Douglas B. Marlowe, J.D., Ph.D., F CPP

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

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

3. 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

4. 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

5. 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)

6. 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)

7. 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

8. 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

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

10. 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

11. Program Planning 15 times greater cost benefits }

12. Annual Staff Training Five times greater cost benefits }

13. Evaluation Four times greater cost benefits }

14. Judicial Assignments Three times greater cost benefits }

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

16. 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)

17. 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?)

18. 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