EVALUATING THE IMPACT OF ADDING THE RECLAIMING FUTURES APPROACH TO JUVENILE TREATMENT DRUG COURTS Michael L. Dennis, Ph.D., Chestnut Health Systems, Normal, IL (On behalf of the Juvenile Drug Court Reclaiming Futures National Program Office and Evaluation Team) Presentation at the Reclaiming Futures Leadership Institute, Asheville, NC, May 8, Supported by the Reclaiming Futures/Juvenile Drug Court Evaluation under Library of Congress contract no. LCFRD11C0007 to University of Arizona Southwest Institute for Research on Women, Chestnut Health Systems & Carnevale Associates The development of this presentation is funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) through an interagency agreement with the Library of Congress – contract number LCFRD11C0007. The views expressed here are the authors and do not necessarily represent the official policies of OJJDP or the Library of Congress; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Available from

Purpose 2 1.Illustrate why it is so important to intervene with juvenile drug users 2.Review what we know about juvenile treatment drug courts (JTDC) so far 3.Compare JTDC to a newer Reclaiming Futures version of JTDC in terms of their impact on substance use, recovery, emotional problems, illegal activity and costs to society

Background 3

Adolescence is the Age of Onset Source: 2010 NSDUH, Neumark et al., 2000 Over 90% of use and problems start between the ages of It takes decades before most recover or die

55 5 Source: Dennis & McGeary, 1999; OAS, 1995 Adolescence Use Related to Range of Problems

Problems in the Adolescent Treatment System  Less than 1 in 13 adolescents (8%) with substance use disorders get into treatment  Only 67% stay the 45 days minimum recommended by ONC  Only 56% are positively discharged or transferred  Only 43% stay the 90 days recommended by research  Only 23% leaving higher levels of care are transferred to outpatient continuing care.  The majority of programs do NOT use standardized assessment, evidenced-based treatment, track the clinical fidelity of the treatment they provide, or monitor health disparities in service delivery or client outcomes  Varied staff education with a median of less than BA.  Average of 30-32% staff turnover every year  Most lack or are just starting the multi-year process of setting up electronic medical records Source: SAMHSA 2012 & Institute of Medicine (2006).

77 7  About half of the youth in the juvenile justice system have drug related problems (Office of Juvenile Justice and Delinquency Prevention (OJJDP), 2001; Teplin et al., 2002).  Juvenile justice systems are the leading source of referral among adolescents entering treatment for substance use problems (Dennis et al., 2003; Dennis, White & Ives, 2009; Ives et al 2010).  By 2009 there were 476 juvenile treatment drug courts (JTDC) in approximately 16% of the Counties in the US and they were growing at a rate of 4% per year (Huddleston & Marlowe, 2011) Juvenile Justice and Substance Use Source: Dennis, White & Ives, 2009

Juvenile Treatment Drug Court Effectiveness  Low levels of successful program completion among youths in drug courts was noticeable in several early studies (Applegate & Santana, 2000; Miller, Scocas & O’Connell, 1998; Rodriguez & Webb, 2004).  JTDC was found to be more effective than traditional family court with community service in reducing adolescent substance abuse (particularly when using evidence-based treatment) and criminal involvement during treatment (Henggeler et al., 2006).  JTDC youth did as well or better than matched youth treated in community based treatment (Sloan, Smykla & Rush, 2004; Ives et al., 2010).  But still much room for improvement.

Methods 9

10 Juvenile Treatment Drug Court (JTDC) Sites & Data  Cohort of 16 CSAT grantee sites using the GAIN in Box Elder, MT; Buffalo, NY; Laredo, TX; San Antonio, TX (2); San Rafael, CA;Belmont, CA; Tarzana, CA; Pontiac, MI; San Jose, CA; Austin, TX; Peabody, MA; Providence, RI; Detroit, MI; Philadelphia, PA, & Viera, FL.  Intake data collected on1,934 adolescents from these sites between January 2006 through November 2011  Analysis on 1,351 (79% of 1712 due) adolescents with 1+ follow-up at 3, 6, and 12-months post intake.

