Evaluating Reclaiming Futures: Final Performance Review

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1 ...to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire s future. One Eagle Square Suite 510 Concord, NH (603) Fax: (603) Board of Directors Martin L. Gross, Chair John B. Andrews John D. Crosier Gary Matteson Chuck Morse Todd I. Selig Stuart V. Smith, Jr. Donna Sytek Georgie A. Thomas James E. Tibbetts Brian F. Walsh Kimon S. Zachos Evaluating Reclaiming Futures: Final Performance Review Executive Director Stephen A. Norton [email protected] Deputy Director Dennis C. Delay [email protected] Research Associate Ryan J. Tappin [email protected] Office Manager Cathleen K. Arredondo [email protected] Executive Director Emeritus Douglas E. Hall [email protected] November 2007

2 Authors Ryan J. Tappin Research Associate Laura McGlashan Research Associate Acknowledgements The Center wishes to thank the court and probation staff from New Hampshire s juvenile drug courts and district courts for their assistance in gathering data for this report. Ray Bilodeau, Drug Court Clinical Director, Gary Fowler from the Administrative Office of the Courts, and Bill McGonagle of the Division for Juvenile Justice Services were particularly helpful in providing the Center with data. About this paper This paper is the final in a series of reports the New Hampshire Center for Public Policy Studies has published in connection with its independent evaluation of New Hampshire s Reclaiming Futures (RF) initiative. 1 The paper focuses on RF s impact on drug court operations, as well as its impact on youth in the drug court program. The paper is intended for members of the judiciary, juvenile justice professionals and other staff of the state s juvenile drug courts, and anyone else with an interest in juvenile justice in the state of New Hampshire. The Center was hired in 2003 by the Administrative Office of the District Courts to carry out a formal, independent evaluation of New Hampshire s Reclaiming Futures initiative in juvenile drug courts. New Hampshire is one of ten sites nationwide piloting the RF approach. The Center is performing the study in conjunction with a national evaluation, associated with the Chapin Hall Center for Children at the University of Chicago. The evaluation is funded by a grant from the Robert Wood Johnson foundation. 1 Reclaiming Futures is a program funded by the Robert Wood Johnson foundation. <

3 Evaluating Reclaiming Futures: Final Performance Review Contents Executive Summary... 1 Data and methodology... 5 Data sources...5 Limitations of the data... 6 Reclaiming Futures a new approach to helping teens overcome drugs and crime... 8 Teen drug use in NH is higher than the national average... 8 The courts start juvenile drug courts to address the problem of teen drug use... 8 Who are NH s drug court youth?... 9 New Hampshire s Reclaiming Futures initiative Implementing the RF model in NH s drug courts Use of screening has declined over the RF, but universal screening is forthcoming More RF youth received comprehensive assessments Service coordination has improved through central administrative support from RF.. 15 Treatment initiation and engagement Drug court completion remains the same but varies by court Youth spend nine months in the program More youth are being kept in the community One third of youth commit a new drug offense by one year after drug court Discussion Opening communication and standardized screening Introducing Evidence-Based Practices Administrative infrastructure developed, but with an uncertain future Community engagement remains a challenge NH s Reclaiming Futures project lessons learned and drug courts moving forward 28 Appendix Tables and Figures Table 1: Main process measures of the four Reclaiming Futures drug courts by RF program year... 4 Table 2: Admission dates for each RF year... 5 Table 3: Percent of drug court youth population from each jurisdiction... 6 Table 4: Risk factor characteristics of youth in the RF drug courts by jurisdiction... 9 Table 5: Percent of youth graduating drug court Table 6: Average number of drug court events by RF year Table 7: Percentages of youth placed out of the home and in detention Table 8: Prior and during program charges by RF year and termination status Table 9: Subsequent charges by RF year and termination status Figure 1: Percent of youth receiving a screening for AOD issues at intake Figure 2: Percent of youth receiving a comprehensive AOD assessment by RF year Figure 3: Percent of case plans with RF specific quality measures by RF year... 18

4 Evaluating Reclaiming Futures: Final Performance Review 1 Executive Summary New Hampshire has one of the highest rates of teen drug use in the United States, and one of the highest percentages of youth who need treatment but do not receive it. 2 Moreover, drug charges against New Hampshire juveniles have increased by 60 percent between 1996 and 2002, even as the overall total delinquency charges declined. 3 In an effort to respond to this problem, seven of New Hampshire s 36 district courts have started juvenile drug court programs. Juvenile drug courts connect youth offenders to a coordinated system of drug and alcohol treatment in their communities, combined with the provision of strict court supervision and sanctions. To support their efforts to improve treatment for youth in the court system, the district courts sought and received funding from the Robert Wood Johnson Foundation for the Reclaiming Futures (RF) initiative. RF s main goals for improving juvenile drug courts have been to ensure that all youth receive a clinical assessment to identify treatment needs, coordinated treatment based upon a written case plan, and involvement in community activities that will strengthen their chances of success. Another primary goal of RF has been to institute standardized drug and alcohol screening for all youth entering the court system. To these ends, RF has funded a variety of activities, including training in evidence-based practices as well as staff to help volunteers develop activities for youth. RF has also funded administrative support for drug courts to improve the treatment approach and standardize those improvements across the drug court programs. This report focuses on the original four juvenile drug courts, which were the target of RF in New Hampshire. This paper is the final in a series of reports designed to provide ongoing feedback to those working with RF and the juvenile drug courts. It reviews data evaluating the RF program on a variety of different measures, focusing on RF s impact on drug court operations, and its impact on youth in the program. 1. New Hampshire s juvenile drug court system is managing a very troubled population of youth. Over half of the youth were multiple drug users, 71% had immediate family members who used substances, and 65% had a mental health issue of some kind identified before or during the program. During RF, these characteristics remained consistent, but some variation across jurisdictions existed. 2. RF has successfully put tools into place to centralize and standardize drug court operations. When RF started, the drug courts had no written guidelines or 2 Youth Risk Behavior Survey (YRBS), 2003 and the Substance Abuse and Mental Health Services Administration (SAMHSA) Household Survey of Drug Use, National YRBS data are available at New Hampshire data are available at SAMHSA data are available at 3 New Hampshire Center for Public Policy Studies. Teen Drug Use and Juvenile Crime. December 2004.

5 Evaluating Reclaiming Futures: Final Performance Review 2 standards, no way to aggregate or share information about program operations, and no methods for tracking progress towards goals. One drug court case managers was responsible for clinical supervision of all the programs. RF devoted considerable resources to improving these shortcomings by developing the drug courts administrative infrastructure. The tools RF put into place including the development of a drug court manual, the institution of a data-driven case management system, and the provision of administrative supports have helped to sustain the drug court model and expand it to other jurisdictions. The tools will also support RF s coordinated treatment approach, and allow for individual case management and ongoing program evaluation. 3. RF has been successful in instituting a standardized alcohol and drug screening process for all youth entering the court system, which opened communication between departments. RF succeeded in bringing the courts and the Department of Juvenile Justice Services (DJJS) together to jointly create a standardized screening process for all youth in the juvenile justice system. This is a significant accomplishment as several major barriers to implementing such a system existed. The use of a standardized screening tool is currently being implemented in the drug courts, and is expected to expand to all juvenile courts. This collaboration successfully fostered open and regular communication between the courts and DJJS. It remains to be seen whether this communication will continue after RF advisory meetings have been reduced. 4. RF has made significant progress toward its goal of ensuring that every drug court youth receive a comprehensive assessment. The number of drug court youth receiving a comprehensive assessment, as well as the number of assessments that were completed in a timely manner increased substantially over the course of RF. Moreover, the number of clinicians using an evidence-based tool, the Global Appraisal of Individual Needs (GAIN), has increased as well. RF has been the primary force driving the expansion of the GAIN in New Hampshire. 5. Despite the system changes and increased use of assessments, data on other main process measures have shown both decreases and inconsistencies. a. Screenings: Despite the successful institution of a system-wide alcohol and drug screening tool, the number of drug court youth who were screened for substance abuse problems has declined over the RF initiative. The decline may be largely related to the loss of administrative supports, which necessitated a change in screening procedures, and by direct referrals of youth to a comprehensive assessment in lieu of screening. b. Case plans: The use of written case plans increased slightly from before RF to RF. However, the quality of those case plans has generally decreased. And, there have been significant inconsistencies in the use and quality of case plans both across the RF years and jurisdictions, and even within the same jurisdiction. c. Program Completion: The percentage of youth completing drug court has remained constant since the RF initiative began. The number of graduates

