Volume 4, Issue 2 • Fall 2015

Table of Contents

Editor's Note

An Outcome-Based Evaluation of a Short-Term Residential Treatment Program for American Indian Youth with Substance Abuse Problems

Substance Use Services for Adolescents in Juvenile Correctional Facilities: A National Study

Communication Patterns Among Juvenile Detainees: A High-Risk Population for Transmission of Human Immunodeficiency Virus (HIV) and Other Sexually Transmitted Diseases

Meeting Treatment Needs: Overall Effectiveness and Critical Components of Juvenile Drug Court/Reclaiming Futures Programs

I’ve Got My Own Problems:
The Impact of Parental Stressors on Parental Anger

Development, Delivery, and Evaluation of a Pilot Stress Reduction, Emotion Regulation, and Mindfulness Training for Juvenile Justice Officers

Does Permissive Parenting Relate to Levels of Delinquency?
An Examination of Family Management Practices in Low-Income Black American Families

Employers’ Perceptions on the Disclosure of Juvenile Records

Truancy Reduction and Prevention: The Impact of Provider Contact in Intervention Efficacy

Meeting Treatment Needs: Overall Effectiveness and Critical Components of Juvenile Drug Court/Reclaiming Futures Programs

Josephine D. Korchmaros, Southwest Institute for Research on Women, University of Arizona; Sally J. Stevens, Southwest Institute for Research on Women, University of Arizona; Alison R. Greene, Southwest Institute for Research on Women, University of Arizona; Monica Davis, Southwest Institute for Research on Women, University of Arizona; and Rachel Chalot, Southwest Institute for Research on Women, University of Arizona.

Correspondence concerning this article should be addressed to Josephine D. Korchmaros, Southwest Institute for Research on Women, University of Arizona, 181 S. Tucson Boulevard, Ste. 101, Tucson, AZ 85716. E-mail: jkorch@email.arizona.edu

Acknowledgments: The authors wish to acknowledge the contributions of the evaluation sites and the evaluation partners, Chestnut Health Systems (CHS) and Carnevale Associates, LLC (CALLC), to the National Cross-Site Evaluation of Juvenile Drug Courts and Reclaiming Futures. In addition, the authors are appreciative of support from the Library of Congress–Federal Research Division and the Office of Juvenile Justice and Delinquency Prevention (OJJDP).

The development of this article is funded by OJJDP through an interagency agreement with the Library of Congress–contract number LCFRD11C0007. The views expressed here are the authors’ and do not necessarily represent the official policies of OJJDP or the Library of Congress; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Keywords: juvenile drug courts, treatment programs, Strategies in Practice, Reclaiming Futures

Abstract

There is a current trend to incorporate evidence-based practices into juvenile drug courts in an effort to enhance substance abuse treatment capacity. Consequently many jurisdictions that have been implementing the Juvenile Drug Court: Strategies in Practice (National Drug Court Institute & National Council of Juvenile and Family Court Judges, 2003), have incorporated Reclaiming Futures (Nissen, Butts, Merrigan, & Kraft, 2006) into their juvenile drug courts. The expectation is that the integrated Juvenile Drug Court: Strategies in Practice and Reclaiming Futures (JDC/RF) program would lead to increased engagement of youth in juvenile drug court resulting in improved rates of program clients receiving substance abuse treatment. Results of the National Cross-Site Evaluation of JDC/RF indicate that the overall probability of a JDC/RF program client receiving treatment is relatively high, but varies by program. Specifically, JDC/RF programs lacking systems integration were less effective at serving substance abuse treatment needs, regardless of the characteristics of their clients. This finding suggests that all communities should focus on system integration when delivering services to adolescents with substance abuse problems in the justice system. In addition, JDC/RF programs with greater access to targeted treatment were more effective at serving substance abuse treatment needs. Even though this effect was accounted for by client characteristics, results suggest that targeted treatment should remain a particular focus of juvenile drug courts.

Introduction

Adolescence is a critical period in human development because significant physical and neurological maturation occur. Substance use during childhood and adolescence can have numerous negative effects that have the potential to significantly impair healthy development, as well as lead to substance abuse, substance dependence, or a substance use disorder (SUD) (Dennis, Babor, Roebuck, & Donaldson, 2002). SUDs among youth in the United States (U.S.) are not uncommon (Swendsen et al., 2012). More than 1.7 million (7%) U.S. youth ages 12 to 17 have an SUD, with significantly higher rates among those involved with the juvenile justice system (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). Moreover, adolescents involved with the justice system have more severe substance abuse-related issues than their non-involved peers (Tarter, Kirsci, Mezzich, & Patton, 2011). Thus, incorporating effective substance abuse treatment into the juvenile justice system has become critical for achieving effective youth rehabilitation and eliminating lifelong addiction and recidivism. Treatment programs backed by promising research are being implemented in juvenile drug courts nationwide. However, just as no two juvenile court jurisdictions are the same, no two individual juvenile clients are the same. Successful completion of a juvenile drug court program that includes substance abuse treatment by one client does not guarantee successful program completion for everyone. Characteristics unique to the implementation of the juvenile drug court program, as well as characteristics unique to the individual being treated, have an impact on whether a particular youth will successfully complete juvenile drug court and, thus, successfully complete treatment.

