Viewing Then Doing?: Problem-Solving Court Coordinators' Perceptions of Medications for Opioid Use Disorders from a Nationally Representative Survey in the United States.

Background. Overdose deaths in the United States (U.S.) surpassed 100,000 in 2021. Problem-solving courts (PSCs), which originally began as drug courts, divert people with nonviolent felonies and underlying social issues (e.g. opioid use disorders (OUDs)) from the carceral system to a community-based treatment court program. PSCs are operated by a collaborative court staff team including a judge that supervises PSC clients, local court coordinators that manage PSC operations, among other staff. Based on staff recommendations, medications for opioid use disorders (MOUDs) can be integrated into court clients' treatment plans. MOUDs are an evidence-based treatment option. However, MOUDs remain widely underutilized within criminal justice settings partially due to negative perceptions of MOUDs held by staff. Objective. PSCs are an understudied justice setting where MOUD usage would be beneficial. This study sought to understand how court coordinators' perceptions and attitudes about MOUDs influenced their uptake and utilization in PSCs. Methods. A nationally representative survey of 849 local and 42 state PSC coordinators in the U.S. was conducted to understand how coordinators' perceptions influenced MOUD utilization. Results. Generally, court coordinators hold positive views of MOUDs, especially naltrexone. While state and local coordinators' views do not differ greatly, their stronger attitudes align with different aspects of and issues in PSCs such as medication diversion (i.e. misuse). Conclusions. This study has implications for PSCs and their staff, treatment providers, and other community supervision staff (e.g. probation/parole officers, court staff) who can promote and encourage the use of MOUDs by clients.

Pandemic Procedures: Adapting Problem-Solving Court (PSC) Operations and Treatment Protocols During COVID-19.

With an ongoing pandemic claiming hundreds of lives a day, it is unclear how COVID-19 has affected court operations, particularly problem-solving courts (PSCs) which have goals rooted in rehabilitation for participants in their programs. Even with practical recommendations from national organizations directing courts on how to manage COVID-19, whether and how PSCs met the needs of PSC participants during this time is underexplored. This study, drawn from a larger national study using a survey of PSC coordinators, examines the COVID-19 responses of PSCs to remain safely operational for participants. A sub-sample of survey respondents (n = 82 PSC coordinators) detailed how the COVID-19 pandemic led to changes to their court and treatment operations amidst the constraints of the pandemic. The courts' shifts in policy and practice have important impacts for court participants' treatment retention and success in the PSC program, and these shifts need more in-depth research in the future.

Medication-Assisted Treatment in Problem-solving Courts: A National Survey of State and Local Court Coordinators.

Problem-solving courts (PSCs) are a critical part of a societal effort to mitigate the opioid epidemic's devastating consequences. This paper reports on a national survey of PSCs (N = 42 state-wide court coordinators; N = 849 local court coordinators) and examines the structural factors that could explain the likelihood of a local PSC authorizing medication-assisted treatment (MAT) and MAT utilization. Results of the analyses indicate that MAT availability at the county level was a significant predictor of the likelihood of local courts authorizing MAT. The court's location in a Medicaid expansion state was also a significant predictor of local courts allowing buprenorphine and methadone, but not naltrexone. Problem-solving courts are in the early stages of supporting the use of medications, even when funding is available through Medicaid expansion policies. Adoption and use of treatment innovations like MAT are affected by coordinators' perceptions of MAT as well as structural factors such as the availability of the medications in the community and funding resources. The study has important implications for researchers, policymakers, and practitioners.

The effects of judicial supervision on recidivism of offenders in Australia and New Zealand: a systematic review and meta-analysis.

This meta-analysis compares recidivism reduction in problem-solving courts employing judicial supervision in Australia and New Zealand to traditional processes. Using a four-phased search strategy, 16 studies totalling a treatment sample of 6588 individuals and 32,147 comparison participants were identified from 7161 unique records. Meta-analyses indicate that the problem-solving courts significantly reduced both the odds and incidences of recidivism compared with standard justice processes but that the heterogeneity observed within the latter analysis plus reliance on weak methodologies limits the strength of these conclusions. Studies at risk of bias may have had an undue influence on the odds of recidivism analysis. Additionally, the benefits of treatment on the incidence of recidivism are closely linked to the overlap of measurement and treatment periods. The findings suggest a positive impact from judicial supervision but further rigorous research is needed that closely matches experimental samples, strictly measures participants post-intervention and meticulously reports pertinent information.