6 Evaluating Reclaiming Futures: Final Performance Review 3 and youth removed from the program for non-compliance varies widely by jurisdiction and RF year. 6. Pro-social engagement and treatment access in the community continues to be a challenge. Although data were not available on the number of Pre RF youth involved in community activities, data collected by drug court staff indicate that 93% of youth in the later RF years were involved in community activities at some point in the program. However, few youth were engaged weekly and challenges to connecting youth with strength or interest based activities still remain. It is noteworthy that over the course of RF, fewer youth were placed outside the home. This suggests that more youth were successfully treated in their communities, and fewer youth were held in detention. 7. Recidivism rates of RF youth require further study. Almost half of drug court youth committed at least one new drug-related offense within two years of ending the program. Eighty-eight percent of youth incurred any new charge (drug and non-drug related) within the two years. However, the small number of youth with sufficient time elapsed after drug court makes a comparison of Pre RF to RF youth not possible. 8. Key data including the lack of severity of alcohol and/or drug problems, socioeconomic status, and presence of a concurrent mental health disorder are not readily accessible to those working in the juvenile justice system, and in some cases are missing altogether. The lack of accessible data prevents not only the meaningful evaluation of the drug court program that takes into account all factors influencing outcomes, but also the determination of the most appropriate and cost-effective interventions for juvenile offenders system-wide. 9. Despite RF s efforts to create consistency across the various drug court programs, the analysis shows a great deal of variation by jurisdiction in factors critical to understanding the potential success of RF. This is particularly evident with the use of out-of-home placement and the number of youth receiving comprehensive assessments. Sanctions, rewards, program admission and termination, and most services are carried out by the order of the presiding judge. Although drug court guidelines have been established, variation across courts remains. The jurisdictional variations in outcomes suggest that judicial leadership has played an important role in the drug court program and should be a critical consideration going forward.

7 Evaluating Reclaiming Futures: Final Performance Review 4 Overall, many process measures, highlighted in Table 1, have indicated an improvement in drug court operations over the course of Reclaiming Futures. It remains to be seen if these changes will continue in the drug courts as the financial support from RWJ has ended, and if the inconsistent measures will improve as operations become more institutionalized. Table 1: Main process measures of the four Reclaiming Futures drug courts by RF program year Drug Court youth Total youth Screened Assessed Engaged in community activities Written case plan completed Graduated Pre RF 41 93% 78% 56% 59% RF Year % 75% No data 58% 50% RF Year % 88% 74% 67% RF Year % 97% 93% 66% 48% Total RF % 85% N/A 64% 53% Total drug court youth % 83% N/A 62% 55% However as a result of program differences across the courts, inconsistencies in data availability, and the small numbers of youth in drug court documenting the full impact of drug courts will require further study into these variations and their effect on outcomes of interest that are beyond the scope of this report. Because of RF, the tools for ongoing program evaluation and outcomes research are now available internally. In the future, the courts should continue the resources necessary to carry out and improve evaluating the drug courts as well as continue to develop baseline performance goals and different definitions of youth success as a method to compare and measure program performance.

8 Evaluating Reclaiming Futures: Final Performance Review 5 Data and methodology The Center s evaluation compares drug court youth before Reclaiming Futures (RF) started in 2003 and to youth in drug court during the initiative, on a number of service and outcome measures. The youth in the study are from New Hampshire s four original juvenile drug courts in Concord, Laconia, Nashua and Plymouth. Youth were followed from the start of drug courts in August 2001 through the end of Table 2 shows the breakdown of the admission dates for each of the RF years. 4 Table 2: Admission dates for each RF year Program year Date of admission Pre RF August 1, 2001 June 30, 2003 RF year 1 July 1, 2003 June 30, 2004 RF year 2 July 1, 2004 June 30, 2005 RF year 3 July 1, 2005 June 30, 2006 Data sources The Center used several data sources throughout its evaluation of RF. Most of the data used in this report were gathered by Center staff from drug court youths paper files. The Center has also gathered qualitative data by attending RF trainings and meetings, and through interviews with drug court staff. Other data was provided by drug court staff to the Center and/or was obtained from administrative sources. A detailed description of the various data sources follows. 1. Drug court paper files The drug court youths paper files contain detailed information on drug and mental health assessments, case plans, youth alcohol and drug severity characteristics, 5 and the contents of all judicial orders issued during the program. Research staff reviewed these files at the courts and recorded their contents in a custom-made research database. 2. Drug court administrative database Drug court has implemented a case management database, funded by RF, to replace the old spreadsheet data collection protocol used by drug court staff. The Center used data collected in this database to describe treatment received, pro-social engagement, and community service participation. These data represent 71 RF youth in the later project years through July 1, Where noted, the Center also used data from the original drug court spreadsheets, which contain data on drug court youth admitted through December 31, The Center considers the start date for the RF years to be July 1, 2003, when RF began its trainings and interventions with drug court staff. The Center assigned any cases that were open on July 1, 2003 to the RF group if the youth served the majority of his or her time in drug court after July 1, 2003, under the RF intervention. 5 Assessments, case plans, and drug use history were often missing in the drug court paper files.

9 Evaluating Reclaiming Futures: Final Performance Review 6 3. Court charges data Charges data were obtained from the Administrative Office of the Courts database. 6 The data set received contained all youth charges from 2000 through June 2006 from all courts in the state of New Hampshire. 7 The data include charges occurring one year prior to a youth s entry into drug court, and charges occurring during and after drug court for 109 participants who were either graduated or terminated from the program. Limitations of the data Few youth in drug court creates a challenge to evaluation The small scale of drug court in New Hampshire creates challenges in statistically evaluating the underlying causes of any changes witnessed in the data. Ideally, the Center would compare Pre RF and RF youth by jurisdiction, while controlling for other factors likely to impact the outcomes being evaluated. Because of the small number of participants, however, most of the analyses aggregate data across jurisdictions when comparing Pre RF and RF youth, or by RF program year. Table 3 details the percent of youth from each jurisdiction in the Pre RF and RF groups to date. The percentage of youth from each jurisdiction varies across these groups, making it important to understand the variation between jurisdictions when analyzing differences between these groups. For example, Plymouth youth are much more heavily represented in the Pre RF group than the RF group. Thus, any unique conditions relating to these youth are more likely to have affected the Pre RF group. Table 3: Percent of drug court youth population from each jurisdiction Jurisdiction Percent of Pre RF group Percent of RF group Percent of total youth Concord 7% 25% 19% Laconia 27% 20% 22% Nashua 24% 28% 27% Plymouth 41% 27% 32% Total 100% 100% 100% Events that occur throughout a drug court case (such as placements or judicial orders) are analyzed based on RF years 1 through 3, and the total RF category reflects the sum of these three years. Data for youth admitted after RF year 3 has been only included when discussing AOD screening prior to admission to the program. 6 Youth dockets were retrieved from the database using the youth s full name, data of birth, address, and filing data of the index docket. Corrections to typographic errors and date of births were made; these dockets were then grouped by name and matched to the project s study ID in order to maintain confidentiality 7 Due to the implementation of a new statewide court database system, data from the Concord and Nashua courts were collected through the end of 2005.