Juvenile Drug Courts

In 2000, the Centers for Disease Control and Prevention reported that adolescent substance use, which had come to a peak in the 1990s, remained alarmingly high (National Drug Court Institute [NDCI] & National Council of Juvenile and Family Court Judges [NCJFCJ], 2003). Given the aforementioned risks associated with adolescent substance use, this increase was viewed as a major public health crisis. The peak in adolescent substance use occurred roughly a decade after a similar peak in use among adults. Drug-related arrests among adults dramatically increased in the 1980s, in large part due to a drastic increase in accessibility and use of crack cocaine (NDCI & NCJFCJ, 2003) as well as the enforcement of increasingly harsh antidrug laws (Peugh & Belenko, 1999). In response, jurisdictions began creating separate dockets to focus on individuals who had been brought into the criminal justice system as a result of substance abuse. Rather than being exclusively punitive, sentencing practices under these dockets included therapeutic elements focused on treating the underlying dependence that often accompanied criminal activity. As these dockets grew in number, they began to be evaluated. Research conducted on these courts was encouraging, demonstrating a decrease in recidivism among participants of adult drug courts compared to those in non-specialized courts (Hora, Rosenthal, & Schman, 1999).

The demonstrated successes of adult drug courts combined with the reported dramatic increase in adolescent substance use during the 1990s motivated a small number of jurisdictions to experiment with implementation of drug courts targeting juvenile offenders, the first of which began in 1993 (Cooper, 2001). As the number of juvenile drug courts increased, several evaluations were conducted yielding mixed results (Belenko, 2001; Marlowe, 2010; Roman & DeStefano, 2004), which some indicate were due to poor methodology (Mitchell, Wilson, Eggers, & MacKenzie, 2012). Additional research, however, demonstrated that the inclusion of evidence-based practices increased positive outcomes, including reduction of substance use and crime (Belenko & Logan, 2003; Henggeler et al., 2006; Henggeler, McCart, Cunningham, & Chapman, 2012).

Juvenile Drug Court: Strategies in Practice

Responding to the unique needs of juvenile drug court programs, a decade after the first juvenile drug court was established the Bureau of Justice Assistance, the NCJFCJ, and the Office of Juvenile Justice and Delinquency Prevention (OJJDP) created the Juvenile Drug Court: Strategies in Practice program (NCJFCJ, 2014; NDCI & NCJFCJ, 2003). The Juvenile Drug Court: Strategies in Practice was developed to serve as a framework for planning, implementing, and operating a juvenile drug court to focus on providing appropriate, individualized substance abuse treatment to adolescents involved in the justice system. While modeled after Defining Drug Courts: The Key Components (National Association of Drug Court Professionals [NADCP], 1997), Juvenile Drug Court: Strategies in Practice recognizes that juveniles are developmentally different from adults and thus includes specific strategies that incorporate age-relevant practices (e.g., inclusion of family, school-based support) (NDCI & NCJFCJ, 2003). Developers and administrators of Juvenile Drug Court: Strategies in Practice expect that juvenile drug courts implementing this program will have improved systems of care, improved provision of effective substance abuse treatment, and improved client engagement in substance abuse treatment compared to drug courts not implementing this program.

In the past decade, there has been a dramatic rise in the number of scientifically rigorous studies indicating the effectiveness of juvenile drug courts. Generally, results have shown that youth in juvenile drug courts do as well as, or better than, matched youth in community-based treatment programs in terms of reduced substance use, crime, mental health, and family problems (Henggeler et al., 2006; Ives, Chan, Modisette, & Dennis, 2010; Rodriguez & Webb, 2004; Sloan, Smykla, & Rush, 2004). In terms of reduced substance use and crime, youth in juvenile drug courts (particularly those using evidence-based practices) have better outcomes than youth randomly assigned to traditional family court with community service (Henggeler et al., 2006). In addition, results of a 19-site quasi-experimental study show that youth in juvenile drug courts significantly reduced their substance use, victimization, emotional problems, and illegal activity while the economic impact of crime declined (Dennis, 2013). Results of two recently conducted meta-analyses, one of 34 rigorous evaluations of juvenile drug courts (Mitchell et al., 2012) and one of 41 studies of juvenile drug courts (Stein, Deberard & Homan, 2013), indicate that juvenile drug court is associated with a small but statistically significant reduction in recidivism.

This favorable effect of juvenile drug court on recidivism, however, depends on graduation from the juvenile drug court program (Stein et al., 2013), which is a marker of successful completion of substance abuse treatment for juvenile drug court clients. Overall, juvenile drug court program graduates have demonstrated dramatically lower recidivism rates than their juvenile drug court peers who did not graduate. In addition, other related variables such as greater length of time in a juvenile drug court program, or amount of substance abuse treatment received as a result of participating in the juvenile drug court program, are strongly associated with increased likelihood of successful juvenile drug court graduation and decreased likelihood of recidivism (Stein et al., 2013). Because there seems to be an association between amount of substance abuse treatment received, higher program graduation rates, and decreased recidivism, programmatic factors affecting the amount of substance abuse treatment received seem of particular importance. Juvenile drug courts could implement these programmatic factors consequently increasing the amount of substance abuse treatment provided, increasing graduation rates, and, ultimately, reducing recidivism.

The Juvenile Drug Court and Reclaiming Futures Initiative

The current trend in juvenile drug court treatment is the inclusion of evidence-based practices as reflected in current federal policy. The Office of National Drug Control Policy (ONDCP) supports the expansion of drug courts, including juvenile drug courts, to achieve its aim of increasing public health and safety (ONDCP, 2010). In 2007, OJJDP entered into a public-private partnership with SAMHSA’s Center for Substance Abuse Treatment (CSAT) and the Robert Woods Johnson Foundation, to advance the mission of juvenile drug courts by integrating evidence-based practices into substance abuse treatment services (Solovitch, 2009). This initiative required juvenile drug courts to implement the Reclaiming Futures model to support the delivery of evidence-based substance abuse treatment as a component of the juvenile drug court program.