Supporting the end of prostitution permanently (SEPP) prostitution court: examining inter-professional collaboration within alternative criminal justice settings.

Problem-solving courts such as prostitution courts are becoming an important feature of the American court landscape. Internationally, while there is a great deal of skepticism regarding problem solving courts, at least five countries (e.g., England, Scotland, Ireland, Australia, and Canada) are deliberating whether this "revolutionary panacea" which has swept America's criminal justice system is the right approach for them. Few studies have explored the benefits and challenges of problem solving courts (i.e. prostitution court) using an interprofessional collaborative framework. The purpose of this case study is to examine contemporary issues related to prostitution courts using Bronstein's model of interprofessional collaborative framework which identifies five components that facilitate optimum IPC: 1) interdependence, 2)newly created professional activities, 3)flexibility, 4)collective ownership of goals, and 5) reflection on the process. Some benefits of IPC include working collaboratively, adaptability, adjusting expectations, investment in the process and making changes as needed. Some of the challenges of IPC were coercive power, dual roles, bait and switch, hierarchy, and push for outcomes at the expense of clients. As criminal justice systems nationally and internationally contemplate widespread implementation of different kinds of problem-solving courts, these benefits and challenges need to be considered before states and countries adopt these courts.

Court as a health intervention to advance Canada's achievement of the sustainable development goals : a multi-pronged analysis of Vancouver's Downtown Community Court.

BACKGROUND: The increase in problematic substance use is a major problem in Canada and elsewhere, placing a heavy burden on health and justice system resources given a spike in drug-related offences. Thus, achievement of Sustainable Development Goal (SDG) Target 3.5 to 'Strengthen the prevention and treatment of substance abuse' is important for Canada's overall realization of the SDGs, including SDG 3 (Good Health and Wellbeing). Since 2008, Vancouver's Downtown Community Court (DCC) has pioneered an innovative partnership among the justice, health and social service systems to address individuals' needs and circumstances leading to criminal behaviour. While researchers have examined the DCC's impact on reducing recidivism, with Canada's SDG health commitments in mind, we set out to examine the ways health and the social determinants of health (SDH) are engaged and framed externally with regard to DCC functioning, as well as internally by DCC actors. We employed a multi-pronged approach analyzing (1) publicly available DCC documents, (2) print media coverage, and (3) health-related discourse and references in DCC hearings. RESULTS: The documentary analysis showed that health and the SDH are framed by the DCC as instrumental for reducing drug-related offences and improving public safety. The observation data indicate that judges use health and SDH in providing context, understanding triggers for offences and offering rationale for sentencing and management plans that connect individuals to healthcare, social and cultural services. CONCLUSIONS: Our study contributes new insights on the effectiveness of the DCC as a means to integrate justice, health and social services for improved health and community safety. The development of such community court interventions, and their impact on health and the SDH, should be reported on by Canada and other countries as a key contribution to SDG 3 achievement, as well as the fulfillment of other targets under the SDG framework that contain the SDH. Consideration should be given by Canada as to how to capture and integrate the important data generated by the DCC and other problem-solving courts into SDG reporting metrics. Certainly, the DCC advances the SDGs' underlying Leave No One Behind principle in a high-income country context.

"God, I hope it doesn't fade out": Team Member Perspectives on the Future of Veterans Treatment Courts.

Despite their rapid spread over the last 15 years, little research has explored the perceptions of Veterans Treatment Courts (VTCs) team members regarding the viability and longevity of VTCs. The present qualitative study explores the perceptions of 145 VTC team members from 20 VTCs around the United States regarding the future of their own VTC and VTCs in general. Our analysis revealed four overarching themes about team members' expectations and hopes for VTCs in the future: the need for continued funding and increased resources; desires to expand participation in VTCs; hope and uncertainty about the future of VTCs; and depending on specific people to ensure the future of VTCs. While interviewees in general felt quite hopeful and optimistic that VTCs would continue to exist and may even expand, there was unease about exactly how this would occur. These concerns included securing stable funding sources, maintaining 'buy in' from key individuals, and resource needs for expanding the participation and eligibility criteria of VTCs. Given the important role that VTCs can play in effectively supporting justice-involved veterans, and offering more benefits compared to a traditional justice-system response, it seems vital to ensure that VTCs are able to continue operating in the future.

