loudoun county adult drug treatment court

1. Loudoun County Adult Drug Treatment Court Washington/Baltimore HIDTA Conference Hyattsville, Maryland March 11, 2010 Introduction Introduction

2. What is a �Drug Court?� Specialized court docket focused on non-violent, substance abusing offenders Based on a national model and best practices Coordinated effort among many agencies Goal: Break the cycle of substance abuse, addiction & associated crime Docket is within existing court docket 8 AM every Wednesday morning What makes DC different? Regular judicial intervention, using sanctions & incentives which stresses certainty and immediacy Team approach�non adversarialDocket is within existing court docket 8 AM every Wednesday morning What makes DC different? Regular judicial intervention, using sanctions & incentives which stresses certainty and immediacy Team approach�non adversarial

3. Why a Drug Court? Began in Miami-Dade County, FL in 1989 Due to dockets overwhelmed with drug offenders Why in Loudoun Dockets overwhelmed with repeat drug offenders Benefits Public health Public safety Cost savings Saves lives

4. Basic Components of Drug Court The Drug Court program combines intensive judicial supervision with substance abuse treatment. The program includes: Regularly scheduled Drug Court sessions Intensive Probation supervision Substance abuse treatment Random drug testing Other services as needed Other services: DC offenders have variety of issues: Family treatment Housing Transportation Employment/Education HealthOther services: DC offenders have variety of issues: Family treatment Housing Transportation Employment/Education Health

5. How are Drug Courts Different? Traditional Individual agency services Probation or jail Repeated failures Drug court Collaboration Cooperation Jail diversion National model-best practices

6. Drug Court Team Circuit Court Office of the Commonwealth�s Attorney Criminal Defense Bar Community Corrections Program Sheriff�s Office Mental Health, Substance Abuse and Developmental Services Probation and Parole

7. Drug Court Partners Clerk of the Circuit Court OAR of Fairfax County, Inc. Loudoun Aftercare Program Department of Family Services Virginia Alcohol Monitoring Residential Treatment Providers Homeless Shelters Community members/volunteers

8. The participant must: Reside in Loudoun County Be a non-violent offender and may not be on probation for a Felony DUI Be alcohol or drug dependent Be on supervised probation with a pending Probation Violation that is due to their alcohol or drug dependency The Drug Court Team must unanimously approve each participant�s entrance into the program. Most dispose of all pending charges before entrance into DC.Most dispose of all pending charges before entrance into DC.

9. Who are Drug Court Participants? Eligibility: Nonviolent Addicts Felony PV Loudoun resident Participants: 180 screened 76 entered 15 graduated Underlying offenses: 55% drug 43% property 2% other Gender 55% male 45% female Age Range of 19 to 58 2009: Male-67% Female-33% Race: 73% White 21% Black/African American 3% Black and White 3% Multi-race2009: Male-67% Female-33% Race: 73% White 21% Black/African American 3% Black and White 3% Multi-race

10. Entry Process Probation Officer alleges Probation Violation has occurred Probation Violation letter is written to the Court Drug Court Pre-screening form completed Case is placed on Drug Court docket 1st Appearance in Drug Court Defense Counsel appointed, if necessary Assessment for eligibility completed by Mental Health/Substance Abuse Services Drug Court Team reviews case If eligible: Concedes and/or found in violation of probation Begins Drug Court Program the same day If ineligible: Case is continued to standard Probation Violation processing

11. Communication Monday staffing Team staffing Court Daily contacts Access to Judges

12. Phase 1(90 days) Weekly Drug Court 3 substance abuse treatment groups 30 AA/NA in the first 30 days, 4 per week thereafter (to include 1 per weekend day) 3 urine screens and random screens 2 meetings with Probation Officer Full time employment, education or community service 10PM to 5AM curfew Obtain a sponsor Obtain stable housing Submit Participation Fee 60 consecutive days of abstinence from drugs and alcohol

13. Phase 2 (90 days) Drug Court every other week Weekly 3 substance abuse treatment groups 4 AA/NA meetings per week (to include 1 per weekend day) 2 urine screens and random screens 1 meeting with Probation Officer Full time employment, education or community service Maintain weekly contact with sponsor Maintain stable housing Progress towards payment of costs, fines, fees and restitution 90 consecutive days of abstinence from drugs and alcohol