Reclaiming Futures Model

Reclaiming Futures (http://reclaimingfutures.org/) is a systems change approach to juvenile justice focused on increasing and improving adolescent substance abuse treatment, as well as improving the way communities intervene with youth (Nissen et al., 2006; Nissen & Merrigan, 2011). The focus of Reclaiming Futures is not the creation of a new program, but rather driving changes within communities to collaborate within existing frameworks to deliver effective substance abuse treatment for juvenile offenders. Each Reclaiming Futures community has a leadership team consisting of a judge, juvenile probation representative, adolescent substance abuse treatment professional, community member, and a project director (Reclaiming Futures National Program Office, 2014). These leaders work collaboratively to administer the program at a local level and are connected to a national network of leadership teams structured to encourage frequent communication regarding local concerns, as well as broader issues related to adolescent substance abuse. These leaders utilize the Reclaiming Futures six-step model—(a) Initial screening, (b) Initial assessment, (c) Service coordination, (d) Initiation of treatment, (e) Engagement, and (f) Transition (Reclaiming Futures National Program Office, 2013; Solovitch, 2009)—to provide youth in their local juvenile justice system with “more treatment, better treatment, and beyond treatment” (http://reclaimingfutures.org/model/model-solution). A coordinated individualized response is emphasized with the first three steps and community-directed engagement is emphasized with the latter three steps. As expected with the implementation of Juvenile Drug Court: Strategies in Practice, it is expected that the implementation of Reclaiming Futures in juvenile drug courts would result in increased engagement of youth in juvenile drug courts and, consequently, in substance abuse treatment. Implementation of both of these models could lead to improved graduation rates, which are critical to juvenile drug court effectiveness (Stein et al., 2013).

A preliminary evaluation of ten Reclaiming Futures pilot sites was conducted at the Urban Institute in Washington, D.C. A survey instrument was used to examine thirteen indices of systematic change over time (Butts & Roman, 2007). Positive changes were found in twelve indices, with the greatest improvements in the areas of treatment effectiveness and the use of screening and assessment tools. An examination of the impact of Reclaiming Futures on receipt of substance abuse treatment and, relatedly, graduation from JDC, is lacking.

Juvenile Drug Court Client Characteristics that Affect Receipt of Substance Abuse Treatment and Graduation from Juvenile Drug Court

Not graduating from juvenile drug court is fairly common. Only slightly more than half of all youth who initially enroll in a juvenile drug court end up graduating (Stein et al., 2013). As graduation is a marker of having received substance abuse treatment, as well as successful completion of substance abuse treatment, this low graduation rate is concerning. Substance abuse treatment cannot be effective if juvenile drug court clients do not receive it.

Multiple client characteristics have been found to be related to receipt of substance abuse treatment and graduation from juvenile drug court. Among juvenile drug court clients, females graduate at slightly higher rates than males; and ethnic/racial minority youth are less likely to graduate and experience higher rates of recidivism during and after the program than ethnic/racial majority youth (Stein et al., 2013). In addition, juvenile drug court clients who are more severely addicted are less likely to successfully graduate from juvenile drug courts than those who are not as severely addicted (Stein et al., 2013). Although age was generally unrelated to graduation or recidivism, researchers consider its potential impact important (Stein et al., 2013).

Less is known about the impact of juvenile drug court program characteristics on receipt of substance abuse treatment and, relatedly, graduation from juvenile drug court. Juvenile drug court program characteristics, as well as client characteristics, should be considered when examining factors that impact receipt of substance abuse treatment and, relatedly, graduation from juvenile drug court.

The National Cross-site Evaluation of Juvenile Drug Courts and Reclaiming Futures

The National Cross-Site Evaluation of Juvenile Drug Courts and Reclaiming Futures (JDC/RF) is a 4-year evaluation of five JDC/RF programs implemented in five juvenile drug courts located across the country, heretofore referred to as JDC/RF sites. The five JDC/RF sites received grants under the aforementioned JDC/RF initiative to enhance the capacity of existing juvenile drug courts to serve substance-involved youth through the integration and implementation of both the Juvenile Drug Court: Strategies in Practice and Reclaiming Futures, resulting in a JDC/RF program at each site. The JDC/RF sites represent rural and urban communities and are located in the following regions of the United States: Pacific Alaska Region, Pacific Region, Rocky Mountain Region, Southwest Region, and Great Lakes Region.

This national cross-site evaluation includes implementation, process, and outcome evaluations. It focuses on describing what was involved in the implementation of Reclaiming Futures (e.g., trainings), as well as describing the process of implementation and its influence on the system (e.g., how and what changes were made to the juvenile drug court system). Furthermore, it focuses on evaluating the services provided by the JDC/RF program (e.g., what was provided, who was served, and whether the services were effective), and evaluating the cost-effectiveness of integrating Juvenile Drug Court: Strategies in Practice and Reclaiming Futures.

The national cross-site evaluation uses evaluation-related data from multiple sources. One source is the JDC/RF program clients. The JDC/RF sites were required to establish local-level program monitoring and evaluation, which involved collecting performance-related client-level data (e.g., status in the JDC/RF program). Additional data were obtained from JDC/RF site personnel and other individuals working in youth-serving agencies in the local communities using the following procedures: (a) use of web-based surveys that are administered monthly, bi-annually, and annually; (b) annual qualitative interviews with four individuals per JDC/RF site; (c) bi-annual observations of JDC/RF team meetings; and (d) annual site visits.