Impact of COVID-19 on Florida family dependency drug courts.

BACKGROUND: To promote parent-child reunification, family dependency drug courts (FDDCs) facilitate substance use disorder treatment for people whose children have been removed due to parental substance use. The COVID-19 pandemic disrupted FDDC operations, forcing FDDCs to quickly adapt to new circumstances. Although existing research has examined COVID-19 impacts on adult drug courts and civil dependency courts, studies have yet to examine the impact of COVID-19 on FDDCs specifically. METHODS: To explore the impact of COVID-19 on FDDCs, we conducted 20 focus groups and 5 individual interviews with court team members from five Florida FDDCs between 2020 and 2022. Data were analyzed using iterative categorization. RESULTS: Five overarching themes emerged. First, FDDCs adopted virtual technology during the pandemic and more flexible drug screening policies. Second, virtual technology was perceived as improving hearing attendance but decreasing client engagement. FDDC team members discussed a potential hybrid in-person/virtual hearing model after the pandemic. Third, COVID-19 negatively impacted parent-child visitation opportunities, limiting development of bonds between parents and children, and parent-child bonding is a key consideration during judicial reunification decisions. Fourth, COVID-19 negatively impacted the mental health of court team members and clients. Court team members adopted new informal roles, such as providing technical support and emotional counseling to clients, in addition to regular responsibilities, resulting in feeling overwhelmed and overworked. Court team members described clients as feeling more depressed and anxious, in part due to limited visitation opportunities with children, which decreased clients' motivation for substance use recovery. Fifth, COVID-19 decreased recruitment of potential clients into FDDCs. CONCLUSIONS: If FDDCs continue to rely on virtual hearings beyond the pandemic, they must develop practices for improving client engagement during virtual hearings. FDDCs should preemptively develop procedures for improving parent-child visitation during future public health crises, because limited visitation opportunities could weaken parent-child bonding and, ultimately, the likelihood of reunification.

A national survey of state laws regarding medications for opioid use disorder in problem-solving courts.

BACKGROUND: Problem-solving courts have the potential to help reduce harms associated with the opioid crisis. However, problem-solving courts vary in their policies toward medications for opioid use disorder (MOUD), with some courts discouraging or even prohibiting MOUD use. State laws may influence court policies regarding MOUD; thus, we aimed to identify and describe state laws related to MOUD in problem-solving courts across the US from 2005 to 2019. METHODS: We searched Westlaw legal software for regulations and statutes (collectively referred to as "state laws") in all US states and D.C. from 2005 to 2019 and included laws related to both MOUD and problem-solving courts in our analytic sample. We conducted a modified iterative categorization process to identify and analyze categories of laws related to MOUD access in problem-solving courts. RESULTS: Since 2005, nine states had laws regarding MOUD in problem-solving courts. We identified two overarching categories of state laws: 1) laws that prohibit MOUD bans, and 2) laws potentially facilitating access to MOUD. Seven states had laws that prohibit MOUD bans, such as laws prohibiting exclusion of participants from programs due to MOUD use or limiting the type of MOUD, dose or treatment duration. Four states had laws that could facilitate access to MOUD, such as requiring courts to make MOUD available to participants. DISCUSSION: Relatively few states have laws facilitating MOUD access and/or preventing MOUD bans in problem-solving courts. To help facilitate MOUD access for court participants across the US, model state legislation should be created. Additionally, future research should explore potential effects of state laws on MOUD access and health outcomes for court participants.

Reflecting on Therapeutic Jurisprudence in the Criminalization of Mental Illness and Addiction.

Problem-solving courts were created as a means of therapeutic jurisprudence. They arose in the context of the post-deinstitutionalization influx of defendants with behavioral and social problems entering the criminal court system. Seeing that typical judicial practices were poor solutions for individuals primarily facing problems such as homelessness, substance use disorders, and mental illness, courts developed specialized dockets as a solution to the problem of not being able to restrict the flow of these individuals into courtrooms. Although highly regarde, mental health courts (MHCs) and drug courts (DCs) can harm people with mental illness and addiction and contribute to the oppression of disenfranchised populations, including racial and ethnic minorities. By tying access to needed treatment to criminal justice system involvement, MHCs and DCs can increase criminalization of mental illness, subject individuals to long-term collateral consequences, and interfere with social policy reforms that would dismantle the prison-industrial complex (PIC). As forensic mental health professionals, we must reflect on our practices and consider the impact that our professional decisions have on the patients that we serve, and on society as a whole, and advocate for criminal justice and healthcare system reforms that truly free individuals in need of mental health or substance use treatment from the grasp of the PIC.