10 Evaluating Reclaiming Futures: Final Performance Review 7 Data are missing on several factors that predict youth success, which prevents rigorous comparisons Important factors in predicting program success and outcomes could not be consistently measured using the court files or administrative data. These factors include AOD abuse severity as measured by a standardized evaluation instrument, mental health history, socioeconomic status, health status and insurance coverage, employment at entry into and exit from the juvenile justice system, and educational attainment. The Center also was unable to obtain specific data on the types and amount of substance abuse and/or mental health treatment services. Additionally, a youth who moved out of state or committed an offense outside of New Hampshire would not have his or her charges reflected in the Administrative Office of the Courts database; therefore, youths total number of prior or subsequent charges may have been underreported. Furthermore, the Center set out to perform a matched comparison study of drug court youth versus youth who were traditionally adjudicated in juvenile courts without drug court programs. Due to the lack and inconsistency of key data for youth in the traditional juvenile courts, including severity of an alcohol and/or drug abuse problem, socioeconomic status, and the presence of a concurrent mental health disorder(s) all strong predictors of recidivism 8 the Center could not be certain that comparison youth were truly representative of a drug court population. Therefore, we could not compare the two groups. 8 McClellan AT, Lewis DC, et al. Drug Dependence, a Chronic Medical Illness. JAMA. 2000; 284:

11 Evaluating Reclaiming Futures: Final Performance Review 8 Reclaiming Futures a new approach to helping teens overcome drugs and crime Reclaiming Futures 9 has sought to improve the quality and appropriateness of treatment received by substance abusing youth offenders while under the supervision of the juvenile justice system. The initiative s staff and advisory board have worked to make these improvements not by offering new programs, but by changing the way the treatment and juvenile justice systems interact with one another and respond to young offenders with substance abuse problems. The initiative focused its efforts on youth in New Hampshire s four original juvenile drug courts. Teen drug use in NH is higher than the national average An estimated 12 percent of New Hampshire teens, or 13,600 young people, have a problem with alcohol or drugs or both. 10 According to two independent surveys, a significantly higher percentage of New Hampshire teens use marijuana, as compared to youth across the nation. Alcohol and cocaine use is also higher than the national averages. 11 Furthermore, the SAMHSA survey indicated that New Hampshire is among the top ten states for the percent of teens needing but not receiving treatment for drug abuse. Over 7,000 adolescents under age 17 in New Hampshire do not receive the alcohol or other drug treatment services they need. 12 The seriousness of New Hampshire s juvenile drug problem is affirmed by the state s court statistics. Although rates of juvenile crime in most categories are low and falling in New Hampshire, the arrest rate of juveniles for drug crimes is the ninth highest in the United States. Drug charges against New Hampshire s juveniles rose by 18% between 2000 and The courts start juvenile drug courts to address the problem of teen drug use In an effort to address the problem of teen drug use, New Hampshire opened its first juvenile drug court at Plymouth District Court in The following year, three more drug court sites were added in Laconia, Concord, and Nashua. Three more drug courts have since begun operations in Claremont, Derry, and Berlin, with plans for continued expansion. The juvenile drug court program is designed to connect non-violent, drug involved youth offenders to alcohol and drug treatment in the community, combined with strict court 9 Reclaiming Futures is a project financed by the Robert Wood Johnson Foundation and managed by New Hampshire s Office of the Administrative Judge of the District Courts 10 Substance Abuse and Mental Health Services Administration survey 2002 and 2004 available on the web at > Accessed 20Sept Ibid. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance Survey, available on the web at < Accessed 20Sept Ibid. 13 New Hampshire Center for Public Policy Studies, Teen Drug Use and Juvenile Crime, December 2004.

12 Evaluating Reclaiming Futures: Final Performance Review 9 supervision and sanctions. By addressing youths substance abuse and other issues that contributed to criminal behavior, the program aims to improve the quality of their lives relationships, school and/or job performance, extracurricular activities and community connections and, ultimately, to end further illicit drug use and crime. Who are NH s drug court youth? As a group, drug court youth are troubled. A review of the youths individual case files revealed that many of their families are in crisis. Many drug court youth experienced significant trauma during their childhood: financial hardship, divorce, the death or incarceration of a loved one, domestic violence, physical abuse, sexual molestation, and suicide attempts. Youth enter the program with a wide range of challenges and needs. Sixty-nine percent of juveniles admitted to drug court had prior delinquency charges. 14 More than half of youth were multi-drug users 15 who began using at an early age 12 years old on average. Seventy-one percent of youth had at least one parent, grandparent, or sibling with a history of substance abuse problems. In spite of these complex drug histories, only 34% received substance abuse treatment before entering drug court, as shown in Table 4. Table 4: Risk factor characteristics of youth in the RF drug courts by jurisdiction Concord Laconia Nashua Plymouth Overall Demographics Average age at entry to drug court (years) Gender (% male) 84% 56% 67% 74% 68% Race (% white) 76% 94% 66% 94% 85% AOD History Average age of first use (years) Multi-drug user (uses other drugs in addition to marijuana and alcohol) 53% 58% 59% 55% 56% Received substance abuse treatment prior to drug court 41% 18% 47% 37% 34% Had parent/sibling/grandparent with a history of substance abuse 79% 64% 71% 70% 71% Mental Health 16 Received counseling prior to drug court, but had no diagnosis 75% 67% 54% 73% 67% Prior mental health diagnosis upon admission 38% 18% 29% 49% 34% Variation across the jurisdictions exists, particularly with race and with prior treatment. The two urban courts, Concord and Nashua, have a far great proportion of minority youth participating in drug court. In contrast, the two rural courts, Laconia and Plymouth, have few youth who received AOD treatment services before admission to the program. When 14 Not including the charge that initiated the referral to drug court. 15 Multi-drug user is defined as using drugs in addition to marijuana, alcohol and/or tobacco. 16 Due to missing data, mental health measures were based on only 64% of drug court youth.

13 Evaluating Reclaiming Futures: Final Performance Review 10 these data are aggregated by RF year or by termination status, there is little variation across the risk factors measured. 17 New Hampshire s Reclaiming Futures initiative RF has been working with the courts, probation, private treatment providers, and community groups to change how the juvenile justice system responds to young offenders who are involved with alcohol and drugs. RF sought to strengthen and improve the drug court programs by emphasizing comprehensive clinical assessments, coordinated services, individualized case plans, and youth involvement in community activities. In addition, RF worked with the courts and DJJS to implement a new screening procedure to identify alcohol and drug problems among all youth in the juvenile justice system, not just those involved in drug court. Juvenile drug courts were originally funded with a combination of court, state agency, and federal grant funds. As the program developed and outside funds were depleted, the courts restructured and reduced staffing. When RF started, three of the four drug court programs had been in operation for less than a year. There were no written guidelines or standards, no way to aggregate or share information about program operations, and no methods for tracking progress towards goals. One drug court case manager was responsible for the clinical supervision of all the programs. RF has devoted considerable resources to overcoming these shortcomings by developing the administrative infrastructure that includes a data-driven case management tool and drug court operations manual. In addition to providing administrative support, the RF initiative has been working toward the following specific goals: 1. Institute standardized screening to identify potential alcohol and drug use for every youth referred to the juvenile justice system, not just those in drug court, beginning in the four RF drug court jurisdictions. 2. Standardize and monitor drug court operations to provide a foundation for system improvements and track adherence to the RF coordinated services model. 3. Ensure that every RF drug court youth receives a comprehensive clinical assessment to assess severity of alcohol and drug use using a standardized, comprehensive assessment tool. 4. Ensure that every RF drug court youth receives coordinated, comprehensive services, using an individualized case plan that provides for the youth s involvement in appropriate treatment and positive activities to improve rehabilitation. 5. Improve treatment completion and drug court outcomes by ensuring the drug court programs adhere to the new, coordinated treatment model. The following sections of this report review RF s progress toward each of the goals, assess how well the RF model has been integrated into the drug courts, and analyze the 17 See Tables A-2 and A-3 in the appendix.

14 Evaluating Reclaiming Futures: Final Performance Review 11 recidivism of youth entering drug court before and during the RF initiative. The final section discusses RF s overall impact on the provision of youth services in the drug court program and examines implications for the future. Implementing the RF model in NH s drug courts Use of screening has declined over the RF, but universal screening is forthcoming One of RF s main goals has been to institute alcohol and drug screening for all youth entering the court system, beginning in the four RF drug court jurisdictions. Yet, the use of youth screenings has declined over the course of the initiative. Almost all Pre RF youth 93% had an AOD screening at intake. In the early RF years, youth referred to drug court were screened by drug court coordinators using various instruments, including a structured interview, the SASSI, and/or the CRAFFT. However, none of the youth who entered drug court after RF year 3 received a screening for potential substance abuse problems, as shown in Figure 1. Figure 1: Percent of youth receiving a screening for AOD issues at intake 100% 90% Youth receiving an AOD screening 80% Percent of drug court youth 70% 60% 50% 40% 30% 20% 10% 0% Before RF RF year 1 RF year 2 RF year 3 After RF year 3 Several factors may have contributed to the decline of screenings. The abolishment of the drug court coordinator positions as of the summer of 2006 reduced the level of administrative support, which may have led to the decrease in screenings for potential drug court youth. It is also possible that drug court staff may be directly referring some youth for a comprehensive assessment in lieu of screening. Furthermore, since RF has moved universal screening in the juvenile justice system forward, drug court staff may