11 Reclaiming Futures JTDC (RF-JTDC) Sites & Data  Cohort of 10 grantee CSAT and/or OJJDP sites using the GAIN in Cherokee Nation, OK; Denver, CO; Greene County,MO; Hardin County, OH; Hocking County, OH; Nassau County, NY; & Seattle, WA; Snohomish County, WA; Travis County, TX; & Ventura County, CA.  Intake data cllected on 811 adolescents from these sites between January 2008 through December 2011  Analysis on 556 (89% of 625 due) adolescents with 1+ follow-up at 3, 6, and 12-months post intake.

12 Source: Dennis, White & Ives, Key Strategies for JTDC (BJA, 2003) 10 Key Components of DC (NADCP, 1997) 1. Engage all stakeholders in creating an interdisciplinary, coordinated, and systemic approach to working with youth and their families. 1. Drug Courts integrate alcohol and other drug treatment services with justice system case processing. 2. Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process rights. 3. Define a target population and eligibility criteria that are aligned with the program’s goals and objectives. 3. Eligible participants are identified early and promptly placed in the Drug Court program. 4. Schedule frequent judicial reviews and be sensitive to the effect that court proceedings can have on youth and their families. 7. Ongoing judicial interaction with each Drug Court participant is essential 5. Establish a system for program monitoring and evaluation to maintain quality of service, assess program impact, and contribute to knowledge in the field 8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness.

13 Source: Dennis, White & Ives, Key Strategies for JTDC (BJA, 2003) 10 Key Components of DC (NADCP, 1997) 6. Build partnerships with community organizations to expand the range of opportunities available to youth and their families. 10. Forging partnerships among Drug Courts, public agencies, and community-based organizations generates local support and enhances Drug Court program effectiveness. 7. Tailor interventions to the complex and varied needs of youth and their families. 4. Drug Courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services. 8. Tailor treatment to the developmental needs of adolescents. 9. Design treatment to address the unique needs of each gender. 10. Create policies and procedures that are responsive to cultural differences and train personnel to be culturally competent. 11. Maintain a focus on the strengths of youth and their families during program planning and in every interaction between the court and those it serves.

14 Source: Dennis, White & Ives, Key Strategies for JTDC (BJA, 2003) 10 Key Components of DC (NADCP, 1997) 12. Recognize and engage the family as a valued partner in all components of the program. 13. Coordinate with the school system to ensure that each participant enrolls 14. Design drug testing to be frequent, random, and observed. Document testing policies and procedures in writing. 5. Abstinence is monitored by frequent alcohol and other drug testing. 15. Respond to compliance and non- compliance with incentives and sanctions that are designed to reinforce or modify the behavior of youth and their families. 6. A coordinated strategy governs Drug Court responses to participants’ compliance. 16. Establish a confidentiality policy and procedures that guard the privacy of the youth while allowing the drug court team to access key information. 9. Continuing interdisciplinary education promotes effective Drug Court planning, imple-mentation, and operations.

15  RF is a “systems change” approach to improving the access and quality of substance use and mental health services to youth in the juvenile justice system both in general and specifically applied to JTDC here.  RF was adapted from the system of care frameworks from the children’s mental health movement to be inclusive, continuous, strength- and culturally-based and rely upon both family and community strengths.  RF’s goals are to stimulate the development of interdisciplinary professional and community teams to install evidence-based and culturally relevant screening, assessment, appropriate integrated care coordination, treatment and developmentally appropriate recovery support systems following engagement in the justice and treatment systems.  RF provides access to a “community of practice fellowships” with other sites around the US to help mentor, coach and collaborate in a mutual development and continuous learning process Reclaiming Futures (RF) “more treatment, better treatment, beyond treatment”

