order to meet grantee reporting requirements to the Center for Substance Abuse Treatment. Demographic data, employment, and income findings reported were derived from information collected from this instrument. The BASIS-32 is a self-report survey which has been shown to be valid and reliable across inpatient and outpatient settings, measuring perceived levels of social, behavioral, and psychological functioning (Chun-Chung Chow, Snowden, & McConnell, 2001; Eisen, Wilcox, Leff, Schaefer, & Culhane, 1999). Researchers who tested the psychometric properties of the survey using confirmatory factor analysis found it to be moderately reliable and valid across Caucasian, African American, Asian American, and Latino respondents (Chun-Chung Chow et al., 2001). This instrument is a 32-item scale which assesses the respondent s functioning levels through questions which ask the client to indicate the level of difficulty s/he is experiencing in particular areas (e.g., daily life activities, work, school, household responsibilities, etc.) using a 5-point Likert-scale format from 0 to 4, with 0 indicating no difficulty and 4 indicating extreme difficulty. Reliability analysis of the BASIS-32 for this sample produced a lower internal consistency coefficient than previous research would predict (.67), though within the acceptable range for an exploratory study such as this. The MHSIP collects self-report data on client satisfaction with treatment received. A 2000 research workgroup on the development of the MHSIP found four domains of satisfaction present in the survey, identified as: general satisfaction, access, appropriateness/quality, and outcome (MHSIP Policy Group, 2000). This instrument has also been found to be measurement invariant across Caucasian, African American, Asian/Pacific Islander, and Latino respondents (Arneill-Py, 2004). A 14-item measure using MHSIP survey questions derived from the instrument s original 28 questions was used in the study to ease the reporting burden placed upon volunteer respondents who were interviewed using multiple scales and questionnaires. Cronbach s alpha for the study s sample on the adapted MHSIP was.90, indicating high reliability. Factor analysis of this sample s responses confirmed that the four-domain structure of the instrument was retained in its adapted form.

6 156 FAMILY COURT REVIEW PROCEDURES Family drug treatment court participants were identified to interviewers when they were accepted into the program, following an orientation phase of approximately 1 month. Female participants were recruited, as the original drug treatment program only accepted child welfare referred mothers. Interviewers met with the participants in a private room at the drug court office, explained the purpose of the study, and invited the participant to enroll in the study. It was explained to the potential research subject that she would be contacted 6 and 12 months after the date of the initial interview to be interviewed again. CSAT-GPRA reporting requirements at the time of this study involved interviewing participants within 2 weeks of the date of program entry, 6 months after program entry, and 12 months after program entry. After informed consent was given, participants were interviewed using the previously described survey instruments, which typically lasted 1 hour. The MHSIP was administered during follow-up interviews but not during the baseline session, because it was not expected that participants would have developed an informed opinion of treatment received in drug court within only a month of program orientation. Subjects interviewed at follow-up were reimbursed for their time and effort with $20 in the form of a check issued by the researchers university. SAMPLE DESCRIPTION Because participants in the study were volunteers, not all clients of the family drug treatment court were enrolled. Also, several participants were fully active in the program before the project began and therefore were not interviewed at baseline. The participation rate of available baseline interviewees was 88%. At the time of this report, 77 program participants had been interviewed at program entry and, of these, 33 participants had been interviewed at 6 months. The reasons for the substantial attrition from the study were because many participants were terminated from the program for noncompliance before they had completed 6 months of treatment and could not be located (n = 23, 53.5% of nonrespondents); several participants had not been enrolled for 6 months at the time of this study (n = 15, 34.9% of nonrespondents); and five (11.6%) were located but refused the interview invitation. One program participant was hospitalized during the time her 6-month interview would have occurred and therefore was only interviewed at baseline and 12 months. It was determined that her results were likely incomparable and should not be included with other participants 6-month observations. Only data from participants who were interviewed at both baseline and 6 months were included in