15 Evaluating Reclaiming Futures: Final Performance Review 12 have reduced the use of other screening instruments in anticipation of the new screening protocols. Recently, RF succeeded in bringing the courts and DJJS together to jointly create a standardized screening process for all youth in the juvenile justice system. This is a significant accomplishment as there were several major barriers to implementing such a system. Barriers included opposition to screening by defense attorneys, and a lack of collaboration and the inability to come to a consensus among other key players, including the courts and juvenile probation. RF, the courts, and DJJS have agreed both on a screening tool, the Global Appraisal of Individual Needs Short Screen (GAIN-SS), and a procedure for implementation. Together they developed guidelines for administering the screening. These specify that the GAIN-SS shall be completed by the youth s probation officer upon a plea of true, or the entry of a finding of true by the court. If the youth refuses to participate with the GAIN-SS, the judge has the option to order a pre-dispositional investigation (PDI) and/or a mental health and substance abuse comprehensive assessment. Use of the GAIN-SS is currently being implemented in the drug courts and its use is expected to expand to all other juvenile districts in the near future. More RF youth received comprehensive assessments Part of the RF initiative was to ensure that every drug court youth receive a comprehensive clinical assessment to identify substance abuse problems as well as other treatment needs. Comprehensive assessment is considered necessary to ensure that the nature and severity of substance abuse problems are fully understood, and to identify mental health problems and other issues that may have implications for treatment. 18 In fact, 24 percent of youth who were assessed during drug court were found to have mental health problems that had never been identified previously. 19 To support its goal of ensuring youth receive comprehensive assessment, RF has worked toward instituting a new standardized clinical assessment tool that has been proven to consistently identify substance abuse as well as physical and mental health problems: the Global Appraisal of Individual Needs, or GAIN. Use of the GAIN has increased considerably The GAIN is an intensive, 64-page assessment tool that contains questions on substance use, health, and social functioning. It returns numeric scores as well as a narrative assessment report. Extensive training and certification are required before clinicians can administer the instrument. Before RF, there were no clinicians in New Hampshire certified in the use of the tool. 18 Allen J. Assessment of Alcohol Problems, An Overview, National Institute on Alcohol Abuse and Alcoholism, 19 New Hampshire Center for Public Policy Studies. Evaluating Reclaiming Futures: Performance Review 3. May 2006.

16 Evaluating Reclaiming Futures: Final Performance Review 13 RF has been the primary force driving expanded use of the GAIN in New Hampshire. It has provided extensive training and support. In previous reports, the Center found that adoption of the GAIN still posed a significant challenge for RF. Only three clinicians had been certified to use it and no GAIN assessments had been conducted. 20 It is projected that by the end of 2007, over 75 clinicians state-wide will have been trained to administer the GAIN, including 6 trainers. Regional trainings for providers are now held twice yearly. Furthermore, two of the state s ten community mental health centers are using the GAIN for youth assessment. 21 RF also has worked to have the GAIN approved as eligible for payment by Medicaid and the state. Originally, the Department of Health and Human Services (DHHS) did not recognize the GAIN as a reimbursable service. RF met with Medicaid administrators to explain what a GAIN assessment includes and to clarify the procedures necessary for payment. Together, RF and DHHS distributed this information to the judiciary, juvenile probation staff, and providers, who now understand the appropriate language to use to ensure payment for services. These interventions by RF were critical steps in supporting the growing acceptance and expanded use of the tool. Additionally, RF has played a critical role in convincing a major adolescent substance abuse treatment initiative to use the GAIN. RF succeeded in influencing the administrators of the new Adolescent Treatment Initiative (ATI) 22 to require all of its providers to use the GAIN. 23 ATI is a major initiative that is currently funding $5 million in adolescent substance abuse treatment across the state, so its adoption of the GAIN was a significant step toward continued and expanded use across the state. Finally, acceptance of the GAIN has been facilitated by the fact that it could improve the quality of treatment outside of the drug court programs for all New Hampshire youth. The GAIN s numeric scores allow providers to measure treatment outcomes, improving the state s ability to focus on treatment that works. In addition, some federal grants now require the use of the GAIN, so certified providers stand well-positioned to apply for those grants and bring new resources into the state. Overall, RF has facilitated an increase in pressure on evidenced-based tools, which will allow use of the GAIN to be sustained beyond RF. Use of the GAIN in drug court has also increased considerably. At the end of 2006, 35 drug court youth had been assessed using the GAIN, which is 30% of all RF youth and 53 % of those in RF Years 2 and 3. It remains to be seen whether use of GAIN assessments will improve outcomes, and whether drug court youth who receive GAIN assessments are being more appropriately 20 New Hampshire Center for Public Policy Studies. Evaluating Reclaiming Futures: Performance Review 2. November Maria Gagnon, MSW, Assistant Director, NH Adolescent Treatment Initiative, October ATI is funded by the New Hampshire Charitable Foundation and administered by New Futures, a private, non-profit advocacy group that works to reduce substance abuse in New Hampshire. 23 As described at a public meeting on the Adolescent Treatment Initiative in 2004.

17 Evaluating Reclaiming Futures: Final Performance Review 14 matched with services compared to youth who do not receive the GAIN. In previous reports, the Center found that most non-gain assessments were fairly comprehensive: 84 percent identified alcohol and drug problems, 88 percent found mental health issues, and 41 percent noted strengths. 24 These percentages are comparable to those found in the GAIN assessments completed during RF. Overall, the use of assessments in drug court has increased The Center recorded every assessment contained in a youth s drug court paper file. This count included assessments by licensed alcohol and drug counselors, comprehensive assessments by psychologists and other clinicians, pre-dispositional investigations (PDIs) by probation officers that included an AOD assessment, and/or GAIN assessments. 25 Any one of these assessments identify the severity of a youth s alcohol and drug problems and meet the standards for comprehensive assessment set by RF in the drug court manual. In Performance Review 3, the Center found that the use of assessments in drug court had not increased. Since that time, the Center finds that there has been a substantial increase in the use of assessments, particularly during RF years 2 and 3, as shown in Figure 2. Eighty-eight percent of RF year 2 youth and 97% of RF year 3 youth received an assessment. This is a substantial increase over the years before RF, during which, only 78% of youth received an assessment. 24 These are the percentage of assessments that identified issues, not the percent of youth who had issues. Some youth have multiple assessments. 25 The Center did not count any assessment completed more than six months prior to entry into drug court because it would be considered too old to be clinically valid, per RF Director.

18 Evaluating Reclaiming Futures: Final Performance Review 15 Figure 2: Percent of youth receiving a comprehensive AOD assessment by RF year 100% 90% Received a comprehenisve AOD assessment Assessed within 60 days of admission 80% 70% Percent of drug court youth 60% 50% 40% 30% 20% 10% 0% Before RF RF year 1 RF year 2 RF year 3 There has also been an overall increase in the number of youth receiving timely assessments. 26 Fifty-nine percent of Pre RF youth were assessed within 60 days of entering drug court, as compared to 65% of youth during the RF years combined. The percentage of youth receiving timely assessments steadily increased to 88% in RF year 3. As reported in Performance Review 3, the results vary by jurisdiction. The Center reported that Nashua had the lowest percentage of assessments. Nashua continues to lag behind the other three drug court sites on overall assessments during three of the four RF years. Whereas the other sites assessed 82% of drug court youth or more during RF, Nashua assessed approximately only one-third of its youth in the first RF year. Interestingly, however, the percentage of Nashua youth receiving assessments increased substantially during RF years 2 and 3 at an average of 87%. Service coordination has improved through central administrative support from RF After youth are comprehensively assessed, RF seeks to ensure that they receive comprehensive services that are coordinated across state and community agencies. 26 Data on timely assessments does not include PDIs, representing assessments received by a community provider outside of the juvenile justice system. Assessments performed six months prior through 60 days after admission are included.

