Typologies of Family Dependency Treatment Court Participants: Parental Characteristics and Differential Child Placement Outcomes.

Background: Family Dependency Treatment Court (FDTC) is a problem-solving court for parents who have child welfare involvement and designed to address parental substance misuse by providing treatment and wrap-around services, with the goal of reunifying parents with their children. Objectives: This study aimed to identify different classes of FDTC parents and compare how child placement outcomes differ by class. Parental characteristics and permanent placement outcomes for 354 parents participating in a Central Florida FDTC were assessed using administrative data. An exploratory latent class analysis was conducted to classify parents. Results: Results revealed three distinct classes of FDTC participants: 1) co-occurring issues, 2) racial/ethnic minority participants, and 3) prescription opioid, meth, and heroin users. Regression analyses showed that parents with co-occurring issues were over two times more likely to achieve permanency (OR = 2.05, p < .05), and were two times less likely to terminate their parental rights (TPR) compared to the other two classes. Conclusions: Implications for tailoring FDTC procedures to parents' individual needs, combating racial/ethnic disparities in access to services and placement outcomes, and improved child welfare and placement outcomes are discussed.

Characteristics of substance-addicted mothers that predict graduation from the family treatment court.

INTRODUCTION: In the United States, substance addiction is a major contributing factor to incarceration of mothers and separation of children from their families. Five hundred Family Treatment Courts (FTC) operate across the country to combat the growing problem of women addicted to drugs. The FTC model provides mothers with substance addiction treatment, intensive judicial monitoring, repeated drug testing, counseling, incentives or sanctions, and case management with the goal of reaching long-term sobriety and reunification with their children. DESIGN: This retrospective study examined the relationship between sociodemographic characteristics and substance use characteristics, in predicting participants' graduations from the FTC program. METHODS: Data were gathered from 317 participants from five Family Treatment Courts in the southeastern United States and analyzed using logistic regression. RESULTS: Participants who completed the FTC program were more likely to be older, completed Cognitive Behavioral Training, completed high school, and Caucasian. CONCLUSION: Age and completion of Cognitive Behavioral Therapy were the greatest predictors of graduating from the Family Treatment Court. These results convey the need for development of interventions tailored to each participant's age to maximize the success of the FTC participants. In addition, Cognitive Behavioral Therapy should be integrated into all FTC programs. CLINICAL RELEVANCE: The findings from this study will offer research scholars a foundation for designing future studies, aid researchers in creating interventions to increase success in substance addiction treatment programs, and contribute to the framework for theory development. In addition, understanding characteristics that may influence graduation from the Family Treatment Court will provide valuable information on developing interventions to support participants' success.

Embedding a Co-occurring Disorders Rehabilitation Intervention in Veterans Courts: A Pilot Study with Male Veterans.

Veterans treatment courts (VTCs) have expanded dramatically despite their limited empirical base. This pilot study examined MISSION-Criminal Justice (CJ), a co-occurring disorders wraparound intervention, delivered alongside two VTCs. Baseline data from 26 male veterans enrolled in two VTCs and MISSION-CJ, and 6-month follow-up data for 18 of the 26 veterans, are presented. Veterans on average were 37.5 years old, 85% Caucasian, had significant histories of criminal justice involvement (14.3 lifetime arrests), had an average of 14.7 years of alcohol use and 9.3 years of illicit drug use, and roughly three-quarters reported mental health symptomatology. At 6-month follow-up, veterans demonstrated improvements in behavioral health, substance use, and criminal justice outcomes. This study demonstrated promising preliminary outcomes of MISSION-CJ in VTCs. A randomized controlled trial is a critical next step to examine whether these outcomes remain consistent with a more rigorous design.

IDENTIFYING PREDICTORS OF SUBSTANCE USE AND RECIDIVISM OUTCOME TRAJECTORIES AMONG DRUG TREATMENT COURT CLIENTS.