the analysis, in order to examine changes in participants lives after a period of program involvement. By following the required protocol of CSAT-GPRA, participants also were sought and invited to be interviewed at 12 months after program entry, but only five respondents were successfully interviewed at the 12-month window by the time of this report s development; therefore, the third observation window is not reported upon at this time. The administration of the BASIS-32 and the MHSIP were not initiated until after GPRA data collection had begun with respondents, so the available sample size on these measures is smaller. Twenty-eight participants were surveyed with the MHSIP at 6 months, and 24 participants completed the BASIS-32 at both baseline and 6 months to examine changes in social/behavioral functioning over time. Study participants ranged in age from 22 to 43 years, with an average age of 32. The study population of those who completed both the baseline and 6-month interviews was

7 Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE % (n = 17) African American and 48% (n = 16) Caucasian. All were residents of the drug court s jurisdiction. The drugs of choice among participants included cocaine or crack cocaine (52%), sedatives/barbiturates (16%), marijuana (16%), alcohol (12%), and opiates/heroin (4%). At the time of this report, 7 study participants had successfully completed treatment, 6 were terminated before completion, and 20 were still enrolled in the program. DATA ANALYSIS Since data were examined over time among the same participants, paired-sample t tests were utilized to identify significant changes in income. Similarly, in order to examine changes in employment status, which was measured as a dichotomous variable (employed or not), the McNemar s chi-square test for paired sample proportions was conducted. Due to the non-normal distribution of the BASIS-32 data, nonparametric tests were employed to examine changes in scores over time. Specifically, the Wilcoxon signed-rank test was used to examine changes in perceived functioning from program entry through 6 months of treatment, which accounts for differences in ordinal ranks (such as the 0 4 scale used) without inappropriately treating the ranks as interval variables. Both McNemar s chi-square test used here to examine employment and Wilcoxon signed-rank test are recommended procedures for small samples (Agresti & Finlay, 1997). All analyses were performed using SPSS. FINDINGS ON OCCUPATIONAL AND SOCIAL FUNCTIONING AND CLIENT SATISFACTION INCOME Participants (n = 33) reported on average $99.00 from earned wages in the month prior to family drug court entry. By 6 months, the average income from earned wages rose to an average of $572.00, an increase of $ (t = 4.915, df = 32, p <.001). Notably, a decrease was observed in the amount of public assistance payments reported by respondents after 6 months of treatment from an average of $ at baseline to $84.00 at 6 months, which may indicate a trend toward increased self-reliance, but this result was not significant at the p <.05 level (t = 1.916, df = 32, p =.064). EMPLOYMENT Data were available on employment status (0 = unemployed, 1 = employed) for all participants at baseline and at 6 months (n = 33). Employment status was found to be significantly improved after 6 months of program involvement (p <.001) 3, with 17 unemployed respondents at baseline gaining employment by 6 months and 12 employed participants at baseline maintaining employment. Only one of the employed participants at baseline was unemployed at 6 months, while three respondents reported no change in unemployed status. It is important to note that the one previously employed participant who was unemployed at 6 months was enrolled full-time in an educational program at follow-up. BASIS-32 FINDINGS Life functioning in all areas measured showed improvements through decreased levels of perceived difficulty on all 32 items after 6 months in the drug court program, and

8 158 FAMILY COURT REVIEW several functioning improvements were statistically significant (n = 24). Results from this analysis indicated that the largest positive changes in perceived levels of functioning were reported in a reduction of feelings of isolation and loneliness (z = 2.827, p <.002); less fear, anxiety, and panic (z = 1.835, p <.035); less uncontrollable, compulsive behavior (z = 2.157, p <.024); and less dissatisfaction with one s life (z = 2.351, p <.008). CLIENT SATISFACTION Descriptive measures of participants satisfaction with the treatment provided in family drug treatment court were obtained from answers to the adapted MHSIP Consumer Survey administered at 6 months after program entry from 28 participants. Responses were overwhelmingly positive to the treatment experience. Ninety-two percent of participants surveyed agreed to the statement, I liked the services I received, with 15 of these respondents strongly agreeing with the statement. Seventy-five percent of participants indicated that they would choose to receive