19 Evaluating Reclaiming Futures: Final Performance Review 16 Coordinated treatment that addresses multiple needs is considered to be the most effective in helping youth overcome substance abuse. 27 RF has supported the development of a drug court operations manual and a case management system One of RF s first tasks was to create drug court operations manual. RF staff developed the manual based on a series of meetings with court and probation personnel. The manual sets standards for drug court operations, including requirements for the critical components of the RF treatment approach, such as assessments, case plans, and youth involvement in pro-social activities in their communities. It emphasizes involving the broader community in the development of the drug court program. The manual is one tool RF is using to promote its treatment approach across all drug court sites. Furthermore, the probation staff working in the juvenile drug courts has also developed an additional operations manual. This manual provides probation staff with guidelines for working with youth in the drug court program. It includes administrative forms as well as procedures and guidelines for the various components of drug court, such as phases, treatment, and graduated sanctions and incentives. Another tool RF funds allowed to develop was a case management system for all drug courts. This system is a computerized database, which aims to collect and manage individual case information consistently and efficiently. RF and the courts hired the Center to develop the system under the direction of the Drug Court Clinical Director, an RF funded position. RF designed the case management system to promote the RF treatment approach. The treatment team uses it during their weekly meetings to enter data on assessments, case planning, pro-social activities, treatment attendance, and other critical components of the RF model. The case management system will allow drug court staff to monitor adherence to the drug court manual and to the RF treatment approach, by generating reports on each drug court s progress concerning various components of the RF model. The courts have launched the database in all six drug courts, and it is being managed by the Drug Court Clinical Director. Drug court staff has begun to use the case management database to provide the treatment teams and judges weekly updates for each youth. These reports detail a youth s treatment, pro-social engagement, school involvement, drug tests, and other important information that judges can use to determine rewards, sanctions, and other next steps for each case. Treatment teams The RF drug courts coordinate treatment and supervision of youth through weekly meetings of a treatment team, which discusses the progress and needs of the youth and 27 Rutherford B and Banta-Green C. Adolescent Substance Abuse Treatment: A Review of the Literature. ADAI Technical Report Alcohol and Drug Abuse Institute, University of Washington. 1998

20 Evaluating Reclaiming Futures: Final Performance Review 17 his or her family. The coordination of services that occurs from the drug court treatment teams is unique in New Hampshire s juvenile justice system. The team generally includes a clinician, the youth s probation and parole officer, a court clerk, a representative from the youth s school, and individual(s) from the community supporting the youth. Families may attend the meetings to participate in the case planning. RF staff has worked with the treatment teams to promote the RF coordinated treatment approach and to support its implementation. The RF Drug Court Clinical Director and RF Project Director have provided support to the drug court teams. In many drug courts across the country, the judge is a central member of the treatment team. However, in New Hampshire s juvenile drug courts the judge does not participate in treatment team meetings. Drug court staff has indicated that it would be inappropriate for the judge to discuss a case prior to the hearing. However, in several cases, the judge s orders have completely disregarded, or significantly modified, treatment team recommendations. It is not known how these changes have impacted the drug court program, including staff morale, inter-agency relationships, and in the youth s cases themselves. Use of case plans remained inconsistent RF s drug court manual requires treatment teams to develop individualized case plans and to involve families in the process. The plans are used to coordinate treatment and to focus the team on the youth s strengths and rehabilitation goals. Drug court case plans outline the services needed and the goals to be accomplished during drug court. Some of the drug courts used case plans before RF began, but RF has been working to increase their use. RF also has been working to ensure that the goals included in the plans are individualized, and that they include pro-social activities that build youths strengths. The Center has been tracking these changes in the use of these plans during RF. 28 The percent of youth with case plans increased overall from 56% before RF to 64% for youth in all RF years combined. However, the quality of case plans has generally decreased. And, there have been significant inconsistencies in the use and quality of case plans both across the RF years and jurisdictions, and within the same jurisdiction. Figure 3 illustrates the percent of case plans with specific quality measures by RF year. 28 The Center measured if a case plan contained a particular element of quality or not. Individualized goals address a youth s particular needs such as Attend weekly treatment sessions with (clinicians name) and submit to twice-weekly drug tests. Goals that are not individualized could apply to any youth such as Stop using alcohol and drugs.

21 Evaluating Reclaiming Futures: Final Performance Review 18 Figure 3: Percent of case plans with RF specific quality measures by RF year 100% 90% Case plan was indivdualized Case plan had pro-social goals 80% 70% Percent of drug court youth 60% 50% 40% 30% 20% 10% 0% Pre RF RF year 1 RF year 2 RF year 3 The percentage of files with case plans reached a high of 74% during RF Year 2, but declined again in RF year 3. At the same time, interestingly, the percentage of plans with individualized goals was 68% in RF year 2, whereas, in all the other RF years, plans containing individualized goals exceeded 90%. Case plans varied by jurisdiction. For example, few of the Laconia case plans during RF contained individualized pro-social goals, despite the resources RF invested in developing those opportunities. The decrease in the number of case plans during year 3 is due to a decrease in case plans in three of the jurisdictions. And, the overall increase in case plan quality in Plymouth was primarily attributable to a change in format that was spearheaded by the Drug Court Clinical Director. Case plans goals were inserted into the treatment team agenda every week, thus keeping the case plans updated and relevant and focusing the team on the youth s individualized goals. Drug court staff has indicated that the centralized drug-court database has replaced the paper file version of the case plan. Nevertheless, the Center located case plans in the paper files for youth admitted after the database was implemented. And, in only one case was there an electronic version where there was no case plan in the paper file. Drug court staff has raised this, as well as proper use of the drug court database, as a point for ongoing improvement and training.

22 Evaluating Reclaiming Futures: Final Performance Review 19 Treatment initiation and engagement Due to the lack of quality treatment data through administrative sources, the Center has not focused analyses on treatment initiation or engagement. However, the data from the new drug court database has allowed the Center to evaluate some measures of treatment and pro-social engagement. 29 Treatment time shows that some youth are left waiting The data show that only one-half of RF youth had their first treatment session within 14 days the time frame dictated by the RF model. For 30% of drug court participants, treatment initiation took longer than one month; the median time to a youth s first treatment session was 16 days. Engagement defined as three successful treatment contacts within 30 days of a youth s entry into the program is also an important component of the RF model. Data show that 46% of youth were engaged within 30 days. For many of the drug court participants, engagement took longer than two months, with the median engagement days being 34. These results indicate that some youth must wait before receiving treatment services. In PR3, the Center reported that, according to statistics kept by court personnel, drug court youth missed only one to two treatment sessions on average. 30 At that time, however, the courts were not able to provide consistent or complete data on attendance. Since then, the new case management system has enabled the courts to collect treatment data. The data shows that drug court youth miss an average of only one treatment session during their time in the program. Sixty-four percent of these drug court youth in the sample missed at least one treatment session. And, only 18% of youth missed more than two sessions, indicating that most youth are attending the majority of their treatment sessions as prescribed. Most youth get engaged in a pro-social activity and/or are employed while in the program Building youths strengths is considered to be an important element of effective alcohol and drug treatment, 31 and is one of RF s top priorities. The RF coordinated treatment approach involves community members in youths rehabilitation. Community volunteers and agencies can support youth as they transition out of the justice and treatment systems and help them to get involved in activities that build the strengths they need to succeed. For example, community members can help youth become involved in sports, in volunteer work, or to find a job that builds new skills. RF has also worked closely with the treatment teams to encourage them to include strengths-based activities as part of the youth s rehabilitation. The new drug court database indicates that 93% of youth in the later RF years were involved in a pro-social activity and/or employed at some time during the program. Nine 29 Data for this section reflect 56 of RF youth admitted in the later RF years. Data was derived from the drug court database. 30 See footnote See footnote 27.