16  RF sites commit to a process of rigorous system “redesign” in order to increase the  availability and quality of substance and mental health services,  integration of graduated sanctions and incentives, and  positive youth development opportunities during and after treatment and justice system involvement  RF teaches how sites how to use  community engagement to develop innovative partnerships with a wide range of community stakeholders (e.g., businesses, faith communities, civic organizations, and service organizations, schools).  essential youth development activities to decrease stigma and increase a youth’s sense of aspirational possibilities for his/her life  RF thus incorporates and compliments the 16 strategies for JTDC and 10 key components of DC in general, and impacts the whole system Reclaiming Futures (RF) - continued “more treatment, better treatment, beyond treatment”

17  All intake and follow-up data collected using the Global Appraisal of Individual Needs (GAIN) ( )  The GAIN Coordinating Center (GCC) provided local trainers and several staff from each site with initial 3.5 days of training and participated in a mastery based certification program (Administration certification within 3 months of training; Local Trainer certification within 6 months of training)  Local trainers and/or on line training was used to handle staff turnover  Interviews were generally staff-administered on computer using PC or web-based software and used to computer generate tentative diagnosis, treatment planning statements and placement recommendations  Data cleaned, de-identified and combined GCC staff for analysis  Preliminary data analysis reviewed by RF national program, coaches and other cross-site evaluation team members. GAIN Training and Data Management

18 Matching with Propensity Score Weights  A comparison of 63 intake characteristics found that 26 (41%) differed significantly between JTDC and RF-JTDC.  To make a stronger quasi-experimental comparisons of the groups, we controlled for these differences by using them to create propensity score that reflected how similar the people in the JTDC comparison group were to those in the RF-JTDC.  After propensity score weighting of the JTDC group, 19 (73%) of the of the original 26 differences were eliminated  6 (23%) were reduced but still statistically significant (having high count of multi-morbidity*, high health problems*, prior mental health treatment*, 1+ year behind in school**, Hispanic**, Caucasian*), and  1 (4%) was slightly enlarged (Expelled or dropped out of school*) *RF-JTDC higher **JTDC higher

Results: Baseline Needs 19

20 Count of Major Clinical Problems at Intake: RF-JTDC Source: RF-JTDC (weighted n=556)

21 General Victimization Scale: RF-JTDC (Number of 15 items endorsed) Source: RF-JTDC (weighted n=556)

22 Major Clinical Problems* by Victimization: RF-JTDC *Based on count of self reporting criteria to suggest alcohol, cannabis, or other drug disorder, depression, anxiety, trauma, suicide, ADHD, CD, victimization, violence/ illegal activity Source: RF-JTDC (weighted n=556)

Results: Services 23

24 Days of Services Received* *Days of Substance Abuse (SA), Mental Health (MH), Physical Health (PH) treatment and Juvenile Justice System (JJS) Involvement (primarily days on probation (>70% of total days).) \a p<.05 that post minus pre change is statistically significant \b p<.05 that year after values for Reclaiming Futures JTDC is higher than the average for other JTDC Source: JTDC vs. RF-JTDC (weighted n=1112) Substance Abuse Treatment Mental Health Treatment Physical Health Treatment Juvenile Justice System

25 Average Annual Cost of Service Utilization* *Behavioral, physical, mental health treatment, incarceration, probation and parole. Subset to records with valid responses at both time periods. Source: JTDC vs. RF-JTDC (weighted n=1112)

26 Level of Care: JTDC vs. RF-JTDC \a, b \a OP: Outpatient, IOP: Intensive Outpatient; STR: Short Term Residential; M-LTR: Medium to Long Term Residential; CC-OP Continuing Care Outpatient. \b Distribution of clients by Level of Care is significantly different between JTDC and RF-JTDC. Source: JTDC vs. RF-JTDC (weighted n=1112)

