Mental Health Court Outcomes: A Comparison of Re-Arrest and Re-Arrest Severity Between Mental Health Court and Traditional Court Participants

Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.     

Mental health, gender, and drug court completion

Drug-involved offenders report high rates of mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues of drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators of mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors of drug court completion. Policy implications include assessing the mental health status of all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood of successful program outcomes. Drug courts must better meet the needs of participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention. This research was supported by grant RO1 DA12424 “Drug Court Offenders in Outpatient Treatment,” by the National Institute on Drug Abuse.     

Collaborations between drug courts and service providers: Characteristics and challenges

Addressing the multiple treatment needs of drug-involved offenders can enhance outcomes including sobriety and recidivism. Meeting drug court offenders' needs requires collaborative linkages between courts and providers of treatment and other services; however, there has been limited research on linkages. Using semi-structured interview data collected from administrators of fourteen drug courts and providers of services to offenders in those drug courts, this study described collaborative linkages and the challenges involved in fostering them. Although results suggest a moderate to strong level of linkage as perceived by both drug court administrators and service providers, services other than substance abuse treatment were sparsely provided through the drug courts. Limitations in funding, management information systems, and staffing were perceived as barriers to linkage. Results offer directions for enhancing linkages between drug courts and service providers and should be of value in improving quality of drug court treatment and offender outcomes.     

Matching Judicial Supervision to Clients' Risk Status in Drug Court

This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts.     

Improving the quality of drug court clinical screening: a call for performance measurement policy reform

Despite the widespread use of the drug court model, standardized performance measures for drug courts are not uniformly utilized, and rarely include process measures. To ensure that drug courts are being implemented in the most effective manner, the use of performance measurement tools should be considered for wide scale adoption. Drug court effectiveness is moderated by participant characteristics, and is most effective for individuals with the highest substance use needs. Therefore, having quality clinical screening processes is crucial to ensuring that drug courts are serving the population for which they are effective. This paper examines clinical screening in drug courts, to answer the following 1) what is the current state of screening, 2) what works, and 3) why measurement matters. It also proposes a clinical screening performance measure to improve fidelity and ensure appropriate participant enrollment. The creation of a performance measure would create opportunities to improve drug court outcomes, and leverage pay-for-performance models.     

An experimental trial of adaptive programming in drug court: outcomes at 6, 12 and 18 months

Objectives

To test whether an adaptive program improves outcomes in drug court by adjusting the schedule of court hearings and clinical case-management sessions pursuant to a priori performance criteria.

Methods

Consenting participants in a misdemeanor drug court were randomly assigned to the adaptive program (n?=?62) or to a baseline-matching condition (n?=?63) in which they attended court hearings based on the results of a criminal risk assessment. Outcome measures were re-arrest rates at 18 months post-entry to the drug court, and urine drug test results and structured interview results at 6 and 12 months post-entry.

Results

Although previously published analyses revealed significantly fewer positive drug tests for participants in the adaptive condition during the first 18 weeks of drug court, current analyses indicate the effects converged during the ensuing year. Between-group differences in new arrest rates, urine drug test results and self-reported psychosocial problems were small and non-statistically significant at 6, 12, and 18 months post-entry. A non-significant trend (p?=?.10) suggests there may have been a small residual impact (Cramer’s v?=?.15) on new misdemeanor arrests after 18 months.

Conclusions

Adaptive programming shows promise for enhancing short-term outcomes in drug courts; however, additional efforts are needed to extend the effects beyond the first 4 to 6 months of enrollment.     

Does recent physical and sexual victimization affect further substance use for adult drug-involved offenders?

This study examined whether physical and sexual victimization experiences were related to further substance use for a sample of drug-involved adult offenders and whether this increase could be attributed to depression experienced after the victimization occurred. A total of 674 men and 284 women from the longitudinal Multisite Adult Drug Court Evaluation (MADCE) were included in analyses. The study included 23 drug court and 6 comparison sites. Study participants completed three interviews: at baseline enrollment and then at 6 and 18 months after baseline. Multilevel path modeling showed that physical and sexual victimization experiences during the year before the baseline interview were associated with further substance use at 18 months and that this relationship was mediated by depression. All relationships held for both men and women, and beyond the contribution of several control variables, including drug court program participation. Public health and criminal justice personnel working with substance-using offenders should screen individuals for victimization-related trauma and, if identified, provide assistance to evaluate and improve such individuals' mental health and, subsequently, decrease their likelihood of using substances.     