23 Evaluating Reclaiming Futures: Final Performance Review 20 percent of youth participated in an activity (or worked) every week during the program. And, seventy-three percent of youth participate in at least one pro-social activity during their time in drug court. On average, youth participated in one activity every two weeks. Moreover, 45% of youth were employed at some time during the program. Previously, the Center reported that there was no change over time in the number of judicial orders for pro-social activities. And, results from the new database show that only two youth received a judicial order to participate in a pro-social activity. However, it is important to mention that the Center has observed that judges often address a youth s pro-social activities during drug court sessions without actually ordering the youth to take any action. Therefore, counting the number of judicial orders which require a youth to participate in a pro-social activity does not fully reflect the extent to which judges address the issue. RF staff report that discussion of pro-social activity is now a regular part of drug court hearings and treatment team meetings, and that teams have increased their focus on pro-social activities since the beginning of RF. In addition to ordering pro-social and/or employment activities, drug court judges may direct youth to become more involved in school or to improve their school performance (for example, join a homework club, or pass science class ). Fourteen youth, 25%, received a judicial order for some school involvement. Those orders often addressed the youth s school attendance (or lack thereof) during the program. Since pro-social, employment, and school involvement data were not consistently recorded in youth paper files prior to implementation of the drug court database, the Center was unable to determine the percentage of youth involved in any of these activities. Therefore, it is unknown whether involvement has increased over time. Not all youth participate in community service activities According to data from the new database, 61% of youth performed community service. This does not reflect the number of youth ordered to perform community service activities. Many youth are ordered to perform community service but have the opportunity to bank their hours as a reward for program compliance. Conversely, community service hours may have been ordered as a sanction for program noncompliance. For those youth who did perform community service, the average amount performed was 27 hours. Drug court completion remains the same but varies by court Youth graduate from drug court when they have achieved sobriety for an extended period of time and successfully completed the different phases of the drug court program and their course of treatment. Youth who do not comply with the requirements are sanctioned, often multiple times, and may be ultimately removed from the program if they repeatedly violate the program standards or commit other offenses that prevent their continued participation. Judges impose a variety of sanctions when they remove youth from the program. These include sending them to the Youth Development Center, to other out-of-home placement, or back to district court.

24 Evaluating Reclaiming Futures: Final Performance Review 21 Using drug court completion as the measure of successfully completing treatment, the percentage of youth graduating the program has remained relatively constant. Fifty-nine percent of Pre RF youth graduated compared to 56% of RF youth. 32 There is wide variation across jurisdictions and across the genders in the percent of youth graduating. To date, 68% of girls have graduated, compared to 48% of boys. This raises the question of whether girls are more responsive to the program than boys, or whether success may be related to other factors, such as the number of prior charges. However, gender did not differ by more than a few youth across jurisdiction, and so, is unlikely this explains the variation across courts. Table 5 shows the percent of youth who graduated by jurisdiction, RF year, and gender. Overall, nearly half of RF drug court youth have graduated. Plymouth has graduated the highest percentage of participants at 73%. Laconia graduated the lowest percentage of drug court youth at just over one-third of participants. Concord and Nashua both graduated about half of the youth admitted in their drug court programs. Table 5: Percent of youth graduating drug court by jurisdiction, RF year, and gender Graduated Overall 55% Jurisdiction Concord 46% Laconia 38% Nashua 54% Plymouth 73% RF year Pre RF 59% RF Year 1 50% RF Year 2 65% RF Year 3 55% Total RF 56% Gender Male 48% Female 68% 32 These statistics include youth aged-out while in compliance with the program. A youth ages-out of drug court when they reach the age of criminal responsibility age 17. A drug court participant who was successfully completing requirements at the time of aging-out is included as a graduate in this analysis. Only five youth aged-out while in compliance.

25 Evaluating Reclaiming Futures: Final Performance Review 22 While the graduation percentages measure program completion, it is unknown to what extent they predict long-term success. Additionally, the Center has observed variation in graduation standards by jurisdiction as the presiding judge is the only one that holds the authority to graduate a youth from the program. This may help to explain the variation in graduation rates by jurisdiction. The standardization of program requirements by drug court and probation staff may diminish the variation in graduation in the future. Youth spend nine months in the program Drug court continues to be successful at keeping most drug court youth in the program and in treatment. Youth spend an average of nine months in the program. During that time they receive an average of 28 drug tests, attend 23 drug court hearings, and some amount of treatment and other rehabilitative services, as previously discussed. Table 6 presents the average number of court events by RF program year. On average, youth entering in RF year 1 spent 11 months in the program. The average time in the program declined to an average of eight and a half months in RF year 3. The number of drug tests and the number of positive drug tests also were at a peak in the first RF year and declined over the course of the initiative. It would make sense that as the number of tests declined, the number of positive tests would also decline. However, the total number of positive tests as a share of total drug tests performed declined from onequarter in RF year 1 to 14% in RF year 3. This is particularly interesting given that the youth admitted in RF year 3 had a higher proportion of youth who were multi-drug users over the early RF years. Jurisdiction Table 6: Average number of drug court events by RF year Time in drug court (months) Court events Drug court hearings Drug tests Positive drug tests Pre RF RF year RF year RF year Total RF Total youth Analysis of the data by termination type shows that judges are not quick to remove noncompliant youth from the program. Only five percent of youth were removed from the program in less than 90 days. On average, even those who are removed from drug court attend 22 drug court sessions, indicating that these youth have received many of the services offered by the drug court program. 33 Some variation in length of time in the program also exists by jurisdiction. Concord, on average, kept youth in the program for over 11 months; whereas, Laconia youth averaged about seven and a half months in drug court. The number of hearings, logically, follows the same pattern. Furthermore, Nashua s drug court youth were drug tested far more 33 See Table A-7 in the appendix.

26 Evaluating Reclaiming Futures: Final Performance Review 23 often than the other courts 37 times versus between 25 and 33 in the other jurisdictions. 34 More youth are being kept in the community With the intensive services and supervision that drug courts provide, many youth who may have been placed in a secure facility may have been diverted due to their participation in drug court. However, out-of-home placements were utilized for a variety of reasons, including lack of home supervision, the youth was a danger to him/herself or others, for more intense treatment services, and as a sanction for program violations. Overall, two-thirds of youth in drug court were placed out of the home and, on average, for about 6 weeks of the total time in drug court. Table 7 presents the use of out-of-home placements. 35 Table 7: Percentages of youth placed out of the home and in detention by court, gender, RF year, and termination status Ever Placed Detention Residential Treatment % Avg days % Avg days % Avg days % Avg days Overall 68% 44 56% 13 39% 58 14% 113 Jurisdiction Concord 79% 64 62% 11 59% %* 88 Laconia 61% 33 52% 13 24% 41 9%* 119 Nashua 80% 29 76% 13 44% 38 12%* 94 Plymouth 57% 51 39% 15 33% 39 18% 150 RF Year Pre RF 61% 40 51% 15 41% 53 5%* 213 RF Year 1 80% 51 70% 14 48% 81 27% 123 RF Year 2 68% 43 56% 11 24% 67 15%* 125 RF Year 3 64% 27 42% 12 39% 33 6%* 1 Gender Male 69% 47 61% 13 34% 60 13% 140 Female 67% 45 46% 14 50% 61 17% 89 Termination Status Graduates 53% 42 42% 9 33% 50 13% 132 Removals 88% 45 74% 16 47% 70 15% 108 *These percentages represent less than five youth. Over the course of RF, the use of out-of-home placements declined from a high of 80% in RF year 1 to 64% in RF year 3. This pattern also holds true for the use of secure detention, which was often used as a sanction for program violations. Variation by jurisdiction, gender, and termination type do exist, particularly with the use of 34 Ibid. 35 In previous reports, the Center published data regarding the out-of-home placements of youth in drug court. Those data represented earlier drug court youth and the data was obtained through BRIDGES. The data presented here represents all drug court youth through the third RF year and was obtained through paper file reviews.

27 Evaluating Reclaiming Futures: Final Performance Review 24 detention. 36 Furthermore, the length of time youth spend in placement also decreased over the RF project. This reduction in the use of placement suggests that youth admitted in the later RF years may have been more successfully supervised in the community than youth entering the program before or in the first year of RF. Keeping youth in the community has been a focus of drug court since its inception. In the early years of drug court, secure detention was often used as a sanction for program violations. In the past year, probation staff, in conjunction with RF, has developed guidelines for graduated sanctions for program violations (as well as for positive reinforcement), which provide objective direction for the appropriate use of out-of-home placements as a sanction. One third of youth commit a new drug offense by one year after drug court The Center compared Pre RF youth to early RF youth with respect to charges committed prior, during and subsequent to the drug court program. The differences in prior charge history and offenses committed while under the court s supervision is detailed in Table 8. Table 8: Prior and during program charges by RF year and termination status No. of youth Within one year of entry into drug court During drug court Any charge* Drug charge $ Felony charge $ Any charge Drug charge Felony charge Overall % 51% 19% 40% 18% 8% RF Year Pre RF 41 56% 49% 17% 27% 15% 7% RF Year % 44% 27% 59% 22% 15% RF Year 2 and Partial RF Year 3 combined 27 78% 67% 11% 33% 19% 0% Total RF 68 77% 53% 21% 49% 21% 9% Termination Status Graduates 65 65% 62% 15% 34% 19% 5% Removals 44 75% 36% 25% 50% 18% 14% *This does not include the charge that initiated entry into drug court. $ This includes all charges upon entry into the program, including the charge that initiated entry into drug court. The data indicate that youth in the RF group may have had different criminal behaviors than that of the Pre RF youth. Sixty seven percent of youth in the RF years 2 and 3 group had drug charges coming into the program as compared to only 49% of Pre RF youth. And, a higher percent of youth in RF years 2 and 3 had a charge of any kind over that of 36 For a complete discussion of the use of out-of-home placement in the drug courts, see New Hampshire Center for Public Policy Studies, Services and Recidivism in New Hampshire s Juvenile Drug Courts. April 2007.

