Douglas B. Marlowe, J.D., Ph.D., FCPP Targeting & Best Practices for Treatment Courts Douglas B. Marlowe, J.D., Ph.D., FCPP

Annals of Research and Knowledge (ARK) 4/1/2014 Dispositional Continuum Treatment / Public Health Emphasis Functioning of the individual Punishment / Public Safety Emphasis Risk of recidivism Cost to taxpayers l--- Treatment Courts ---l Pre-plea diversion Post-plea diversion Sentence to incarceration Sentence to restrictive intermediate punishment (IP / RIP) Sentence to probation or community supervision Decriminalization/ medicalization De-felonization

Risk Principle Not a risk for violence or dangerousness Difficult or complicated prognosis The higher the risk level, the more intensive the supervision and accountability should be, and vice versa Mixing risk levels is contraindicated

Prognostic Risk Factors Current age < 25 years Delinquency onset < 16 years Substance abuse onset < 14 years Prior rehabilitation failures Prior convictions or incarcerations Antisocial Personality Disorder Family history of crime or addiction Criminal or delinquent peer affiliations

Prognostic Risk Tools Level of Service Inventory—Revised (LSI-R) Level of Service Case Management Inventory (LS/CMI) Correctional Offender Management Profiling for Alternative Sanctions (COMPAS) Ohio Risk Assessment System (ORAS) Risk and Needs Triage (RANT) Risk Prediction Index (RPI) Static Risk Tool Wisconsin Risk & Need Assessment (WRN) Federal Post Conviction Risk Assessment (PCRA)

Violence Risk Tools Historical, Clinical, Risk Assessment-20 (HCR-20) Psychopathy Checklist- Revised (PCL-R) Static-99 Spousal Assault Risk Assessment (SARA) Sexual Violence Risk-20 (SVR-20)

Need Principle Clinical disorders or functional impairments (diagnosis) The higher the need level, the more intensive the treatment and rehabilitation services should be, and vice versa Focus on criminogenic and responsivity needs first (especially addiction & mental illness) Mixing need levels is contraindicated

Addiction and Mental Illness Neurological or neurochemical brain disorders Chronic, relapsing and progressive (worsen without treatment) Worsen if punished for “distal” infractions, such as substance use Worsen if not punished for “proximal” infractions, such as lying, treatment absences, or tainted urine specimens

Risk & Need Quadrants High Risk Low Risk High Need Low Need Treatment Court Treatment Deferral High Need Intensive Probation Banked Probation Low Need

Treatment Court Case Likely to be in the community Likely to recidivate or fail in treatment Severe mental illness or substance dependence NOT Empirically Relevant: Drug dealing or violence charge / history Motivated for treatment; good attitude Failed treatment or probation previously Unproven nexus between drug use and crime

Program Planning 15 times greater cost benefits }

Annual Staff Training Five times greater cost benefits }

Evaluation Four times greater cost benefits }

Judicial Assignments Three times greater cost benefits }

} Team Functioning Twice the cost benefit Judicial Officer, Prosecutor, Defense Attorney, Treatment Provider, Probation Officer, Coordinator

Sentencing Reform Require risk & need assessment before disposition (especially for felonies, serious misdemeanors, & probation/parole revocations) Use immunity Valid, reliable, & culturally unbiased instruments Non-specialized risk tools may not be used to inform in/out decisions (expedited review) Require professionals to consider risk and need in certain cases (expedited review)

Sentencing Reform (cont.) Require professionals to consider effectiveness and cost-effectiveness (return rehabilitation to forefront of sentencing) Require SAC to publish recidivism rates and costs of alternative dispositions Include dispositional rationale on the record Restrictive basis for appeal (abuse of discretion; clearly erroneous) Publish data on dispositional decisions (blinded?)

Treatment Court Standards As a condition of funding and accreditation, require treatment court teams (and other programs) to: Attend pre-implementation and annual trainings Report data annually on adherence to best practices Develop and evaluate remedial plans for deficiencies Target high risk and high need cases Develop alternative tracks/programs for other cases Apply graduated sanctions for distal infractions (right of interlocutory review) Prioritize criminogenic and responsivity needs