A Detailed Cost Evaluation of a Juvenile Drug Court that Follows the Juvenile Drug Court Model (16 Strategies)

Although juvenile drug courts (JDCs) have now been in operation for 17 years, there is still no definitive appraisal as to this model's cost effectiveness and in particular, no detailed cost analysis of a JDC program following the 16 strategies until this one. The cost data presented in this paper build on the process and outcome evaluations performed on the Clackamas County Juvenile Drug Court (CCJDC). The criminal justice costs incurred by participants in drug court are compared with the costs incurred by eligible non‐participants. CCJDC participants had far more positive outcomes than those who did not participate in the program. In the two years after drug court entry, CCJDC participants cost the taxpayers $961 less per participant than similar individuals who did not attend the drug court program.     

Military Socialization: A Motivating Factor for Seeking Treatment in a Veterans’ Treatment Court

The veterans’ treatment court movement is just beyond the nascent period, and given the rapid proliferation of these courts in recent years it is imperative that the scientific community understand their operational procedures and assess whether they are meeting a unique need beyond those addressed by other problem-solving courts. This paper provides an in-depth examination of veteran culture and how it helps to distinguish veterans’ treatment courts from other courts that focus on similar populations (e.g., drug, DWI, and mental health courts). Using in-depth semi-structured interviews and focus group data collected from veteran participants, veteran mentors, and court team members in Pennsylvania, we employ content analysis to explore the veteran culture as a motivator for participants to enroll in a veterans’ treatment court and engage with others throughout participation in treatment. The results of this exploratory study suggest that a shared culture serves to motivate justice-involved veterans to seek out the veterans’ treatment court over other treatment options and remain engaged in this problem-solving court, while inspiring a sense of obligation to do well in treatment for them and their fellow veterans. The shared experiences of military service and across-the-board support for fellow service members suggest that the veterans’ treatment court creates a unique environment for pursuing treatment.     

Sustained Outcomes? an Exploratory Study of Juvenile Drug Courts and Long-Term Recidivism

This exploratory study examined juvenile drug courts’ effect on adulthood recidivism. Utilizing a twelve-year average follow up time, adult recidivism rates were compared between previous juvenile drug court participants and a comparison group of juveniles who participated in traditional probation. Linear regression models indicated limited recidivism effects of drug court on arrests or convictions into adulthood. The findings suggest that gender and race may play a role in how justice-involved juveniles interact and experience juvenile drug court, highlighting the need for gender-responsive and culturally responsive policies, practices, and programs within juvenile drug courts. Recommendations are made regarding future research areas and ways to potentially improve long-term juvenile drug court outcomes.     

Drug Court through the Lenses of African American Women: Improving Graduation Rates with Gender-Responsive Interventions

Drug courts began in the United States in 1989, and nearly three decades of evidence has shown that drug courts are more effective than other criminal justice interventions at reducing criminal recidivism. There has, however, been a trend in some drug courts where African Americans are less likely to graduate than their White counterparts, which is concerning because evidence has also shown that graduating the program reduces the odds of recidivating. Little is known about African Americans’ experiences in drug court, and this is the first known qualitative study to ask African American women (N?=?8) about the most helpful aspects of drug court that support them in graduating and how the drug court could be more helpful in supporting them to graduate. The women felt that the drug court judge was their advocate and understood the unique challenges they faced with balancing the demands of drug court with motherhood. Conversely, the women felt that they were not receiving effective, gender-responsive treatment for their substance use disorders, which was a barrier to them graduating drug court. The findings are discussed in reference to drug court practice and future research.     