services from this agency even if they had other options; this is notable given the forced-choice nature of the drug treatment court option in this jurisdiction, with the likelihood of parental rights termination greatly increased when one refuses treatment. Eighty-two percent of participants reported that they would recommend the service to a friend or family member. Ninety-six percent of participants said that drug court staff saw them as often as was necessary, and 89% of respondents said that staff returned their calls within 24 hours. Sixty-eight percent of participants agreed that the location of services was convenient, while 86% of participants stated that the time was convenient for their schedules. Eighty-nine percent believed they got the services they needed, and 96% of participants said that staff believed they could grow, change, and recover. Eighty-six percent of participants felt free to complain, and 96% of participants reported that staff told them what side effects to expect from substance abuse recovery. Eighty-six percent of respondents stated that staff respected their cultural/ethnic background, 89% of participants interviewed believed that drug court staff effectively managed confidentiality requirements, and 96% of respondents said that they received the information necessary to manage the recovery process associated with their addiction. DISCUSSION AND CONCLUSION STUDY LIMITATIONS Reports on substance abuse relapse are notably not included, as this drug court s pre-enrollment orientation process includes intensive crisis intervention and a typical residential treatment stay. This essentially results in no relapses in the prior 30 days reported at the baseline interview, and therefore, improvements were not seen at 6 months; however, relapses at 6 months were not found among the sample, either. Child welfare outcomes also were not evaluated in this study because these data were not captured through participant interviews, and final outcomes of child welfare case dispositions are not known until drug treatment court participants complete treatment. The results from the current study could have been substantially strengthened by the inclusion of and comparison to a control group who did not receive drug court treatment. Although researchers intended to identify a control group sample from a population of family court referred individuals who refused to participate in drug court treatment, permission

9 Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE 159 from and cooperation by the state child welfare agency responsible for the oversight of these cases could not be obtained due to workers caseload constraints and agency concerns regarding case confidentiality. Also, this drug court program did not have an available waitlist from which to alternatively recruit a control sample. Random assignment to a no-treatment condition under these circumstances was not an option, as in the majority of drug court evaluations, because the referring family court s policy was to offer the same opportunity for treatment to all individuals who were willing and eligible to participate (Belenko, 2002). Attrition from the study was an expected obstacle and clearly limits generalizability of any findings due to the small treatment sample. Because the study was linked to participation in drug court treatment by being the primary location for interviewing and maintaining current contact information for participants, arranging interviews with drug court clients who left the program before completing treatment became extremely difficult. A substantial number of participants also continued in treatment when the study took place, but were essentially censored from participating because they had not been enrolled for 6 months and were not due for their CSAT-GPRA follow-up interview (n = 15, 34.9% of nonrespondents). Participants who were interviewed at baseline and 6 months were compared to those who were not on several background characteristics including age, ethnicity, and drug of choice, and on the outcomes of interest at baseline, including employment status, income, and BASIS-32 responses. Significant differences identified between these groups included age of participants and several life functioning items on the BASIS-32 instrument. The average age for those who completed both interviews was 32 years, while the average age for baseline-only interviewees was 28 years. Those interviewed only at program entry reported at baseline (in response to BASIS-32 items) greater difficulties with managing day-to-day life (z = 2.198, p <.029), work (z = 2.143, p <.033), school (z = 2.512, p <.013), developing independence (z = 2.308, p <.022), goals and directions in life (z = 2.719, p <.008), using/misusing drugs (z = 2.025, p <.044), and impulsive, illegal, and reckless behavior (z = 2.001, p <.046). These notable differences in functioning problems at program entry may have increased the likelihood of program failure and therefore study attrition for those who left drug court (n = 23, 53.5% of nonrespondents). These findings suggest that family drug court treatment may have been a more manageable program for those participants who entered the program with better social and behavioral functioning abilities. These methodological limitations all indicate that the promising findings reported here may not be generalizable to other family drug court treatment programs or to individual participants in such programs. However, the study provides an interesting and worthwhile glimpse at this unique and contemporary form of treatment that is increasingly offered as an alternative to family court processing in cases involving parental substance abuse. It should be emphasized that the main purpose of this study is to explore and describe this particular group s drug court experience and to identify how this program s wraparound service delivery and holistic focus works to facilitate improvements in overall life functioning. RESEARCH IMPLICATIONS These preliminary findings reported from family drug treatment court participants are consistent with previous findings from substance abuse research indicating that drug courts and similarly structured interagency collaborative programs can improve social, behavioral, and occupational functioning (Freeman, 2003; McLellan et al., 2003). Substance abuse

10 160 FAMILY COURT REVIEW treatment and drug court studies which have related social stability and socioeconomic status factors to treatment retention, completion, and postprogram recovery suggest that these participants may experience better long-term substance abuse recovery outcomes. If drug court treatment was the key factor in improving these participants functioning levels during program involvement, the drug court may have increased the likelihood of their recovery from substance abuse and dependence (Butzin et al., 2002; Miller & Shutt, 2001; Peters et al., 2001; Peters, Haas, & Murrin, 1999; Truitt et al., 2002). More rigorous study designs for the purpose of identifying causal relationships between program factors and outcomes are needed to establish if in fact the program model can explain functional improvements such as those observed here. While the increases in employment found in this study are notable, employment is a requirement of the program for those considered capable of working, and therefore these changes may merely reflect participants compliance with the program. However, income has been shown to be a critical barrier in the success of child welfare clients attempts to reunify with their children, so this improvement in income, likely achieved through the observed employment gains, is a promising finding for the purpose of this intervention (Wells & Shafran, 2005). The high levels of satisfaction reported are also a positive indicator of potentially better long-term recovery outcomes for these participants. As found by other recent treatment research, satisfaction with treatment is related to program retention (Dearing et al., 2005), and longer stays in treatment programs have been found to improve the likelihood of long-term recovery (Zhang, Friedmann, & Gerstein, 2003). These preliminary findings certainly suggest a need for increased attention to this promising treatment model. Tangible improvements in income and employment status were observed, as well as significant improvements in perceived difficulties in social and behavioral functioning. Enrolled participants also appeared engaged with the treatment provided in drug court across a variety of characteristic dimensions, showing strong receptivity to the program s intervention and implementation plans through high levels of satisfaction. The implications for future research are evident, as this model of drug court treatment has not been extensively explored or studied. More research on family drug treatment court is necessary to investigate this treatment model s capability to successfully treat the target population and to address its complex and challenging child welfare and family preservation goals. Studies with larger treatment samples, comparison groups, and the cooperation of agencies to allow random assignment would all inform the beginning knowledge base regarding this form of treatment. Studies that can further address the multiple intended outcomes of family drug court, like long-term recovery, family stability, and family preservation, would provide important practical information to family courts, child welfare agencies, treatment providers, and families needing a structured intervention. Additionally, these problem-solving, treatment courts should carefully track their own therapeutic processes, successes, and failures in order to inform concerned stakeholders and practitioners about what constitutes best practice in this innovative and comprehensive treatment framework. NOTES * This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT). Points of view in this document are those of the authors and do not necessarily represent the official position or policies of SAMHSA or CSAT.