Purpose of the Current Study

Using data from the National Cross-Site Evaluation of JDC/RF, the current study addresses three aims. First, we examine the overall effectiveness of JDC/RF programs in providing appropriate levels of substance abuse treatment to program clients. Some clients receive the level of substance abuse treatment they need from the JDC/RF program. Other clients receive the level of substance abuse treatment they need via referral made by the JDC/RF program to another substance abuse treatment program—often a higher level of treatment than provided by the JDC/RF program. Thus, in this study we examine receipt of treatment needed as reflected in (a) clients’ successful completion of the JDC/RF program, (b) clients’ continued receipt of substance abuse treatment via continued enrollment in the JDC/RF program, and (c) clients’ continued receipt of substance abuse treatment outside of the JDC/RF program via a referral to another substance abuse treatment program. We expect that the JDC/RF programs will be effective in providing appropriate levels of substance abuse treatment to program clients.

Second, we examine whether JDC/RF program effectiveness, as measured by clients’ receipt of substance abuse treatment as needed, varies across JDC/RF programs and, if so, whether this variation is explained by JDC/RF program characteristics including (a) administration, (b) collaboration, and (c) quality of substance abuse treatment. Although all of the JDC/RF programs are implementing Juvenile Drug Court: Strategies in Practice and Reclaiming Futures, we expect differences in the nature of the implementation and in the clients served by the JDC/RF programs; as a result, we expect variation across the JDC/RF program in clients’ receipt of substance abuse treatment as needed. In addition, we expect that some of this variation will be explained by JDC/RF program characteristics.

Third, we examine whether the effect of JDC/RF program characteristics, as measured by functioning in administration, collaboration, and quality on receipt of needed treatment, is accounted for by program client characteristics including gender, ethnicity/race, age, and substance abuse status at program intake. We expect some, but not all, of the effect of JDC/RF program characteristics on client receipt of substance abuse treatment to be accounted for by client characteristics.

Method

Participants

Data from 522 juvenile drug court clients are included in our analysis. Participant characteristics for the entire sample are shown in Table 1. Of the 522 participants, 74.1% were male and all were between the ages of 12 and 18 years old (M = 15.4 years old). Almost two-thirds (64.8%) reported being from an ethnic/racial minority. The majority of participants (81.4%) started using substances between the ages of 10 and 14. At intake into the JDC/RF program, 72.9% had been using substances for at least 3 years. Based on participants’ reports of substance use-related symptoms, 90.0% reported symptoms of substance abuse or substance dependence.

Table 1. Comparisons of JDC/RF Program Client Characteristics at Intake by JDC/RF Program (N = 522)

Client Characteristics at Program Intake (%)

All JDC/RF

Programs
(N = 522)

JDC/RF

Program 1
(
N = 144)

JDC/RF

Program 2 (N = 74)

JDC/RF

Program 3
(
N = 100)

JDC/RF

Program 4
(
N = 71)

JDC/RF

Program 5
(
N = 133)

F(4,517)

p

Demographic Characteristics

Biological Sex: Male

74.1

66.0

93.2

68.0

62.0

83.5

8.60

<.001

Ethnic/Racial Minority

64.8

72.2

91.9

36.0

15.5

89.5

65.03

<.001

Age

7.63

<.001

12-14 years old

10.0

4.2

8.1

11.0

25.4

8.3

15-17 years old

82.8

84.7

91.9

81.0

73.2

82.0

18 years old and older

7.3

11.1

0.0

8.0

1.4

9.8

Substance Use Related Symptoms

Age of First Substance Use

3.65

<.05

Less than 10 years old

8.8

7.6

12.2

7.0

5.6

11.3

10-14 years old

81.4

82.6

85.1

83.0

73.2

81.2

15-17 years old

9.8

9.7

2.7

10.0

21.1

7.5

Years of Substance Use

13.30

<.001

Less than 1 year

1.5

0.7

0.0

0.0

8.5

0.8

1-2 years

25.5

14.6

20.3

31.0

49.3

23.3

3-4 years

42.5

43.1

45.9

41.0

31.0

47.4

5-9 years

28.7

40.3

32.4

28.0

9.9

24.8

10-19 years

1.7

1.4

1.4

0.0

1.4

3.8

Intensity of Substance Use

29.04

<.001

Substance Use

10.0

2.1

2.7

4.0

22.5

20.3

Substance Abuse

23.2

7.6

28.4

18.0

43.7

30.1

Substance Dependence

66.9

90.3

68.9

78.0

33.8

49.6

Measures and Procedure

Data used for the purposes of this study were collected from three sources: JDC/RF client characteristic data were collected from juvenile drug court clients participating in the study; juvenile drug court clients’ receipt of needed substance abuse treatment (i.e., outcome data) was collected from JDC/RF site representatives; and JDC/RF program characteristic data were collected from local expert informants. Study measures and procedures were reviewed and approved by the University of Arizona’s Institutional Review Board (IRB).

JDC/RF Client Characteristics Measures and Procedures

The first source of data was the JDC/RF clients participating in the study. Each JDC/RF site worked with a local evaluator to collect self-report data from program clients at baseline, or intake, into the JDC/RF program, and follow-up at 3, 6, and/or 12 months post-baseline. All of the JDC/RF sites collected data from program clients, at least at program intake and at 6 months follow-up. Some of the sites also collected data from program clients at 3 months follow-up; some also collected data from program clients at 12 months follow-up. For the current study, of the data available from juvenile drug court clients, only data collected at program intake are analyzed.