27 Type of Treatment: JTDC vs. RF-JTDC \a, b \a A-CRA/ ACC: Adolescent Community Reinforcement Approach/ Assertive Continuing Care; MET/CBT: Motivational Enhancement Therapy/Cognitive Behavior Therapy; 7C: Seven Challenges; EBTx: Other evidenced based treatment approaches; Local manual but not replicated; Other all else; \b Distribution of clients by Type of Treatment is significantly different between JTDC and RF-JTDC. Source: JTDC vs. RF-JTDC (weighted n=1112)

28 Family Engagement in the First 3 months \a, b \a Significantly different between JTDC and RF-JTDC. \b Gap closes but still significantly different at 12 months; Differences not significant on direct or wrap around services. Source: JTDC vs. RF-JTDC (weighted n=1112)

Results: Outcomes 29

30 Change in Days of Abstinence \a \a Days of abstinence s while living in the community; If coming from detention at intake, based on the days before detention. \b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC \c Amount of change is significantly better for RF-JTDC than JTDC Source: JTDC vs. RF-JTDC (weighted n=1112)

31 Change in Days of Victimization \a \a Number of days victimized (physically, sexually, or emotionally ) in past year. Source: JTDC vs. RF-JTDC (weighted n=1112)

32 Change in Emotional Problems Scale \a \a Proportional average of recency and days of emotional problems (bothered, kept from responsibilities, disturbed by memories, paying attention, self-control) in past 90. \b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC \c Amount of change is significantly better for JTDC than RF-JTDC Source: JTDC vs. RF-JTDC (weighted n=1112)

33 Change in Number of Crimes Reported \a \a sum of the number of crimes in the past year \b Change within condition is statistically & clinically significant for both JTDC and RF-JTDC \c Amount of change is significantly better for RF-JTDC than JTDC Source: JTDC vs. RF-JTDC (weighted n=1112)

34 Change in Number of Crimes by Type \a \a Sum of all crimes reported within type. \b Change within condition is statistically & clinically significant \c Amount of change is significantly better for RF-JTDC than JTDC \d In the year after, significantly lower for RF-JTDC than JTDC Source: JTDC vs. RF-JTDC (weighted n=1112) Property ViolentDrug/Other

35 Change in Cost of Crime to Society \a \a Based on the frequency of crime (crimes capped at 99 th percentile to minimize the impact of outliers) times the average cost to society of that crime estimated by McCollister, et al., (2010) in 2011 dollars. \b Year after is significantly lower than year before. \c At follow-up RF-JTDC is significantly lower than JTDC Source: JTDC vs. RF-JTDC (weighted n=1112)

Discussion 36

37 Reprise  Relative to JTDC, the Reclaiming Futures JTDC provided a matched cohort of youth with more services.  Both groups did well at reducing substance use, crime and emotional problems  Relative to JTDC, the Reclaiming Futures JTDC did better in terms of:  increasing the days of alcohol and drug abstinence (58 vs. 94 days) in the year after intake.  reducing the number of violent crimes (-30% vs. -65%)  the number of crimes overall (-45% vs. -65%), property crimes (-51% vs. -61%), and substance related crimes (- 44% vs. -71%).  Relative to JTDC, the Reclaiming Futures JTDC did worse in terms of  Providing family services (42% vs. 29%)  Reducing emotional problem scale (-18% vs. -21%)

38 Reprise (continued)  The overall costs of utilizing services related to substance use, mental health, health and juvenile justice nominally decreased for both Reclaiming Futures-JTDC and JTDC ($ vs. $-4334, nsd).  The average annual cost of crime was significantly  reduced for both JTDC ($ -132,359; -50%) and Reclaiming Futures JTDC ($ -216,231; -75%)  lower in the year after intake for youth in Reclaiming Futures JTDC ($132,142 vs. $70,921 per youth).  Reductions in the cost of crime are far greater than the reduction in services that have often been the focus on past economic analyses.