Drug treatment court (DTC) is a diversion program for individuals with drug-related crimes. However, the DTC literature is conflicting with regard to substance use and recidivism outcomes. This study examines factors associated with improved client outcome trajectories among a multisite, national DTC sample. We conducted a secondary analysis of 2,295 participants using the Global Appraisal of Individual Needs assessment tool. Participants in community-based treatment comprised a nonequivalent comparison group. Zero-inflated Poisson (ZIP) regression examined client sociodemographics in relation to substance use and rearrest at 6-month follow-up. Employed DTC clients were more likely to abstain from substances, but among all study participants, higher baseline use, male gender, and employment predicted substance use. Similarly, among DTC clients, older age and employment predicted no rearrests, but among all study participants, older and employed individuals had worse arrest outcome trajectories. Future work is needed to better understand how client characteristics may inform individualized treatment approaches.

A Specialized Treatment Court for Veterans with Trauma Exposure: Implications for the Field.

This study examines the efficacy of providing a Veterans Treatment Court specialized docket to trauma-affected veterans. Eighty-Six veterans enrolled in a jail diversion and trauma recovery Veterans Treatment Court program. Veteran participants were interviewed at baseline, 6- and 12-months to determine if the program led to improvements in jail recidivism, psychiatric symptoms, quality of life, and recovery. The results suggest that veteran's involved in the Veterans Treatment Court programs experienced significant improvement in PTSD, depression, substance abuse, overall functioning, emotional wellbeing, relationships with others, recovery status, social connectedness, family functioning, and sleep.

Family treatment courts and the COVID-19 pandemic: Barriers and facilitators to program implementation, client engagement, and recovery.

INTRODUCTION: Family Treatment Courts (FTCs) serve child welfare-involved parents with substance use issues who are working toward recovery and reunification with their children. Research has linked FTCs to successful outcomes such as treatment access and completion and family reunification, but there has been less attention to factors that hinder and facilitate program implementation and client engagement. Moreover, little is known about how the shift to virtual services during the COVID-19 pandemic impacted FTC programs and the families they serve. METHODS: This study examined interview data gathered from staff in six FTCs located in different regions of the country to investigate the impact of the pandemic on programs and the clients they serve. Interviews conducted with clients from one FTC in the Midwest reinforce the data. RESULTS: FTC programs and professionals adjusted to the pandemic by attempting to replicate face-to-face services in an online environment. Virtual services were vital for sustaining FTCs and mitigating barriers to client engagement during the pandemic. At the same time, FTCs were compelled to navigate new barriers to online program implementation as well as acute challenges that clients faced such as greater isolation and reduced treatment access. CONCLUSIONS: We discuss implications from these findings with an eye toward maximizing FTC implementation and impact through the intentional use of both in-person programming and online technology after the pandemic.

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.

Impact of a family treatment court on child permanency and safety.

BACKGROUND: Family Treatment Courts have been linked to promising effects on key child welfare outcomes, though few rigorous program evaluations have been conducted. OBJECTIVE: This study employs a robust quasi-experimental design to evaluate effects associated with Family Treatment Court participation on child permanency and safety. PARTICIPANTS AND SETTING: The sample included 648 eligible adults who were referred to a Family Treatment Court in a Midwest metropolitan area, including 266 program participants and 382 non-participants. METHODS: Propensity score weighting was applied to match program and comparison groups on demographic and case characteristics. Child welfare records yielded safety and permanency outcomes. Participants and non-participants were compared following an intent-to-treat principle, with logistic regressions used to test the odds of reunification and maltreatment recurrence, and Kaplan-Meier analyses used to explore time to reunification and permanency. Moderation tests were performed to analyze differences in program impact across racial/ethnic groups and substance use types. RESULTS: Compared to non-participants, program participants were 81 % more likely to reunify. Group differences in time to reunification and permanency were mixed, and there was no evidence of program impact on maltreatment recurrence. Substance use type and race/ethnicity did not moderate associations between program participation and study outcomes. CONCLUSIONS: Mounting evidence suggests that Family Treatment Courts are more effective than usual services in promoting family reunification, though it is unclear if these interventions hasten reunification or increase safety post-reunification. Rigorous evaluations are needed to explore moderating and mediating processes and identify implementation drivers and local conditions that contribute to heterogeneous results.