All JDC/RF sites collected data using the Global Appraisal of Individual Needs (GAIN; Dennis, Titus, White, Unsicker, & Hodgkins, 2003). The GAIN is a standardized biopsychosocial assessment used to obtain information for diagnosis, placement, treatment planning, and outcomes monitoring. The GAIN has demonstrated excellent internal consistency on core scales (Dennis, Funk, Godley, Godley, & Waldron, 2004).

We obtained de-identified client-level GAIN data collected at program intake from the JDC/RF sites via a central data repository housed at and maintained by Chestnut Health Systems GAIN Coordinating Center (http://www.chestnut.org/LI/GAINCoordinatingCenter). Using these data, we assessed the program client-level characteristics of interest in the current study. These data include program intake GAIN data collected from October 1, 2009 through December 31, 2013.

Demographic Characteristics

Program clients’ reported gender was coded for whether (1) or not (0) the client was male. Program clients were also asked to report whether or not they were Hispanic and what their race was, including being of multiple races. Clients who reported being Hispanic and/or any race other than White were coded as being of minority race/ethnicity (1). Those who reported being of only White race and not Hispanic were coded as not being of minority race/ethnicity (0). Program clients’ reported age was coded for ages 12 to 14 (1), 15 to 17 (2), and 18 and older (3).

History and Intensity of Substance Use at Program Intake

The GAIN includes multiple questions about substance use. Use of each of multiple substances (e.g., alcohol, cocaine) is queried separately. Follow-up questions are asked about the substances that program clients report having used. These follow-up questions include questions about extent of use and age of first use. Additional questions ask about substance use–related problems, such as experience of withdrawal symptoms.

To determine age of first use of substances, we compared a program client’s responses to the multiple questions that queried age of first use of each substance the client had reported using at some time in her or his life. Age of first use of substances was the youngest age reported. These responses across clients were recoded to reflect first use of substances before the age of 10 (0), between 10 and 14 years of age (1), and between 15 and 17 years of age (2). All program clients reported engaging in their first use of substances before the age of 18.

Years of substance use was determined by subtracting age of first substance use from current age (age at program intake). The resulting number of years was then recoded to reflect less than 1 year of use (1), 1 to 2 years of use (2), 3 to 4 years of use (3), 5 to 9 years of use (4), and 10 to 19 years of use (5).

Intensity of substance use was determined using the standardized GAIN scales for substance abuse and substance dependence. Those who were determined to have substance dependence were coded as 2; those determined to have substance abuse were coded as 1; and those who did not meet either of these criteria were coded as 0 (indicating substance use without abuse or dependence).

Receipt of Needed Treatment

Juvenile drug court clients’ receipt of treatment as needed was coded from current status in the JDC/RF program, which we collected from JDC/RF site representatives. Program clients who had successfully completed the JDC/RF program, were currently enrolled in the JDC/RF program, or had transferred to other substance abuse treatment as needed, were categorized as having received or currently receiving treatment as needed. Program clients who dropped out of the JDC/RF program against medical advice, were enrolled in but not participating in the JDC/RF program, or were transferred to juvenile justice, were categorized as having not received treatment as needed.

JDC/RF Program Characteristics Measures and Procedures

The third source of data used for this study was local expert informants. Local expert informants provided data regarding characteristics of the JDC/RF programs. The local expert informants are people who have sufficient contact with the JDC/RF programs and personnel in order to make a knowledgeable assessment of the characteristics (i.e., administration, collaboration, and quality of substance abuse treatment) of their respective JDC/RF program. These expert informants included JDC/RF program staff, other individuals associated directly with the juvenile drug court (i.e., staff of partnering agencies), and individuals at youth-serving agencies within the same community as the juvenile drug court (i.e., substance abuse treatment agencies). The samples of expert informants at each JDC/RF program site were identified using two methods. A portion of the sample was nominated by the JDC/RF Program Directors as individuals most qualified to assess the effectiveness of the local juvenile justice and substance abuse treatment system. To address possible sampling bias, the other portion of the sample was identified by the authors of this study as staff of youth-service agencies in proximity to the juvenile drug court who would be likely to serve youth involved in the juvenile drug court.

The local expert informants were surveyed in December 2012. The survey contained 58 items of the 13 multi-item indices developed by Butts and Roman (2007) for their evaluation of the quality of juvenile justice and substance abuse treatment systems. These 58 items were supplemented by nine items developed by van Wormer & Lutze (2010) that correspond conceptually to the indices. These indices were designed to measure the “quality of juvenile justice and substance abuse treatment systems” (Butts & Roman, 2007, p. 1). All items were modified to ask about the past 12 months and respondents reported how much they agree or disagree with each item using a 5-point scale ranging from strongly disagree to strongly agree.

The administration indices included: access to services, data sharing, effort toward systems integration (originally referred to as “systems integration” by Butts and Roman [2007]), and resource management. The Access to Services Index reflects the ease with which program clients access services. This index consists of four items from the Butts and Roman (2007) survey. For example, one index item (which was reverse-coded) queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community had problems due to reductions in funding.” The Data Sharing Index reflects the ease with which their youth-serving agencies share information. This index consists of five items from the Butts and Roman (2007) survey. For example, one item in this index (which was reverse-coded) queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community found it difficult to share information due to legal issues.” The Effort Toward Systems Integration Index reflects how hard the youth-serving agencies in the community are working to integrate systems. Because community youth-serving agencies that have already established integrated systems do not have to continue to work hard to integrate systems, but rather focus on maintaining the current system, higher scores on this index suggest the need for more integrated systems, or, conversely, a lack of systems integration. This index consists of four items from the Butts and Roman (2007) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community worked hard to make sure that treatment goals for individual youth were consistent across agencies.” The Resource Management Index reflects how effective the youth-serving agencies are at using and sharing resources. This index consists of five items from the Butts and Roman (2007) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community worked collaboratively to use existing funding more efficiently.”