28 Evaluating Reclaiming Futures: Final Performance Review 25 the Pre RF youth 78% versus 56%, respectively. 37 Differing by only a few youth, recidivism during the program between the Pre RF group and the youth in RF years 2 and 3 were roughly equivalent. Due to the small number of youth tracked after the program in the later RF years, recidivism data is not aggregated by program year. Therefore, the majority of youth in the RF group represent youth admitted during RF year 1, as shown in Table 9. Table 9: Subsequent charges by RF year and termination status Within 6 months after the end of drug court Within 1 year after the end of drug court No. Any charge Drug charge Felony charge No. Any charge Drug charge Felony charge Overall % 28% 10% 84 64% 36% 14% RF Year Termination Status Pre RF 41 42% 20% 12% 41 56% 24% 15% Total RF 59 59% 34% 9% 43 72% 47% 14% Graduates 57 46% 25% 7%* 48 60% 33% 10% Removals 43 61% 33% 14% 36 69% 39% 19% *These percentages represent less than five youth. The higher percentages of charges seen in the RF youth at all points in time raises the question of whether their anti-social behavior, as evidenced by the higher percent of all charges (not just drug charges), might have been of a different nature than that of Pre RF youth. It is possible that once the RF initiative began, the drug courts started to admit more severe cases in hopes the additional resources would help them address the youths complex issues. The data already show that more boys were admitted in drug court during RF, and previous work has shown that boys have more extensive criminal behavior. 38 Thereby, raising questions about whether many youth were appropriate for the services provided in the drug court program. Furthermore, these questions are also raised when analyzing youth who graduated compared to those who were removed from the program. More of the youth who graduated drug court had a drug charge upon entry into the program than youth who were later removed 62% versus 36%, respectively. Conversely, youth who graduated had lower percentages of entering drug court with any charge or with a felony, as shown in Table 8. This suggests that the youth who were later removed from the program may have been fundamentally different from youth who graduated, at least in terms of criminal behavior. Moreover, the risk factors measured between the groups differed as well. Among removals, more youth were male and of a minority group; whereas, more graduates had a family history of drug use. However, the small number of drug court 37 The Pre RF group consists mainly of youth in one court. The later RF project years include youth from the urban courts. See Table For a complete discussion of the variation in criminal behavior between genders in the drug courts, see New Hampshire Center for Public Policy Studies, Services and Recidivism in New Hampshire s Juvenile Drug Courts. April 2007.

29 Evaluating Reclaiming Futures: Final Performance Review 26 youth tracked at the time of this study makes it difficult to determine what risk factors and characteristics of youth will predict program success. Discussion Reclaiming Futures set out to strengthen and improve the drug court programs by emphasizing clinical assessments, coordinated services, individualized case plans, and youth involvement in community activities. Additionally, RF staff in New Hampshire sought to work with those in the juvenile justice system to institute alcohol and drug screening for all youth entering the courts. RF has brought about a shift in the way the juvenile justice system responds to druginvolved young offenders. It has raised awareness of the complex issues affecting druginvolved juvenile offenders and their families, and the tools available for working with these youth. It has provided a treatment framework essential components of care which did not exist previously. As a result, the system has moved away from the traditional, punitive approach, and toward a collaborative, strength-based approach. RF has worked to better define the roles of those working within the system judges, probation, and treatment providers and to foster collaboration among these parties. Its efforts have resulted in improved relationships, not only among those working in drug court, but also across the juvenile justice system. Opening communication and standardized screening The institution of standardized alcohol and drug screening for all youth entering the court system proved to be difficult. As the Center reported in PR3, several significant barriers to implementing such a system existed. First, some attorneys oppose screening before disposition because it may violate a juvenile s right not to incriminate him or herself regarding illegal drug use, may not be relevant to the case, and could result in additional charges or a more restrictive disposition than originally planned. They advise their clients to limit answers to screening questions. This practice makes it difficult to get accurate information on potential substance abuse. Second, for a long time there has been a lack of consensus among key players including the courts and DJJS around an appropriate screening tool. By RF year 3, RF staff had successfully fostered open and regular communication between the courts and DJJS about screening, but a consensus around a screening tool, court protocols for administering the tool, and a procedure for implementation across the courts were not yet established until recently. This is a significant accomplishment as there were several major barriers to implementing such a system. The use of a standardized screening tool is currently being implemented in the drug courts, and is expected to expand to all juvenile courts in the future. However, it remains to be seen whether this communication will continue between these agencies after the RF supports have been withdrawn.

30 Evaluating Reclaiming Futures: Final Performance Review 27 Introducing Evidence-Based Practices RF has been the primary force driving the use of an evidence-based assessment tool in New Hampshire. The number of drug court youth receiving a comprehensive assessment, as well as the number of assessments that were completed in a timely manner, increased substantially over the course of RF. Moreover, the use of an evidencebased tool, the GAIN, and the number of clinicians certified to administer the GAIN, has increased as well, despite early obstacles. Although, the main obstacle RF encountered Medicaid reimbursement for the use of the tool was overcome, some resistance from the provider community remained. Anecdotal reports raise concerns that the GAIN is too cumbersome and time consuming for many clinicians. Nevertheless, RF convinced a major adolescent substance abuse treatment initiative to implement the GAIN with all of its providers, and regional trainings are now held regularly. The introduction of the GAIN has coincided with a push for evidence-based mental health and substance abuse treatment across the state. However, workforce sparsity, 39 particularly in the rural regions of the state, limited training resources, and nonreimbursable administrative tasks associated with implementing evidence-based practices will continue to challenge the expansion of the GAIN, as well as improved substance abuse treatment practices across the state. 40 Administrative infrastructure developed, but with an uncertain future RF has developed the administrative infrastructure for the drug courts. The tools RF put into place including the development of a drug court manual, the institution of a datadriven case management system, and the provision of administrative supports have helped to sustain the drug court model and allow its expansion to other jurisdictions. The tools have also helped to support RF s coordinated treatment approach, and allow both for individual case management and ongoing program evaluation. Furthermore, the operations manual and trainings developed by probation staff will help the drug courts continue to integrate best-practices for coordinating services. However, with the loss of grant resources, much of the administrative support has been reduced. It remains to be seen if the drug courts can continue efficiently at the same level of operation without administrative support. One clinical director is now responsible for all drug courts, and the drug court coordinator positions have been phased out in each jurisdiction. Therefore, many of the administrative tasks for these cases are switched to the juvenile court clerk and to probation staff adding pressure to the already limited human resources of these departments. 39 New Hampshire Center for Public Policy Studies. Few and Far Between? Children s Mental Health Providers in New Hampshire. September New Hampshire Center for Public Policy Studies. Children s Mental Health in New Hampshire: Evidence-Based Practices. September 2007.