Implementing a Recovery Capital Model Into Therapeutic Courts: Case Study and Lessons Learned.

Recovery capital is a strengths-based and multi-level model for examining the process and outputs of recovery and desistance. Recovery capital posits that the more positive resources one accrues, the better the chances of recovery. Oftentimes growth of one's recovery capital must be initiated through identifying programs in the community to create supportive scaffolding: this may be especially true for individuals involved in the justice system who may experience additional barriers to accessing programming. This manuscript presents the results of a pilot evaluation of the REC-CAP, a recovery-capital oriented system of measurement, planning, and engagement in two drug treatment courts. We include a description of the implementation process and results from surveys and focus groups with the court staff. Results suggests that the trainings were useful and that court staff meaningfully engaged with the REC-CAP system. Court staff felt the REC-CAP provided important information about court clients' strengths and barriers and suggested next steps for staff to take to guide their clients. Future work should explore how the REC-CAP score profile may change with client progress through the court phases as well as how to incorporate more system level supports for a REC-CAP orientation among probation officers and other court staff.

Client attitudes toward virtual treatment court.

INTRODUCTION: As a response to the COVID-19 pandemic, many treatment courts shifted to offering teleservices. We sought to examine the barriers that clients faced when transitioning to virtual court and treatment, and how this transition impacted their perceptions of the treatment court experience. METHODS: The National Center for State Courts administered an online survey between January 1, 2021, and July 31, 2021, deployed to state and local court administrators, which resulted in 1356 unique client responses from 121 courts. The survey measured attitudes about the treatment court process, including interactions with the judge, the behavioral health treatment staff, and treatment groups, as well as barriers to virtual and in-person court. We hypothesized that clients with fewer technological barriers to virtual service, who shifted to virtual court or treatment, would report more positive attitudes to this service delivery. RESULTS: Clients felt more comfortable participating in virtual court sessions than in-person sessions but were less likely to feel like the judge was familiar with their case during virtual court sessions. From the treatment perspective, clients felt more connected with other group members and reported greater benefit from treatment staff when treatment services were delivered in-person, but clients felt less anxious when treatment groups were virtual. CONCLUSIONS: Even though virtual experiences were more comfortable than in-person experiences for clients, the results are nuanced and show preference for some in-person connections as they transitioned to virtual connections. Future research should examine how to improve client connections with staff/group members during virtual court or treatment sessions, particularly as courts and treatment providers are likely to continue some services virtually into the future.

North Carolina Specialty Courts, Treatment Access, and the Substance Use Crisis: A Promising but Underfunded Model.

Treatment courts aim to reduce criminal recidivism by addressing the behavioral health care needs of persons with psychiatric or substance use disorders that contribute to their offending. Stable funding and access to behavioral health providers are crucial elements of success for the treatment court model. What happens when courts lose state funding and must rely on local initiatives and resources? In this study, a survey of North Carolina treatment court professionals identified resource gaps and unmet needs. The authors argue that continuing state investment could make treatment courts more viable and effective. Medicaid expansion is a potential new resource for these problem-solving courts.

Juvenile Drug Treatment Court.

Juvenile drug treatment courts (JDTCs) were established in the 1990s to reduce the cycle of crime, drug use, and delinquency among youthful offenders. The principles and guidelines underlying JDTCs, roles of multidisciplinary team members, and procedures common to JDTCs are described. Youth served by JDTCs are frequently male, identify as racial or ethnic minorities, come from impoverished backgrounds, and experience significant psychiatric comorbidity. This article reviews the small number of clinical trials that have examined adjunctive treatments using family-based and individual behavioral treatment approaches designed to improve the overall efficacy of JDTCs. Considerations for future research on JDTCs are described.

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.

Criminally Involved Parents Who Misuse Substances and Children's Odds of Being Arrested as a Young Adult: Do Drug Treatment Courts Mitigate the Risk?