The collaboration indices included: client information, partner involvement, and agency collaboration. The Client Information Index reflects the extent to which the youth-serving agencies share client information to support treatment planning. This index consists of five items from the Butts and Roman (2007) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community were effective at sharing information to improve services for youth.” The Partner Involvement Index reflects the extent to which the Reclaiming Futures partner agencies interact. This index consists of five items from the Butts and Roman (2007) survey supplemented by three items from the van Wormer and Lutze (2010) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, the Reclaiming Futures partnership in my community was effective in sharing decision-making among various partners.” The Agency Collaboration Index reflects how positive the interagency relationships are. This index consists of five items from the Butts and Roman (2007) survey supplemented by two items from the van Wormer & Lutze (2010) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community tended to see each other as dependable.”

The quality of substance abuse treatment indices included: alcohol and other drug (AOD) assessment, treatment effectiveness, targeted treatment, cultural integration, family involvement, and pro-social activities. The AOD Assessment Index reflects the use of appropriate AOD screening and assessment tools. This index consists of four items from the Butts and Roman (2007) survey supplemented by two items from the van Wormer & Lutze (2010) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, the drug and alcohol assessments used in my community provided reliable information.” The Treatment Effectiveness Index reflects the extent of success in meeting the mental health and substance abuse needs of youth in the community. This index consists of five items from the Butts and Roman (2007) survey supplemented by one item from the van Wormer & Lutze (2010) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, the substance abuse needs of youth in my community were adequately met.” The Targeted Treatment Index reflects the adequacy of the community youth-serving agencies’ access to targeted treatment. This index consists of seven items from the Butts and Roman (2007) survey supplemented by one item from the van Wormer & Lutze (2010) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community had enough access to developmentally appropriate services for youth.” The Cultural Integration Index reflects the extent of the cultural competence and responsiveness of the youth-serving agencies in the community. This index consists of three items from the Butts and Roman (2007) survey. For example, one item in this index (which was reverse-scored) queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community had problems due to lack of bilingual staff.” The Family Involvement Index reflects the extent to which youth-serving agencies in the community involve youths’ families in designing and delivering services for youth. This index consists of four items from the Butts and Roman (2007) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, family input was used to define service and treatment goals for justice-involved youth.” The Pro-social Activities Index reflects the extent to which youth-serving agencies in the community link youth to pro-social activities. This index consists of two items from the Butts and Roman (2007) survey. For example, one item in this index queries agreement with the statement, “In the past 12 months, youth-serving agencies in my community effectively linked youth to pro-social activities (e.g., recreational and cultural activities).”

Of the 194 local expert informants invited to take the survey, 90 (46%) completed the survey. An additional four individuals partially completed the survey; however, because they completed less than 50% of the survey, we excluded their data from analyses. The response rate was similar across the five programs—48% at Program 1, 40% at Programs 2 and 5, 52% at Program 3, and 45% at Program 4.

We coded their responses and created index variables as per Butts and Roman (2007). Responses were coded from -10 to 10, and all items were coded so that larger values reflect more positive opinions regarding the program characteristic of interest (e.g., data sharing). Within each index and JDC/RF program, item scores were averaged to calculate the index scores for each JDC/RF program. As shown in Table 2, all indices had acceptable internal consistency (Cronbach’s alpha ranging from .68 to .92).

Table 2. Comparisons of JDC/RF Program Characteristics by JDC/RF Program (N = 90)

Program Characteristics

All JDC/RF

Programs
(N = 90)

JDC/RF

Program 1
(
N = 14)

JDC/RF

Program 2
(
N = 14)

JDC/RF

Program 3
(
N = 35)

JDC/RF

Program 4
(
N = 15)

JDC/RF

Program 5
(
N = 12)

F(4,85)

p

Administration Indices

Access to Services Index (α=.69)

-1.28

-0.18

0.27

-2.96

-1.08

0.31

3.02

.022

Data Sharing Index (α=.89)

0.52

0.00

0.93

-0.11

1.47

1.33

0.50

.737

Effort Toward Systems Integration Index (α=.72)

1.56

2.23

1.25

0.96

2.08

2.19

0.53

.715

Resource Management Index (α=.82)

1.69

1.50

1.50

0.71

2.80

3.58

1.88

.122

Collaboration Indices

Client Information Index (α=.69)

2.95

3.00

4.14

2.33

2.93

3.33

0.94

.444

Partner Involvement Index (α=.87)

2.83

2.54

2.32

2.59

3.58

3.54

0.59

.668

Agency Collaboration Index (α=.76)

3.60

3.42

4.34

3.31

3.38

4.05

0.47

.758

Quality Indices

AOD Assessment Index (α=.77)

3.06

3.04

3.81

2.12

4.00

3.75

1.70

.157

Treatment Effectiveness Index (α=.71)

1.79

2.20

2.38

1.12

2.00

2.29

0.76

.558

Targeted Treatment Index (α=.74)

-0.08

-1.29

1.01

-0.04

-0.38

0.31

1.11

.358

Cultural Integration Index (α=.68)

1.89

2.98

1.90

1.10

3.33

1.11

1.50

.208

Family Involvement Index (α=.92)

2.00

0.63

2.59

1.57

2.92

3.02

0.80

.529

Pro-social Activities Index (α=.76)

0.25

1.07

0.18

-0.14

-0.83

1.88

0.64

.634

Statistical Analysis

The data were analyzed using multilevel modeling (see Raudenbush & Bryk, 2002 for detailed discussions of this statistical procedure) using the computer program HLM7.01 (Raudenbush, Bryk, & Congdon, 2013). Multilevel modeling simultaneously estimates the effects of variables measured at different levels in hierarchical or nested data. The data from the present study have two levels. The upper-level unit is JDC/RF program. Variables at this level include program characteristics such as the Access to Services Index—one of the Administration Indices. The lower-level unit is program client. Variables at this level include client characteristics such as gender and intensity of substance use at program intake.