Mentally ill offenders eligible for diversion at local court in New South Wales (NSW), Australia: factors associated with initially successful diversion

Diversion away from the criminal justice system and into mental health treatment services is a key strategy for addressing the well-established burden of mental illness suffered by those presenting to court. While mental health courts, court liaison and court diversion services have been developed in many jurisdictions internationally, there is limited research evidence to support their effectiveness in identifying those with mental health need and achieving successful diversion. The Statewide Community and Court Liaison Service in New South Wales, Australia, identifies mentally ill offenders likely to meet legal eligibility criteria for diversion at the busiest local courts across the state. Utilising data collected by mental health clinicians working in the service, 8317 individuals were identified as being eligible for court diversion on at least one occasion during the study period (1 July 2008 and the 30 June 2015) and 57.3% were subsequently diverted by Magistrates. Successful diversion at this first step was associated with being female, older, of non-Aboriginal and/or Torres Strait Islander background, and having a serious mental illness, replicated when stratified by sex and by Aboriginal and/or Torres Strait Islander background. There may be barriers to mental health diversion at court for individuals with particular socio-demographic characteristics which future service developments may need to take into account.     

Correlates of subjective stress among drug court clients

Psychosocial stress is consistently found to promote initiation, intensification, and relapse in drug abuse. It would, therefore, be desirable to identify characteristics of offenders who are at heightened risk for stress-induced exacerbations of addictive behavior. In this cross-sectional, correlational, interview study, 500 clients of two Kentucky drug courts averaged 30 years of age and were predominantly male, White, employed, high school educated, single, and adjudicated in small- and medium-size cities. Five independent correlates of greater subjective stress emerged in stepwise multiple regression analysis (R2 = .395): use of escape-avoidance coping, positive reappraisal coping (inversely associated), more negative life events, better self-rated health (inversely associated), and access to social support related to work problems (inversely associated). Treatment interventions emphasizing effective coping styles and building of social support as well as managing of negative life events and perceptions of health may serve to lessen subjective stress and its consequences in drug-abusing criminal populations.     

Roles and Power within Federal Problem Solving Courtroom Workgroups

Problem solving (PS) courts (e.g., drug, family, gang, prostitution, reentry) are becoming more commonplace. Today, PS courts exist or are planned in nearly all of the ninety‐four U.S. federal districts. These courts focus on integrating therapeutic jurisprudence into the courtroom environment while emphasizing group decision‐making processes among courtroom workgroup members. In this legal setting, courtroom workgroup teams, regularly consisting of judges, prosecutors, defense attorneys, probation officers (POs), and treatment providers engage a collective, case management approach to decision making with shared power among team members. However, despite the court's therapeutic and collaborative design, we find that POs wield powerful influence in decision making. Informed by sixteen months of qualitative fieldwork, including semistructured interviews, observation of courtroom workgroup meetings, and court observations in five federal PS courts in three federal districts, we find that POs exert undetected informational, technical, and relational power within the PS courtroom workgroup. This role and its accompanying power transforms POs into key decision makers, regardless of PS court type, workgroup dynamics, and decision‐making style. The POs' role makes them critical contributors to the outcomes in federal PS courts with important implications for punishment decisions in the federal justice system. With an increasing number of PS courts currently in the planning stages at the federal level, our study has implications for the structure and decision outcomes in these growing courtroom workgroups.     

The Effectiveness of a Mental Health Court in Reducing Recidivism in Individuals with Severe Mental Illness and Comorbid Substance Use Disorder

The current study examined the efficacy of a specialized mental health court in reducing recidivism for severely mentally ill defendants with comorbid substance use disorders. There is a wealth of research supporting the efficacy of mental health courts in reducing recidivism for those with severe mental illness; however, the benefit of these courts for individuals with severe mental illness and comorbid substance use disorders has received limited empirical attention. Participants were 514 defendants enrolled in either a traditional adversarial court or a specialized mental health court. Recidivism was assessed across different outcome variables, including frequency of reoffending, severity of new offenses, and length of time to reoffend. When compared to participants in the traditional adversarial court, enrollment in mental health court was associated with a greater length of time to rearrest and fewer participants were rearrested in the mental health court than the traditional court. Group differences between those with and without comorbid substance use disorders who were enrolled in the mental health court were not found across recidivism outcome metrics. Results of the current study are particularly promising given that defendants with substance use disorders are at a greater risk for reoffending.     