This paper examined (1) the association between parents who are convicted of a substance-related offense and their children's probability of being arrested as a young adult and (2) whether or not parental participation in an adult drug treatment court program mitigated this risk. The analysis relied on state administrative data from North Carolina courts (2005-2013) and from birth records (1988-2003). The dependent variable was the probability that a child was arrested as a young adult (16-21). Logistic regression was used to compare groups and models accounted for the clustering of multiple children with the same mother. Findings revealed that children whose parents were convicted on either a substance-related charge on a non-substance-related charge had twice the odds of being arrested as young adult, relative to children whose parents had not been observed having a conviction. While a quarter of children whose parents participated in a drug treatment court program were arrested as young adults, parental completion this program did not reduce this risk. In conclusion, children whose parents were convicted had an increased risk of being arrested as young adults, irrespective of whether or not the conviction was on a substance-related charge. However, drug treatment courts did not reduce this risk. Reducing intergenerational links in the probability of arrest remains a societal challenge.

Finding the loopholes: a cross-sectional qualitative study of systemic barriers to treatment access for women drug court participants.

BACKGROUND: Therapeutic diversion courts seek to address justice-involved participants' underlying problems leading to their legal system involvement, including substance use disorder, psychiatric illness, and intimate partner violence. The courts have not addressed systemic hurdles, which can contribute to a cycle of substance use disorder and recidivism, which in turn hinder health and wellness. The study purpose is to explore the systemic issues faced by women participants in drug treatment court from multiple perspectives to understand how these issues may relate to health and wellness in their lives. METHODS: Qualitative thematic framework analysis of five separate focus groups consisting of female drug treatment court participants, community providers, and court staff (n = 25). Themes were mapped across the socio-ecological framework and contextualized according to social determinants of health. RESULTS: Numerous systemic factors impacted women's access to treatment. Laws and legal policies (governance) excluded those who could potentially have benefitted from therapeutic court and did not allow consideration of parenting issues. Macroeconomic policies limit housing options for those with convictions. Social policies limited transportation, education, and employment options. Public policies limited healthcare and social protection and ability to access available resources. Culture and societal values, including stigma, limited treatment options. CONCLUSIONS: By understanding the social determinant of health for women in drug treatment court and stakeholder's perceptions, the legal system can implement public policy to better address the health needs of women drug court participants.

Comparative analysis of recidivism outcomes following drug treatment court in Vancouver, Canada.

Drug Treatment Courts (DTCs) integrate therapeutic interventions for substance using offenders with the administration of justice. Available evidence indicates that DTCs are effective at reducing recidivism, but it is not yet established whether they are equally effective for all subgroups of offenders. The current study investigates the comparative effectiveness of a Canadian DTC among subgroups defined by ethnicity, gender, prior offending, and the presence of a co-occurring mental disorder. Results indicate greater reductions in recidivism among female and Aboriginal participants, and no differences in recidivism associated with the presence or absence of co-occurring mental disorders or the number of prior convictions. Longer duration of involvement with the DTC program was positively associated with reduced recidivism. The effectiveness of DTCs with distinct subpopulations may be related to their composition and inclusion of expertise relevant to the needs of diverse participants.

Meeting health and psychological needs of women in drug treatment court.

We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: (1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; (2) interpersonal context of parenting and stigma involving features of this "evil cycle"; (3) institutions with logistical barriers to legal and medical assistance; (4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model.

How does family drug treatment court participation affect child welfare outcomes?

Parental substance use is a risk factor for child maltreatment. Family drug treatment courts (FDTCs) have emerged in the United States as a policy option to treat the underlying condition and promote family preservation. This study examines the effectiveness of FDTCs in North Carolina on child welfare outcomes. Data come from North Carolina records from child protection services, court system, and birth records. Three types of parental participation in a FDTC are considered: referral, enrolling, and completing an FDTC. The sample includes 566 children who were placed into foster care and whose parents participated in a FDTC program. Findings indicate that children of parents who were referred but did not enroll or who enrolled but did not complete had longer stays in foster care than children of completers. Reunification rates for children of completers were also higher. Outcomes for children in the referred and enrolled groups did not differ in the multivariate analyses. While effective substance use treatment services for parents may help preserve families, future research should examine factors for improving participation and completion rates as well as factors involved in scaling programs so that more families are served.