39 Some Important Limitations  This analysis is based on self-reported data.  There was data missing due to attrition (11% to 21%), so outcomes had to be estimated based on the average of the observed waves.  No formal measures of compliance with 16 strategies  No formal cost analyses of JTDC or Reclaiming Futures JTDC were done so cost estimates here are likely to be lower bound estimates.  While adjusted for inflation, the costs of service utilization are somewhat dated and should ideally be updated.  The cost of crime was based on estimates developed for adults (McCollister et al., 2010) that have been applied here to youth.  The cost of service and crime estimates have very large variance and there are also subgroups with changes going in both directions – collecting reducing the power of the statistical tests that could be done.

40 Next Steps  Running by site to verify and better understand the findings.  Will work to publish these findings  OJJDP has just funded another round of Reclaiming Futures JTDC that will hopefully improve mental health and family services  University of Arizona has just been funded to conduct a more formal evaluation of the RF-JTDC model and how it compares to other JTDC that will include  More formal measures of court operations and the 16 strategies  Include more formal costs estimates  Include more quantitative and qualitative data  Examining health disparities by gender and race

41 Questions? Poster available from For questions about this presentation, please contact Michael Dennis at or For questions about Reclaiming Futures, please contact Susan Richardson at (503) or For questions on the National Cross-Site Evaluation, contact Monica Davis, Evaluation Coordinator at x211 or

42 References  Applegate, B. K., & Santana, S. (2000). Intervening with youthful substance abusers: A preliminary analysis of a juvenile drug court. The Justice System Journal, 21(3),  Bhati et al. (2008) To Treat or Not To Treat: Evidence on the Prospects of Expanding Treatment to Drug-Involved Offenders. Washington, DC: Urban Institute.  Bureau of Justice Assistance (2003). Juvenile Drug Courts:Strategies in Practice. Washington, DC: Author  Capriccioso, R. (2004). Foster care: No cure for mental illness. Connect for Kids. Accessed on 6/3/09 from  Chandler, R.K., Fletcher, B.W., Volkow, N.D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. Journal American Medical Association, 301(2),  Dennis, M. L., Foss, M. A., & Scott, C. K. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31(6),  Dennis, M. L., Scott, C. K. (2007). Managing Addiction as a Chronic Condition. Addiction Science & Clinical Practice, 4(1),  Dennis, M. L., Scott, C. K., Funk, R. R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment. Journal of Substance Abuse Treatment, 28(2 Suppl), S51-S62.  Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D. (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. (Version 5 ed.). Bloomington, IL: Chestnut Health Systems. Retrieved from  Dennis, M.L., White, M., Ives, M.I (2009). Individual characteristics and needs associated with substance misuse of adolescents and young adults in addiction treatment. In Carl Leukefeld, Tom Gullotta and Michele Staton Tindall (Ed.), Handbook on Adolescent Substance Abuse Prevention and Treatment: Evidence-Based Practice. New London, CT: Child and Family Agency Press.  Ettner, S.L., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., & Hser, Y.I. (2006). Benefit Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?. Health Services Research, 41(1),