Expanding Therapeutic Jurisprudence Across the Federal Judiciary.

A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve individuals with mental illness and substance use disorders in the federal criminal justice system and allow them to benefit from rehabilitation and diversion programs. This effort will also signal that the federal judiciary has recognized the criminal justice system's failure to address inmate mental health care, and that it is willing to institute changes to provide appropriate, evidence-based interventions.

A tool for measuring therapeutic jurisprudence values during empirical research.

Since its inception in the 1980s, the growing body of Therapeutic Jurisprudence scholarship has continued to challenge and optimise not only our understanding of what the law "is", but also how we can leverage its agency to improve the ways in which we apply, observe and evaluate the law. By focusing on the emotional, human and psychological consequences of legal processes, Therapeutic Jurisprudence empowers practitioners to design emotionally intelligent and remedial strategies to either minimise harmful consequences or enhance restorative legal goals and outcomes. As the influence of Therapeutic Jurisprudence scholarship and its practical applications has continued to gain traction in rapid and organic growth, collaborations brokered with a wide range of social science disciplines have called for a more robust focus on validated measurement scales. To that end, there is a clear and growing need for a suite of Therapeutic Jurisprudence specific tools for empirical evaluation. As there has been no formal attempt within the Therapeutic Jurisprudence research community to begin this process, this paper breaks new ground by providing a validated tool for empirical measurement of the therapeutic quality of judicial officers' behavioural and interactional styles in problem-solving court jurisdictions. Using original empirical data recently collected at a problem-solving court in England, the paper takes the reader through the journey of statistically validating the levied scaling systems by performing Principal Component Analysis and Cronbach's Alpha. In doing so, the paper offers an original contribution to Therapeutic Jurisprudence methodology.

The Eleventh Judicial Circuit Criminal Mental Health Project: Improving Access to Mental Health Treatment in Miami-Dade County.

The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP), a court-based jail diversion program, was established to divert individuals with serious mental illness from the criminal justice system into treatment and support services. The CMHP's success is built on collaboration among a diverse array of community stakeholders. This column describes the establishment and maintenance of these partnerships. CMHP's success is the result of several factors, including motivated local champions, acquisition of grant funding, formalized communication support, and use of the sequential intercept model. As the CMHP grows, system science methods will be useful for supporting optimization and sustainment.

Dissolving the stiff upper lip: Opportunities and challenges for the mainstreaming of therapeutic jurisprudence in the United Kingdom.

Although therapeutic jurisprudence ("TJ") is increasingly well-established internationally, particularly within the United States of America ("US"), to date it remains relatively unacknowledged within the United Kingdom ("UK"). This article will explore the opportunities presented within contemporary UK society for the greater promotion, and eventual mainstreaming, of TJ. It will also consider the challenges faced during this process and how best to overcome these. Its first key area of focus will be upon the potential role of legal education in the UK in educating law students (and academics) about TJ, considering which approaches are likely to be most effective in incorporating TJ perspectives, at what stage this should occur and to what extent TJ is likely to impact on the existing curricula at a time when proposed changes relating to entry into the legal profession are heavily influencing the work of Law Schools. The article will then move on to consider the receptiveness of the UK legal profession to the TJ paradigm in light of recent attempts to move to a competency-based approach to practice and to reconceptualise professionalism to meet the challenges of increasing fragmentation and corporatisation. The third key area it will explore is the UK's recent plans to reintroduce problem-solving courts ("PSCs") into its criminal justice system. The authors will discuss the downfall of the six UK Drug Court ("DC") pilots originally established in 2005 theorising upon their failures and reflecting upon whether the current UK criminal justice system is truly able to support a fresh round of PSC initiatives. The article will end with recommendations for ways in which the international TJ community should begin the process of mainstreaming TJ within the UK. It will conclude that there are currently significant opportunities to be utilised, but that this requires significant commitment and mobilisation amongst existing TJ scholars and practitioners.