14. Phase 3 (90 days) Drug Court every three weeks Weekly 2 substance abuse treatment groups 4 AA/NA meetings per week (to include 1 per weekend day) 1 urine screen and random screens Meeting with Probation Officer every other week Full time employment, education or community service Maintain weekly contact with sponsor Maintain stable housing Progress towards payment of costs, fines, fees and restitution 120 consecutive days of abstinence from drugs and alcohol

15. Phase 4(90 days) Drug Court every three weeks 1 substance abuse treatment group per week 4 AA/NA meetings per week (to include 1 per weekend day) Random urine screens 1 meeting with Probation Officer Full time employment, education or community service Maintain weekly contact with sponsor Maintain stable housing Develop an aftercare plan Progress towards payment of costs, fines, fees and restitution 6 consecutive months of abstinence from drugs and alcohol Complete all requirements for graduation

16. Graduation Complete all phase requirements 6 months abstinence from drugs and alcohol Positive treatment summary No new felony arrests No new Class 1 or 2 misdemeanor arrests Agree to participate in follow-up interviews Recommendation of the Drug Court Team Upon program graduation, a participant may be continued on supervised probation.

17. Aftercare Fills the 6-month gap between graduation and termination of probation Phase IV participants integrated into aftercare by attending monthly Focuses on reinforcing gains in recovery and Step work.

18. Termination Voluntary by participant Decision by Drug Court team Automatic expulsion Possession of firearm Absconding for more than 14 consecutive days Not attending treatment or court for 14 consecutive days Arrest on new felony offense or arrest for new Class 1 or 2 misdemeanor offenses Possession of drugs or alcohol on court, probation or treatment property Moving outside of Loudoun County, VA Committing an act of physical violence while in the program Upon termination from the program, the case will be returned to the normal docket for sentencing on the Probation Violation.

19. SANCTIONS & REQUIREMENTS Reprimand from the Court Writing assignments Demotion to an earlier phase Community service hours Increased frequency of drug testing and probation meetings Increased frequency of treatment sessions and AA/NA meetings Individual treatment sessions Travel restrictions Curfew restrictions SCRAM GPS Monitoring Residential/inpatient treatment Incarceration Termination

20. INCENTIVES Promotion to next Phase Praise from the Court and Team Certificates of recognition Medallions Gift certificates Movie passes Program Graduation Meditation Books, Coffee Mugs, Holiday Celebrations More detailed incentive program funded by grant in development: research says ratio should be 1 sanction to 3 incentivesMore detailed incentive program funded by grant in development: research says ratio should be 1 sanction to 3 incentives

21. Drug Court Fees & Costs to the Participants Program fee Paid to Drug Court $100 one-time only Treatment fee Paid to Loudoun County Mental Health and Substance Abuse Services on a weekly basis Based on a sliding scale Fee amount may change with changing programmatic needs. Generally to offset costs of urine screens and to help fund incentives.Fee amount may change with changing programmatic needs. Generally to offset costs of urine screens and to help fund incentives.

22. Mental Health & Substance Abuse Services �Menu� of services Intake process Risk/needs assessment Evidence based clinical models Integrated system Treatment outcomes

23. Mental Health & Substance Abuse Services Services -Therapeutic Case Management -Individual and Group Therapy -Psychiatric and Medication Management Services -On-site and laboratory confirmation Etoh and drug testing -Supervised Apartment Services (Space limited) -Contracted detox and residential tx

24. Intake Process Clinical assessment Based on form used by Henrico Drug Court Interview with client Collateral information Loudoun County Mental Health Comprehensive Bio-psycho-social Includes risk/needs assessment DRS-2

25. Mental Health & Substance Abuse Services Clinical Models -MRT -SFT -CBT -Gender based groups -Domestic Violence group (Duluth Model) -Multi Family/Support group -Co-occurring services -grounded in the concept that addiction is an illness of the body, mind and spirit -content of our tx interventions have traditionally been consistent with 12-step programs with a primary focus on steps 1-5. -SFT allows us to apply the general therapeutic principles in many other ways than those delineated in the manual. -can be intermixed with other tx strategies -abstinence based model -goal to foster clt�s commitment to participate in 12-step recovery.-grounded in the concept that addiction is an illness of the body, mind and spirit -content of our tx interventions have traditionally been consistent with 12-step programs with a primary focus on steps 1-5. -SFT allows us to apply the general therapeutic principles in many other ways than those delineated in the manual. -can be intermixed with other tx strategies -abstinence based model -goal to foster clt�s commitment to participate in 12-step recovery.