Specifically, we used multilevel logistic regression with a Bernoulli binomial distribution to analyze the data. With this analysis, if the logit equals 0, the probability of receiving treatment as needed is equal to the probability of not receiving it. If the logit is less than 0 (i.e., negative), the probability of receiving treatment as needed is less than the probability of not receiving it. If the logit is greater than 0 (i.e., positive), the probability of receiving treatment as needed is greater than the probability of not receiving it.

We estimated first the simple model, one without any client characteristics or any JDC/RF program characteristics. Estimation of this model indicates the overall probability of receiving treatment as needed and, thus, indicates the average probability that the JDC/RF program clients are receiving treatment as needed. Estimation of the simple model also indicates whether the probability of receiving treatment as needed varies by JDC/RF program. If such variation exists, additional analyses to examine how factors, such as program characteristics, might account for this variance are justified.

We then examined the effects of JDC/RF program characteristics (e.g., Access to Services Index) on the probability of receiving treatment as needed. First, we estimated models for each JDC/RF program characteristic separately in order to examine the overall effect of each program characteristic on program clients’ receipt of treatment as needed. We then estimated models to examine whether the effect of each of the influential JDC/RF program characteristics (i.e., those identified as having an overall effect on program clients’ receipt of treatment as needed) could be accounted for by client characteristics. Each of these models contained the JDC/RF program characteristic identified as having an overall effect on clients’ receipt of treatment as needed and the client characteristics—gender, ethnic/racial minority status, age, and substance abuse status at program intake. Estimation of these models indicates whether the variation in the probability of program clients’ receipt of treatment as needed across JDC/RF programs is explained by the level of quality of the JDC/RF program as indicated by each index (e.g., as indicated by the Access to Services Index), while controlling for the effects of the client characteristics on the probability of clients’ receipt of treatment as needed.

Results

JDC/RF Client Characteristics

Demographic Characteristics

Overall, across all five JDC/RF programs, the majority of youth served were male (74.1%) and of ethnic/racial minority (64.8%) (see Table 1). In addition, the majority of youth served (82.8%) were 15 to 17 years old, although youth as young as 12 and as old as 18 years old were also served by these juvenile drug courts.

All of the demographic characteristics of program clients at intake varied by JDC/RF program (see Table 1). Compared to the other programs, Program 2 served the most male (93.2%) and ethnic/racial minority youth (91.9%), whereas Program 4 served the least (62.0% and 15.5%, respectively). Program 2 served the most 15 to 17 year olds (91.9%) compared to the other programs. Program 4 served the smallest percentage of 15 to 17 year olds (73.2%) and the greatest percentage of 12 to 14 year olds (25.4%), as compared to the other programs.

History and Intensity of Substance Use at Program Intake

Overall, across all five JDC/RF programs, the majority of youth served had substantial substance use histories and related issues (see Table 1). Ninety percent of youth served reported engaging in their first use of substances before the age of 15, with about 9% having reported engaging in their first use of substances before the age of 10. The majority (72.9%) of youth served by the JDC/RF programs had been using substances for 3 or more years, with 30.4% of the youth having been using substances for 5 or more years. Furthermore, of the youth served, 23.2% reported symptoms of substance abuse and 66.9% reported symptoms of substance dependence.

All of the substance use–related symptoms of program clients at intake also varied by JDC/RF program (see Table 1). A greater percentage of Program 2’s clients started using substances at a younger age (12.2%) while a greater percentage of Program 4’s clients started between the ages of 15 and 17 years (21.1%) compared to clients of the other programs. Program 1’s clients reported using substances for a longer period of time (41.7% with 5 or more years of use) while Program 4’s clients reported using for a shorter period of time (11.3% with 5 or more years of use) compared to clients of the other programs. Program 1 had the greatest percentage of clients who reported symptoms of substance dependence (90.3%), whereas Program 4 had the smallest percentage (33.8%) of those who reported symptoms of substance dependence compared to the other programs.

JDC/RF Program Characteristics

Overall, across all five JDC/RF programs, the JDC/RF programs were rated higher on some characteristics than on others (see Table 2). Overall, the JDC/RF programs were rated highest on client information, partner involvement, agency collaboration, and AOD assessment. These programs were rated lowest on access to services, data sharing, targeted treatment, and pro-social activities.

As shown in Table 2, the JDC/RF programs varied on only one of the program characteristics—access to services. All of the JDC/RF programs were rated low on access to services; for all programs, access to services was rated at less than 1 on a scale ranging from -10 to 10. However, on access to services, Programs 3 and 4 (-2.96 and -1.08, respectively) were rated lower than Program 1 (-0.18), which was rated lower than Programs 2 and 5 (0.27 and 0.31, respectively).