43 References  French, M. T., Roebuck, M. C., Dennis, M. L., Diamond, G., Godley, S. H., Liddle, H. A., et al. (2003). Outpatient marijuana treatment for adolescents: Economic evaluation of a multisite field experiment. Evaluation Review, 27(4),  French, M.T., Popovici, I., & Tapsell, L. (2008). The economic costs of substance abuse treatment: Updated estimates of cost bands for program assessment and reimbursement. Journal of Substance Abuse Treatment, 35,  General Account Office (GAO, 2011). Adult Drug Courts: Studies Show Courts Reduce Recidivism, but DOJ Could Enhance Future Performance Measure Revision Efforts. Washington, DC: Author. Retrieved from on April 18,  Health Serve Res February; 41(1): 192–213. Health Research and Education Trust  Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., Chapman, J. E. (2006). Juvenile drug court: enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1),  Institute of Medicine (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions. National Academy Press. Retrieved from  Ives, M.L., Chan, Y.F., Modisette, K.C., & Dennis, M.L. (2010). Characteristics, needs, services, and outcomes of youths in juvenile treatment drug courts as compared to adolescent outpatient treatment. Drug Court Review, 7(1),  Lee, M. T., Garnick, D. W., O'Brien, P. L., Ponos, L., Ritter, G. A., & Acevedo, A. G. M. D. (2012). Adolescent treatment initiation and engagement in an evidence based practice initiative. Journal of Substance Abuse Treatment, 42(4),  Marlowe, D. B. (2008). Recent studies of drug courts and DWI courts Crime reduction and cost savings. NADCP.  McCollister, K. E., French, M. T., & Fang, F. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence 108 (1-2)

44 References  Miller, M L, Scocas, E A & O'Connell, J P (1998). Evaluation of the Juvenile Drug Court Diversion Program, Bureau of Justice Assistance, Rockville, MD. Publication #  National Association of Drug Court Professionals (1997). The 10 Key Components. Washington, DC: Author  Rodriguez, N., & Webb, V. J. (2004). Multiple measures of juvenile drug court effectiveness Results of a quasi- experimental design. Crime & Delinquency, 50(2),  Salom 鬠 H.J., French, M.T., Scott, C.K, Foss,M. and Dennis, M.L. (2003). Investigating the Variation in the Costs and Benefits of Addiction Treatment: Econometric Analysis of the Chicago Target Cities Project. Evaluation and Programming Planning, 26(3):  Scott, C. K., & Dennis, M. L. (2009). Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction, 104(6), Retrieved from http//  Sloan III, J. J., Smykla, J. O., & Rush, J. P. (2004). Do juvenile drug courts reduce recidivism? Outcomes of drug court and an adolescent substance abuse program. American Journal of Criminal Justice, 29(1),  Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2012). National Survey on Drug Use and Health, [Computer file] ICPSR29621-v2. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], doi: /ICPSR29621.v2. Retrieved from  Substance Abuse and Mental Health Services Administration (2012). Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set Discharges (TEDS-D), ICPSR33621-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor],

45 Acknowledgement & Disclaimer  The development of this presentation was funded by the Office of Juvenile Justice and Delinquency Prevention (OJJDP) through an interagency agreement with the Library of Congress (LOC) and contract number LCFRD11C0007 to the University of Arizona’s (UA’) Southwest Institute for Research on Women (SIROW).  The presentation builds on earlier analyses done under Substance Abuse and Mental Health Services Administration (SAMHSA) contract and uses data provided by 27 Juvenile Treatment Drug Court (JTDC) grantees funded by OJJDP & SAMHSA’s Center for Substance Abuse Treatment (CSAT): TI17433, TI17434, TI17446, TI17475, TI17484, TI17476, TI17486, TI17490, TI17517, TI17523, TI17535; , , , (TI22838, TI22856, TI22874, TI22907, TI23025, TI23037, TI20921, TI20925, TI20920, TI20924, TI20938, TI  The Reclaiming Futures National Program Office received direct support from OJJDP to work with a subset of the grantees to implement their model in the context of Juvenile Treatment Drug Courts (see  The presenter and the SIROW wish to acknowledge the contributions of the Reclaiming Futures National Program Office, our evaluation team partners (UA SIROW, Chestnut Health Systems, Carnevale Associates, Randy Muck), the OJJDP & SAMHSA project officers, grantees and their participants for agreeing to share their data to support this secondary analysis and several individuals who have assisted with preparing or providing feedback on the presentation including: Jimmy Carlton, John Carnevale, Monica Davis, Michael Dennis, Barbara Estrada, Michael French, Mark Fulop, Lori Howell, Pamela Ihnes, Melissa Ives, Nora Jones, Raanan Kagan, Josephine Korchmaros, Rachel Kohlbecker, Kathryn McCollister, Rachel Meckley, Daniel Merrigan, Kate Moritz, Randy Muck, Laura Nissen, Scott Olsen, Erika Ostlie, Mac Prichard, Susan Richardson and., Sally Stevens, Liz Wu.  The views expressed here are the authors and do not represent the official policies of the government; The mention of any trade names, commercial practices, or organizations does not imply endorsement by the authors or the U.S. Government