26. Moral Reconation Therapy Dr. Gregory L. Little Dr. Kenneth D. Robinson 120 + outcome studies Reconation

27. Twelve Step Facilitation Therapy Stanford University study 50 yr. longitudinal study by George Vaillant (1983) NIAAA�s Project MATCH (1997) -(Stanford U) found that a 12-Step oriented tx program boosted two year sobriety rates by 30 percent over other modalities. -(Vaillant) the # of AA meetings attended in the first year of sobriety correlates with abstinence. -although CBT, MET and SFT all produced equivalent main effects on post tx drinking outcomes, the SFT by low ASI psychiatric severity interaction proved to be the only statistically significant predicted outcome of Project MATCH. -grounded in concept that addiction is an illness of body, mind and spirit. -content of our tx interventions have traditionally been consistent with 12-step programs. -primary focus on steps 1-5. -allows us to apply the general therapeutic principles in many other ways than those delineated in the manual. -can be intermixed with other tx strategies. -abstinence model. -goal to foster clt�s commitment to participate in 12-step recovery. -(Stanford U) found that a 12-Step oriented tx program boosted two year sobriety rates by 30 percent over other modalities. -(Vaillant) the # of AA meetings attended in the first year of sobriety correlates with abstinence. -although CBT, MET and SFT all produced equivalent main effects on post tx drinking outcomes, the SFT by low ASI psychiatric severity interaction proved to be the only statistically significant predicted outcome of Project MATCH. -grounded in concept that addiction is an illness of body, mind and spirit. -content of our tx interventions have traditionally been consistent with 12-step programs. -primary focus on steps 1-5. -allows us to apply the general therapeutic principles in many other ways than those delineated in the manual. -can be intermixed with other tx strategies. -abstinence model. -goal to foster clt�s commitment to participate in 12-step recovery.

28. Cognitive Behavioral Therapy Based on principles of social learning theory Goals: Overcome skills deficits Increase client�s ability to cope with high relapse risk situations in relationships and with mood states -views etoh and drug use as functionally related to major problems in the person�s life. -views etoh and drug use as functionally related to major problems in the person�s life.

29. Gender Based Groups CSAT Treatment Improvement Protocol (TIP 44) For Adults in the Criminal Justice System CSAT Technical Assistance Publication (TAP 23) Substance Abuse Treatment for Women Offenders: Guide to Promising Practices -literature reviewed (p. 96) reports that among incarcerated women, the longer the clt stayed in women�s tx program the less likely she was to re-offend -sites that evidence shows (p. 3) that effective tx programming does empower addicted women offenders to overcome their substance abuse, to lead a crime-free life, and to become productive citizens. -a review of current knowledge in a report by Brady and Ashley (2005) Women in Substance Abuse tx: results from the Etoh and drug services study suggests that programming with wraparound services, women-only tx and workshops addressing women-focused topics can be beneficial. -positive tx outucomes included decreased use, increased tx retention, improved perinatal/birht outcomes and prenatal care, improements in self-esteem and depression-literature reviewed (p. 96) reports that among incarcerated women, the longer the clt stayed in women�s tx program the less likely she was to re-offend -sites that evidence shows (p. 3) that effective tx programming does empower addicted women offenders to overcome their substance abuse, to lead a crime-free life, and to become productive citizens. -a review of current knowledge in a report by Brady and Ashley (2005) Women in Substance Abuse tx: results from the Etoh and drug services study suggests that programming with wraparound services, women-only tx and workshops addressing women-focused topics can be beneficial. -positive tx outucomes included decreased use, increased tx retention, improved perinatal/birht outcomes and prenatal care, improements in self-esteem and depression

30. Multi Family/Support Groups CSAT Treatment Improvement Protocol (TIP 39) Substance Abuse Treatment and Family Therapy Increases engagement and retention in treatment Reduces client�s drug/etoh use Improves family and social functioning Discourages relapse -evidence indicates (Stanton et al.1982) that SA tx that includes family therapy works better than SA tx that does not. -selected research outcomes of family work in SA tx pg 10-11 -evidence indicates (Stanton et al.1982) that SA tx that includes family therapy works better than SA tx that does not. -selected research outcomes of family work in SA tx pg 10-11

31. Co-Occurring Services CSAT Treatment Improvement Protocol (TIP 42) For Persons with Co-Occurring Disorders -identifies research that clearly demonstrates that SA tx of clt�s with co-occurring mental illness and substance use disorders can be beneficial -identifies research that clearly demonstrates that SA tx of clt�s with co-occurring mental illness and substance use disorders can be beneficial