31 Evaluating Reclaiming Futures: Final Performance Review 28 Community engagement remains a challenge The community engagement piece has also presented, and continues to present, a significant challenge. Community engagement relies on volunteers, and there is no single body responsible for oversight. The drug court experience has shown that the community engagement process is difficult to put into place, and once in place, it is difficult to sustain. Those working within the system have cited continued difficulty in finding mentors and opportunities for youth in the community. There are numerous barriers to engaging drug court youth in pro-social activities in their communities. The loss of paid community liaison positions continues to create challenges to engage youth in their communities, as now the drug courts must rely on volunteer organizations. Moreover, the burden to find pro-social activities has shifted back to probation staff, who are unable to solicit donations, and have raised concerns of confidentiality adding barriers to connecting youth. NH s Reclaiming Futures project lessons learned and drug courts moving forward RF encountered numerous obstacles to reaching its goals, both external and internal to the program. RF staff found it difficult to engage those working in the system, mainly due to the lack of a clear framework, its status as an independent program, and its lack of supervisory authority over the courts and probation. Moreover, since drug court is a small part of a much larger court system it creates a challenge in devoting limited court and probation resources to the program. However, support and leadership from members of the judiciary helped to facilitate buy-in into the drug court and RF models. There are also several issues external to drug court that may have and may continue to hinder the success of the program. Few qualified providers exist to provide treatment services within the community. Not only does New Hampshire have few substance abuse treatment providers, but also there is a lack of providers who are trained in evidencebased practices. There are also a lack of providers who are qualified to treat youth with co-existing disorders of mental health and substance abuse. 41 Furthermore, the drug courts may wish to examine the reasons that youth may be waiting for treatment and to target these areas for improvement in the future. Creating consistency across the various drug court programs also remains a challenge. A great deal of variation across the jurisdictions still exists particularly with the use of out-of-home placements. In addition, differences in admission criteria, procedures for administering sanctions and rewards, judicial philosophies, probation and other staff turnover, the withdrawal of administrative supports, and differences in service availability all create obstacles in providing the same level of treatment for drug court youth in all courts. The variations in youth services and outcomes across the drug court jurisdictions may be explained, in part, by differences in judicial practice. Judicial leadership may, therefore, 41 See footnote 39.

32 Evaluating Reclaiming Futures: Final Performance Review 29 have a significant effect on youth outcomes. The presiding judge plays an important role in setting the tone and environment of drug court. As lead member of the court, the judge provides the leadership, authority, and management to enable the drug court to operate effectively. For these reasons, the New Hampshire drug courts may wish to consider making the judge an active treatment team participant. The judge s presence on the team may improve the team s collaborative and cooperative effort, which ultimately may improve drug court operations and improve youth outcomes. Those involved with drug court agree that a number of basic components will be necessary if drug court is to continue successfully. Currently, it is unknown whether the courts will continue to fund administrative positions for drug court when grant funds come to an end. Yet, those involved with drug court agree that centralized management and designated case coordinators are critical to the success of program operations. RF has devoted considerable funds to developing uniformity among the drug court sites. In the absence of oversight, the uniformity and ability to solve problems in a collaborative manner may deteriorate. In addition, those that have worked in drug court are in agreement that certain logistical changes would improve the success of the program. Drug court staff reports that parent involvement is one of the critical components of success for youth in the program. All of the drug court sessions, however, take place in the middle of the day. The scheduling of drug court sessions during this time has been an issue for many parents and guardians, creating work and other constraints. A remedy to this problem would be to schedule sessions in the late afternoon or early evening. This would make it easier for parents or guardians to attend drug court sessions, and to commit to actively participation in their youth s rehabilitation. Despite these ongoing issues, the Reclaiming Futures initiative succeeded in laying the foundation for lasting changes to the drug courts and the system as a whole. First, standardized, targeted screening may benefit all youth entering the courts. And, the introduction of the evidence-based assessment will have impacts that reach beyond the scope of drug courts for adolescents and adults with mental health and substance abuse issues. Second, the data-driven case management system may improve service coordination and communication between all parties involved with a youth s rehabilitation as well as provide a tool for ongoing program evaluation. Finally, RF was successful in promoting communication between the courts, probation, treatment providers, community groups, and the public around substance abuse issues facing youth in the juvenile justice system.

33 Evaluating Reclaiming Futures: Final Performance Review 30 Appendix Table A - 1: Number of youth admitted to RF drug courts by jurisdiction and RF year Concord Laconia Nashua Plymouth Total youth Pre RF RF Year RF Year RF Year Total RF Total youth Table A - 2: Risk factor characteristics of youth in the RF drug courts by RF year Pre RF RF 1 RF 2 RF 3 RF Total Demographics Average age at entry to drug court (years) Gender (% male) 56% 82% 68% 67% 73% Race (% white) 88% 83% 72% 100% 85% AOD History Average age of first use (years) Multi-drug user (uses other drugs in addition to marijuana and alcohol) 49% 58% 68% 86% 63% Received substance abuse treatment prior to drug court 33% 49% 33% 25% 38% Had parent/sibling/grandparent with a history of substance abuse 68% 68% 74% 76% 72% Mental Health Received counseling prior to drug court, but had no diagnosis 68% 57% 59% 73% 62% Prior mental health diagnosis upon admission 27% 23% 24% 58% 33%

34 Evaluating Reclaiming Futures: Final Performance Review 31 Table A - 3: Risk factor characteristics of youth in the RF drug courts by termination status Graduates Removals Total Closed Cases Demographics Average age at entry to drug court (years) Gender (% male) 60% 77% 68% Race (% white) 91% 81% 82% AOD History Average age of first use (years) Multi-drug user (uses other drugs in addition to marijuana and alcohol) 63% 57% 49% Received substance abuse treatment prior to drug court 36% 35% 32% Had parent/sibling/grandparent with a history of substance abuse 78% 64% 71% Mental Health Received counseling prior to drug court, but had no diagnosis 64% 62% 63% Prior mental health diagnosis upon admission 33% 29% 31%

35 Evaluating Reclaiming Futures: Final Performance Review 32 Table A - 4: Percent of drug court youth screened and assessed for AOD issues by jurisdiction and RF year Pre RF RF year 1 RF year 2 RF year 3 Total RF Total youth Concord Screened 67% 80% 50% 0% 50% 51% Assessed (includes PDIs) 100% 100% 90% 100% 96% 97% Assessed within 60 days 67% 20% 50% 83% 46% 48% Assessed with GAIN 0% 0% 0% 17% 4% 3% Laconia Screened 100% 100% 67% 20% 68% 79% Assessed (includes PDIs) 82% 100% 89% 100% 95% 88% Assessed within 60 days 64% 63% 89% 80% 77% 73% Assessed with GAIN 0% 13% 78% 80% 55% 36% Nashua Screened 100% 100% 75% 14% 74% 81% Assessed (includes PDIs) 50% 38% 88% 86% 61% 59% Assessed within 60 days 50% 31% 63% 71% 48% 49% Assessed with GAIN 0% 6% 50% 43% 26% 20% Plymouth Screened 88% 100% 71% 40% 66% 73% Assessed (includes PDIs) 88% 90% 86% 100% 94% 92% Assessed within 60 days 59% 90% 71% 100% 91% 80% Assessed with GAIN 0% 0% 43% 47% 31% 20% Overall Screened 93% 95% 65% 24% 65% 72% Assessed (includes PDIs) 78% 75% 88% 97% 86% 84% Assessed within 60 days 59% 48% 68% 88% 66% 64% Assessed with GAIN 0% 5% 41% 45% 28% 20% Table A - 5: Count and quality of drug court case plans in cases open at least 60 days by RF year Pre RF RF Year 1 RF Year 2 RF Year 3 Total RF Number Percent Number Percent Number Percent Number Percent Number Percent Number in drug court > 60 days Files containing case plans 22 56% 23 58% 25 74% 21 66% 69 65% Plans with individualized goals 21 95% 21 91% 17 68% 19 90% 57 54% Plans with pro-social goals 17 77% 14 61% 21 84% 16 76% 51 48% Pro-social goals individualized 8 36% 6 26% 9 36% 10 48% 25 24% Table A - 6: Count and quality of drug court case plans in cases open at least 60 days by jurisdiction Concord Laconia Nashua Plymouth Total drug court Number Percent Number Percent Number Percent Number Percent Number Percent Number in drug court > 60 days Files Containing Case Plans 22 79% 15 47% 21 53% 33 73% 91 63% Plans with Individualized Goals 17 77% 12 80% 16 76% % 78 86% Plans with Pro-Social Goals 13 59% 13 87% 17 81% 25 76% 68 75% Pro-social Goals Individualized 4 18% 3 20% 8 38% 18 55% 33 36%

36 Evaluating Reclaiming Futures: Final Performance Review 33 Jurisdiction Termination Status Table A - 7: Average number of drug court events by jurisdiction and termination status Time in drug court (months) Court events Drug court hearings Drug tests Positive drug tests Concord Laconia Nashua Plymouth Graduates Removals Overall