46 Cost to Society Supplemental Information  Costs of Service Utilization (conservative) based on the frequency of using tangible services (e.g., behavioral, physical and mental health care utilization, days in detention, probation, parole) in the 12 months before and after intake valued by economists (French et al., 2003; Salomé et al., 2003), adjusted for inflation to 2010 dollars and summed.  Costs of Crime (tangible & intangible) based on the frequency of committing crimes (e.g., property crime, interpersonal crime, drug/other crime) in the 12 months before and after intake valued on tangible and intangible costs by economists (McCollister et al., 2010), adjusted for inflation to 2010 dollars and summed.

47 DescriptionUnit Cost in 2010$ Inpatient Physical health (PH) hospitalization)Days $ 2, PH Emergency roomTimes $ 6,278,83 Outpatient PH clinic/doctor’s officeTimes $ Mental Health (MH) hospitalizationNights $ 2, MH Emergency roomTimes $ 6, See MD in office or clinic for MHTimes $ Detoxification for AOD useDays $ AOD Emergency roomTimes $ Residential for AOD useNights $ Intensive outpatient program for AOD useDays $ Regular outpatient programTimes $ ArrestsTimes $2, ProbationDays $ 5.76 ParoleDays $ Jail/prison/juvenile detentionDays $ Service Utilization Unit Costs (conservative)

48 Cost of Crime (tangible & intangible) OffenseTangible\aIntangible\bTotal\c Murder $1,340,409$8,851,318 $9,418,451 Rape/sexual assault $43,247$209,322 $252,450 Aggravated assault $20,484$99,630 $112,209 Robbery $22,436$23,670 $44,361 Arson $17,225$5,382 $22,126 Motor vehicle theft $11,045$275 $11,294 Household burglary $6,469$337 $6,775 Larceny/theft $3,694$10 $3,703 Stolen property $8,361$ - $8,361 Vandalism $5,096$ - $5,096 Forgery/counterfeit $5,520$ - $5,520 Embezzlement $5,746$ - $5,746 Fraud $5,276$ - $5,276 \a Including the 2011 est. cost to the victim, justice system, and criminal career. \b Including the 2011 est. cost of pain & suffering, prorated risk of homicide. \c Total is the sum of 2011 est. cost less any uncorrected risk-of-homicide crime victim cost SOURCE: McCollister, K. E., French, M. T., & Fang, F. (2010).

49 Source: French et al., 2008; Chandler et al., 2009; Capriccioso, 2004 in 2009 dollars 49 The Cost of Treatment (and unmet need) $22,000 / year to incarcerate an adult $30,000/ child-year in foster care $70,000/year to keep a child in detention $750 per night in Medical Detox $1,115 per night in hospital $13,000 per week in intensive care for premature baby $27,000 per robbery $67,000 per assault SBIRT models popular due to ease of implementation and low cost

50  Substance abuse treatment has been shown to have a ROI within the year of between $1.28 to $7.26 per dollar invested.  GAO’s recent review of 11 drug court studies found that the net benefit ranged from positive $47,852 to negative $7,108 per participant.  Best estimates are that Treatment Drug Courts have an average ROI of $2.14 to $3.69 per dollar invested when considering only service costs. Return on Investment (ROI) Source: Bhati, et al., (2008); Ettner, et al., (2006), GAO (2012), Lee, et al., (2012) This also means that for every dollar treatment is cut, it costs society more money than was saved within the same year.