32. Treatment Outcomes General Population vs. Drug Court Population Length of Stay Abstinence Deeper engagement in 12-step recovery DRS-2 Results

33. Supervision: Community Corrections & Sheriff�s Office Team Supervision Model Field (Deputy) vs. Office (Probation Officer) Intake Advised of rules and review handbook Drug screen Client provides self-report of personal, criminal, and drug history Photographed Criminal and driving records reviewed

34. Supervision: Community Corrections Regular probation appointments in the office Verify employment and community service hours, as well as income Set up and monitor payment plans for court costs, fines, and restitution Verify completion of sanctions Complete weekly reports and submit to Drug Court Team and Judges Referrals for service: Family services, SCRAM, VASAP, etc.

35. Supervision: Sheriff�s Office Pre-Entry Home Inspection Home and Employment Checks Curfew Enforcement Alcohol Breath Test Warrant Service

36. Supervision: Community Corrections & Sheriff�s Office Drug testing protocols: Redi-Test Dip Strips Breath test Test observed by same sex 2 test to confirm positive results �Over-The-Counter and Prescription Drug Policy 12 Drugs Tested Cocaine Opiates����� THC Amphetamine Methamphetamine Benzodiazepines PCP Oxycodone Barbituates Ecstasy Methadone Buprenorphine

37. OAR of Fairfax County, Inc. OAR of Fairfax: Opportunities, Alternatives, and Resources Provide employment focused case management services including assisting clients with obtaining identification, employment applications, resume and cover letter development, interview preparation, and job search and retention skills. Make client referrals for service to community based organizations for needs such as food, clothing, housing, and healthcare. Facilitate a 12 week life skills class on topics including employment development, budgeting, nutrition, and stress management. Utilize community resources to build relationships with potential employers.

38. Benefits and Outcomes Employed-live & most work in Loudoun Pay taxes-including back taxes Pay court costs/restitution Pay treatment fees Pay program fee Pay child support-garnishments/payments Pay off debts-become self-supporting/sustaining Complete community service: over 3,000 hrs Drug free babies: 4 Education: GED & college Public health: deal w/health issues Diversion from incarceration: DOC issues Recidivism

39. Evaluations HIDTA CSAT- Westat (Cross-site evaluation) SAMHSA-GPRA Virginia: Supreme Court of Virginia Local: Process, outcome and cost benefit evaluations underway by Transformation Systems Incorporated JLARC�Joint Legislative Audit & Review Commission (2008) �the adverse effects of substance abuse impose significant costs on the State and localities, totaling at least $613 million in 2006.� Substance use disorder treatment programming appears to �frequently reduce costs to the state & locality as well as improve public safey & economic benefits� �drug court completers experienced significantly better outcomes in the criminal justice system after treatment ended than 3 comparison groups� particularly in recidivism & employment categories 3 groups: drug court non-completers, State probation treatment completers, and Jail treatment completers Non-drug court completers demonstrated better recidivism rates than did state probation treatment completers JLARC�Joint Legislative Audit & Review Commission (2008) �the adverse effects of substance abuse impose significant costs on the State and localities, totaling at least $613 million in 2006.� Substance use disorder treatment programming appears to �frequently reduce costs to the state & locality as well as improve public safey & economic benefits� �drug court completers experienced significantly better outcomes in the criminal justice system after treatment ended than 3 comparison groups� particularly in recidivism & employment categories 3 groups: drug court non-completers, State probation treatment completers, and Jail treatment completers Non-drug court completers demonstrated better recidivism rates than did state probation treatment completers

40. Program Barriers Housing Transportation Employment Child care Healthcare Referrals

41. Funding Local: Four positions are funded by the Board of Supervisors State: Drug courts were recognized in VA Code � 18.2-254.1 as of July 1, 2004 Currently there are no state funds for new drug courts in Virginia Federal: Drug Court grants are provided by several Federal agencies Diversifying: Future plans for a non-profit to support the program Advocacy is needed at all levels to ensure the program is continued and potentially expanded in the future. Local, state & federal legislators need to hear support.Advocacy is needed at all levels to ensure the program is continued and potentially expanded in the future. Local, state & federal legislators need to hear support.

42. Contact Information Michelle White Program Coordinator 703-737-8212 Michelle.White@loudoun.gov Or visit: http://www.loudoun.gov/ Invite to both regular & graduation to see feel good and internal struggle, growth & change of participants� lives Invite to both regular & graduation to see feel good and internal struggle, growth & change of participants� lives