11 Bryan and Havens/KEY LINKAGES BETWEEN CHILD WELFARE Direct correspondence to: Valerie Bryan, University of South Alabama, Department of Sociology, Anthropology, and Social Work, 34 Humanities Bldg, Mobile, Alabama University of Kentucky, Center on Drug and Alcohol Research, 915-B S. Limestone St., Lexington KY McNemar chi-square test of paired proportions does not report a chi-square test statistic. REFERENCES Agresti, A., & Finlay, B. (1997). Statistical methods for the social sciences (3rd ed.). Upper Saddle River, NJ: Prentice Hall. American University. (2001). Drug court activity update: Composite summary information. Washington, DC: American University, OJP Court Clearinghouse and Technical Assistance Project. American University. (2003). Summary of drug court activity by state and county. Washington, DC: American University, OJP Drug Court Clearinghouse and Technical Assistance Project. Arneill-Py, A. (2004). Measurement invariance of the mental health statistics improvement program consumer survey (Doctoral Dissertation, University of California, Davis, 2004). Dissertation Abstracts International: Section B: The Sciences & Engineering, 65(6-B), Belenko, S. (2001). Research on drug courts: A critical review 2001 update. New York: Columbia University, The National Center on Addiction and Substance Abuse. Retrieved September 25, 2007, from Belenko, S. (2002). The challenges of conducting research in drug treatment court settings. Substance Use and Misuse, 37, Berman, G., & Feinblatt, J. (2001). Problem-solving courts: A brief primer. Law & Policy, 23, Butzin, C. A., Saum, C. A., & Scarpitti, F. R. (2002). Factors associated with completion of a drug treatment court diversion program. Substance Use & Misuse, 37, Chun-Chung Chow, J., Snowden, L. R., & McConnell, W. (2001). A confirmatory factor analysis of the BASIS-32 in racial and ethnic samples. Journal of Behavioral Health Services & Research, 28, Dearing, R. L., Barrick, C., Dermen, K. H., & Walitzer, K. S. (2005). Indicators of client engagement: Influences on alcohol treatment satisfaction and outcomes. Psychology of Addictive Behaviors, 19, Eisen, S. V., Wilcox, M., Leff, H. S., Schaefer, E., & Culhane, M. A. (1999). Assessing behavioral health outcomes in outpatient programs: Reliability and validity of the BASIS-32. Journal of Behavioral Health Services & Research, 26, Family court comes of age as drug court movement flourishes. (2001, October 8). Alcoholism and Drug Abuse Weekly, 13(38), 3 5. Freeman, K. (2003). Health and well-being outcomes for drug-dependent offenders on the NSW drug court programme. Drug and Alcohol Review, 22, Gregoire, K. A., & Schultz, D. J. (2001). Substance-abusing child welfare parents: Treatment and child placement outcomes. Child Welfare, 80, Hiller, M. L., Knight, K., Leukefeld, C., & Simpson, D. D. (2002). Motivation as a predictor of therapeutic engagement in mandated residential substance abuse treatment. Criminal Justice and Behavior, 29, Huddleston, C. W., Freeman-Wilson, K., & Boone, D. L. (2004). Painting the current picture: A national report card on drug courts and other problem solving court programs in the United States (Vol. 1, No. 1). Alexandria, VA: National Drug Court Institute. Hora, P. F. (2002). A dozen years of drug treatment courts: Uncovering our theoretical foundation and the construction of a mainstream paradigm. Substance Use & Misuse, 37, Karoll, B. R., & Poertner, J. (2002). Judges, caseworkers, and substance abuse counselors indicators of family reunification with substance-affected parents. Child Welfare, 81, Leukefeld, C., McDonald, H. S., Staton, M., & Mateyoke-Scrivner, A. (2004). Employment, employment-related problems, and drug use at drug court entry. Substance Use & Misuse, 39, Leukefeld, C. G., Tims, F., & Farabee, D. (Eds.). (2002). Treatment of drug offenders: Policies and issues. New York: Springer. Mateyoke-Scrivner, A., Webster, J. M., Staton, M., & Leukefeld, C. (2004). Treatment retention predictors of drug court participants in a rural state. American Journal of Drug and Alcohol Abuse, 30,

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