Best Practices Standards Vol. I: An Overview

OBJECTIVES  Define Best Practices Standards  Identify the need for Best Practices Standards  Briefly examine each of the Best Practices Standards in Volume One  Discuss the impact of Best Practices Standards on Drug/DWI Court’s operation

Best Practice Standards  Set benchmarks for new and existing programs  Focus on practices supported by reliable and convincing evidence  Are both aspirational and directive

Best Practices Standards I. Target Population II. Historically Disadvantaged Groups III. Roles and Responsibilities of the Judge IV. Incentives, Sanctions, and Therapeutic Adjustments V. Substance Abuse Treatment

Objective Eligibility & Exclusion Criteria  Specified in writing  Communicated to team I. Target Population

High-Risk and High Need Participants 1) Substantial risk for reoffending, community supervision failure, and/or treatment failure. 2) Addicted I. Target Population

1) Validated risk- assessment tool 2) Valid Clinical- assessment tool Validated Eligibility Assessments

I. Target Population Offenders charged with drug dealing or those with violence histories are not excluded automatically Criminal History Disqualifications

Clinical Disqualifications  Co-occurring mental health diagnosis  Medical Condition  Legally prescribed psychotropic or addiction medication Candidates are not disqualified automatically due to: I. Target Population

II. Historically Disadvantaged Groups

 Nondiscriminatory in intent and impact  Valid assessment tools for members of group Equivalent Access

II. Historically Disadvantaged Groups Monitors completion rates for group, if lower  Investigate reasons for disparity  Develop remedial action plan  Reevaluate Equivalent retention

Equivalent Treatment Evidence- based treatment for cultural group Equivalent incentives & Sanctions -Monitor -Remedial action if needed Equivalent Dispositions -Disparate Dispositions? -More frequent terminations? -Harsher sentences? II. Historically Disadvantaged Groups

Team Training  Develop culturally sensitive attitudes  Develop concrete strategies to correct and remediate disparities in services and outcomes

III. Roles & Responsibilities of the Judge

Professional Training  Constitutional  Ethics  Evidence-based substance abuse  Mental Health treatment  Behavior modification  Community Supervision III. Roles & Responsibilities of the Judge

 Length of Term  No less than two consecutive years  Consistent Dockets  Participate in Pre-court Staff Meetings III. Roles & Responsibilities of the Judge

 Frequency of Status Hearings  At least every two weeks during first phase  No less than once per month in later phases  Length of Interaction with participant  At least three minutes III. Roles & Responsibilities of the Judge

Judicial Demeanor Respectful Fair Attentive Enthusiastic Consistent Caring III. Roles & Responsibilities of the Judge

Judicial Decision Making  Seek and value team input  Responsible for weighing facts  Don’t decide by majority vote III. Roles & Responsibilities of the Judge

IV. Incentives, Sanctions, and Therapeutic Adjustments

 Advance Notice  Written policies and procedures  Opportunity to Be Heard Explanation – by participant, by judge  Equivalent Consequences III. Roles & Responsibilities of the Judge

 Progressive sanctions  Intermediate range  Proximal Behaviors  Distal Behaviors IV. Incentives, Sanctions, and Therapeutic Adjustments

Licit addictive or intoxicating substances  Continued use is contrary to evidence- based practices except when medically necessary  Authorized use only:  Competent medical evidence indicates medically indicated, and effective alternative treatments are not reasonably available IV. Incentives, Sanctions, and Therapeutic Adjustments

Therapeutic Adjustments  Early phase: Maintaining abstinence may be extremely difficult  Adjust treatment based on expertise of trained clinicians  Later phase: After treatment and stabilization sanctions can escalate for illicit drug or alcohol use. IV. Incentives, Sanctions, and Therapeutic Adjustments

 Incentivizing Productivity  Improved outcomes when court uses higher levels of praise and positive incentives  Phase Promotion Clearly defined phase structure Clearly defined behavior requirements Rewards participant and sets expectations IV. Incentives, Sanctions, and Therapeutic Adjustments

Use jail sanctions sparingly  Increased recidivism after six day on average IV. Incentives, Sanctions, and Therapeutic Adjustments

 Those who automatically Terminate participants for new drug or alcohol use or drug possession offenses have:  50% higher recidivism  48% loser cost savings IV. Incentives, Sanctions, and Therapeutic Adjustments

 Consequences of graduation and termination  Favorable criminal justice outcomes should result from graduation  More restrictive or more stringent criminal justice outcomes should result from unsuccessful termination or withdrawal IV. Incentives, Sanctions, and Therapeutic Adjustments

V. Substance Abuse Treatment

 Continuum of Care  Standardized patient placement criteria governs level of care provided.  Incarceration  Is not used to achieve clinical or social service objectives (e.g., for detox)  Treatment  Is not used to accomplish non-clinical goals (e.g., for housing or for those who need jail) V. Substance Abuse Treatment

Clinically trained representative from one or two treatment agencies are core members of team and attend staffing and hearings V. Substance Abuse Treatment

 Treatment Dosage and Duration  9 to 12 months; 200 hours of counseling  Treatment Modalities  One individual per week in Phase 1  Group membership is guided by evidence-based selection criteria  Evidence-Based Treatments  Medications V. Substance Abuse Treatment

Medication Assisted Treatment  Effective with and necessary for some participants when combined with psychosocial treatment  Programs avoid blanket prohibitions  Best when prescribed by a physician specializing in addiction medicine  Judge exercises discretion to prohibit MAT only when determined to not be medically necessary by a physician advising the court V. Substance Abuse Treatment

Provider Training and Credentials  Licensed or certified  Experience working with criminal justice populations  Clinically supervised V. Substance Abuse Treatment

 Peer Support Groups  Structured model or curriculum  12-Step and secular alternatives  Continuing Care Continue with pro-social activities and remain connected with a peer support group after Drug Court V. Substance Abuse Treatment

Best Practices Standards Vol. I: An Overview