Implementing the Key Components of Specialized Drug Treatment Courts: Practice and Policy Considerations

The perceived need for specialized drug courts emerged from the most recent "war on drugs." Courts were no longer able to handle such cases effectively because of an overwhelming volume of drug arrests and prosecutions. The increased emphasis on drug enforcement also revealed that many of the most serious criminally involved drug‐using offenders were undeterred by threats of incarceration, but were amenable to substance abuse treatment. Drug court professionals have identified several "key components" that must be in place for these courts to achieve their goals of reducing drug use and crime. Through the lens of these key drug court components, we examine the development and initiation of specialized drug treatment courts in Cook County (Chicago), Illinois. By exploring and documenting Cook County's experiences, we elucidate several of the basic policy and organizational issues surrounding the implementation and operations of specialized drug treatment courts in the United States.     

Testing the Packer Theorem: The Efficiency of Florida’s Criminal Circuit Courts

Herbert Packer’s models of the criminal process are criminal justice theorems, often the foundation of student introduction to the field in introductory textbooks. To date, there is little empirical analysis of the conceptual foundations of the process-based models, namely that courts are more efficient through the utilization of plea bargains, while an increase in trials necessarily decreases efficiency. The present results reveal wide variability in Florida circuit criminal court efficiency within and between circuits from 2004/05 to 2010/11. Regression analysis revealed that the year over year difference in both plea bargain (β?=?.14) and trial percentage (β?=?.13) significantly predicted (p?<?.05) year over year changes in efficiency, but explained a small amount of the variance (R ²?=?.026) controlling for other factors (total model R ²?=?.58–.62). These results show there is more capacity for trials within the Florida courts, and an increase in trials does not negatively impact court efficiency as expected but that other factors are far more relevant in explaining changes in efficiency outcomes. Furthermore, the Packer “assembly line” analogy, a basic tenet of the criminal process, is not found: plea bargains do not strongly predict or explain court efficiency, with structures playing a greater role in court outcomes than the processes conceptualized by Packer. The application to courts and impact on criminal justice education are discussed.     

Are effective drug courts an urban phenomenon?: considering their impact on recidivism among a nonmetropolitan adult sample in Washington State

Drug courts represent a significant development in criminal justice during the past 15 years, and a small but growing literature suggests they are effective in reducing drug use and criminal behavior. Most of these studies evaluate the effects of drug courts in urban areas, however. This study adds to this literature by considering the effects of this intermediate sanction among adult offenders in a small, nonmetropolitan county of northwest Washington. Using a retrospective comparison group of matched control participants, these results show that the prevalence and incidence of rearrest is significantly lower among drug court graduates than probationers. These differences in recidivism persist even when the age, race, gender, and number of days at risk in the community are statistically controlled. Among those who did recidivate, drug court graduates did not significantly differ from controls in duration to first arrest and arrest incidence. Policy implications are discussed.     

THE BEST SEAT IN THE HOUSE: THE COURT ASSIGNMENT AND JUDICIAL SATISFACTION

A survey of 355 judges examined the differences in judicial satisfaction between those assigned to problem-solving courts—such as drug treatment and unified family—and judges in other more traditional assignments such as family law and criminal courts. The unified family court systems, like drug treatment courts, have generally adopted the principles of therapeutic jurisprudence. Significant differences were found on each of the three survey scales: (1) helpfulness, (2) attitude toward litigants, and (3) positive effects of assignment. The judges who were in the problem-solving courts (drug treatment and unified family court) scored higher on all three scales than those who were not (traditional family and criminal court). The group of problem-solving court judges consistently scored higher than the other group of judges, with the drug treatment court judges scoring the highest. The group of traditional criminal court and family court judges scored less positively, with the criminal court judges having the lowest scores. The problem-solving court judges were more likely to report believing that the role of the court should include helping litigants address the problems that brought them there and were more likely to observe positive changes in the litigants. They were also more likely to believe that litigants are motivated to change and are able to do so. They felt more respected by the litigants and were more likely to think that the litigants were grateful for help they received. The problem-solving court judges were also more likely to report being happy in their assignments and to believe that these assignments have a positive emotional effect on them.