How does a drug court experience influence student pharmacists?

INTRODUCTION: Drug court is a highly structured, community-based criminal justice alternative to imprisonment and probation that incorporates chemical dependency treatment for offenders with a substance abuse diagnosis. Drug court provides a unique learning experience for pharmacy students. METHODS: Students from Purdue University College of Pharmacy and the University of Minnesota College of Pharmacy participated in drug court and provided written reflections regarding their experiences. Analysis of reflections explored how students' life experiences might be associated with their understanding of substance use disorder, and how the drug court experience might impact students' attitudes regarding substance use disorder as well as professional and personal development. RESULTS: Consensual qualitative analysis of student pharmacist reflections of the drug court experience led to eleven distinct themes: description of the student experience at drug court; past experiences and exposures; past perceptions and judgments; stereotype deconstruction; empathy development; development of impartiality and fair-minded approach; situational appreciation; analytical thinking; role of the pharmacist; metacognition; and science of substance use disorder. DISCUSSION: Colleges of pharmacy wishing to provide students with an opportunity for personal and professional development focused on substance use disorder and recovery should explore experiential learning opportunities in drug court settings. CONCLUSIONS: The drug court experience allows student pharmacist learners to gain a deeper personal understanding of substance use disorder while examining their own biases. Students reported that this experience challenges them to rethink notions of "good" and "bad" and reflect on personal preconceived views about substance use disorder and morality.

Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience.

Veterans' Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n=21) and veteran participants (n=4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n=19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed.

No Soldier Left Behind: The Veterans Court Solution.

This paper concerns one of the newer iterations of problem-solving courts: veterans treatment courts. We trace the history of problem solving court implementation and explore the functioning of an established veterans court. The focus of this exploratory, qualitative study is the courthouse workgroup and their interactions both within the veterans court and with more traditional criminal courts and criminal justice agencies. We summarize the literature on problem solving courts and the experience, insights and suggestions of the members of the court we examined.

Long-term recidivism of mental health court defendants.

The first MHC was established in 1997 and now, over 15years later, there are over 300 mental health courts in the United States. In a relatively short time these courts have become an established criminal justice intervention for persons with a mental illness. However, few studies have looked at the long-term outcomes of MHCs on criminal recidivism. Of the studies evaluating the impact of MHCs on criminal recidivism, most follow defendants after entry into the court during their participation, and only a few have followed defendants after court exit for periods of one or two years. This study follows MHC defendants for a minimum of five years to examine recidivism post-exit with particular attention to MHC completion's effect. Findings show that 53.9% of all MHC defendants were rearrested in the follow-up and averaged 15months to rearrest. Defendants who completed MHC were significantly less likely to be rearrested (39.6% vs. 74.8%), and went longer before recidivating (17.15months vs. 12.27months) than those who did not complete. This study suggests that MHCs can reduce criminal recidivism among offenders with mental illness and that this effect is sustained for several years after defendants are no longer under the court's supervision.

Why do mental health courts work? A confluence of treatment, support & adroit judicial supervision.

The article contributes to the understanding of 'what works' in mental health courts (MHCs). There are now almost 400 MHCs in the US and more worldwide. A substantial body of evidence demonstrates that MHCs can succeed in reducing recidivism among offenders who suffer mental disorders. This article argues that MHCs succeed when they have achieved the right confluence of essential elements, including providing evidence-based treatment and psychosocial supports and using adroit judge-craft. After a brief review of some of the studies demonstrating MHC success, this article discusses the research into the necessary foundations of rehabilitation programs. It is argued that, although treatment and psychosocial services should be supplied within an evidence-based framework, neither of the two leading conceptual models - Risk-Needs-Responsivity and the Good Lives Model - are empirically proven with offenders who suffer from mental disorders. Despite the absence of proof, the Good Lives Model is argued to be appropriate for MHCs because it is normatively consonant with therapeutic jurisprudence. The MHC judge is another essential element. The judicial role is assayed to elucidate how it functions to promote the rehabilitation of offenders with mental disorders. It is argued that the role of the MHC judge during supervisory status hearings is to establish a therapeutic alliance and practice motivational psychology with each MHC participant.