Simple Model

Results of the simple model indicate that, on average, JDC/RF program clients are more likely to receive treatment as needed than to not receive needed treatment, OR = 5.87, logit = 1.77, t(4) = 3.32, p = .029. The probability of a JDC/RF program client receiving treatment as needed is .85 (5.87/[1+5.87]). Furthermore, the results indicate that this probability of receiving treatment as needed varies by JDC/RF program, variance = 1.35, c2(4) = 107.34, p < .001. Simple percentages indicate that 55.6% of JDC/RF Program 1 clients, 94.6% of Program 2 clients, 96.0% of Program 3 clients, 83.1% of Program 4 clients, and 78.9% of Program 5 clients received treatment as needed.

Overall Effects of JDC/RF Program Characteristics

Results of the multilevel logistic regressions examining the overall effects of JDC/RF program characteristics on client receipt of substance abuse treatment as needed are presented in Table 3. These results indicate that only two of the program characteristics were associated with receipt of substance abuse treatment as needed. Effort toward systems integration was negatively associated with receipt of substance abuse treatment as needed. Because higher scores on this index suggest the need for a more integrated system, this finding suggests that a JDC/RF program implemented within a system perceived as needing more systems integration is less effective at serving the substance abuse treatment needs of its youth clients than one implemented within a system not perceived as needing more systems integration.

Table 3. Overall Effects of Individual JDC/RF Program Characteristics on Client Receipt of Treatment as Needed (N = 522)

Program Characteristics

Logit

OR

t

p

Administration Indices

Access to Services Index

-0.45

0.63

-1.88

.157

Data Sharing Index

-0.06

0.94

-0.09

.937

Effort Toward Systems Integration Index

-1.95

0.14

-6.35

.008

Resource Management Index

-0.43

0.65

-1.44

.246

Collaboration Indices

Client Information Index

0.08

1.08

0.09

.934

Partner Involvement Index

-0.59

0.56

-0.91

.431

Agency Collaboration Index

0.58

1.78

0.56

.616

Quality Indices

AOD Assessment Index

-0.41

0.67

-0.73

.520

Treatment Effectiveness Index

-1.25

0.29

-1.94

.148

Targeted Treatment Index

1.86

2.82

5.70

.011

Cultural Integration Index

-0.62

0.54

-1.51

.229

Family Involvement Index

0.38

1.46

0.81

.476

Pro-social Activities Index

-0.54

0.58

-1.55

.218

Targeted treatment, the second program characteristic associated with receipt of substance abuse treatment as needed, was positively associated with receipt of substance abuse treatment as needed. This finding suggests that a JDC/RF program implemented within a community where youth-serving agencies are perceived as having adequate access to targeted treatment is more effective at serving the substance abuse treatment needs of its youth clients than one implemented where youth-serving agencies are not perceived as having adequate access to targeted treatment.

Additional findings support this interpretation of the data. Results of a correlational analysis show that perceptions of effort toward systems integration are strongly negatively associated with perceptions of targeted treatment (r = -.50, p < .001). This finding suggests that as people involved in or familiar with the JDC perceive less adequate access to targeted treatment within their community, they perceive greater recent effort within their community to integrate systems, or a greater need for a more integrated system within their community.

Effects of JDC/RF Program Characteristics While Controlling for Effects of Client Characteristics

Results of the multilevel logistic regressions examining the effects of JDC/RF program characteristics on client receipt of substance abuse treatment as needed while controlling for effects of client characteristics are presented in Table 4. These results indicate that only effort toward systems integration has a statistically significant association with receipt of substance abuse treatment as needed unique from the effects of gender, ethnic/racial minority status, age, and substance abuse status at program intake. The overall effect of targeted treatment on receipt of treatment as needed is completely accounted for by the effects of gender, ethnic/racial minority status, age, and substance abuse status at program intake. The effect of effort toward systems integration on receipt of treatment as needed is such that the greater the current effort to integrate systems (or the greater the need for a more integrated system), the lower the probability of receiving treatment as needed.

Table 4. Effect of Individual JDC/RF Program Characteristics on Client Receipt of Treatment as Needed While Controlling for Effects of Client Characteristics (N = 522)

Characteristics

Logit

aOR

t

p

Model A: Effort Toward Systems Integration Index

Effort Toward Systems Integration Index

-1.58

0.21

-3.19

.050

Biological Sex: Male

-0.36

0.70

-1.33

.185

Ethnic/Racial Minority

-0.24

0.79

-0.89

.376

Age

-0.10

0.90

-0.36

.719

Substance Abuse Status

-0.13

.88

-0.40

.710

Model B: Targeted Treatment Index

Targeted Treatment Index

0.49

1.64

1.06

.368

Biological Sex: Male

-0.39

0.68

-1.40

.161

Ethnic/Racial Minority

-0.28

0.75

-0.98

.327

Age

-0.10

0.90

-0.36

.722

Substance Abuse Status

0.10

1.11

0.32

.767

Discussion

The JDC/RF model incorporates an integrative approach; an approach that focuses on both the macro (systems level) and micro (individualized treatment; NDCI & NCJFCJ, 2003; Nissen, Butts, Merrigan, & Kraft, 2006; Nissen & Merrigan, 2011). The model aims to embed and integrate different systems of care (e.g., justice, treatment, families, schools) and involve individuals at all levels (e.g., judge, probation officers, counselors, volunteers). The 16 strategies of the Juvenile Drug Court: Strategies in Practice (NDCI & NCJFCJ, 2003), and the key components of Reclaiming Futures’ six-step model (Reclaiming Futures National Program Office, 2013; Solovitch, 2009) are distinct, yet there is a great deal of overlap between the two models. For example, two of the Juvenile Drug Court: Strategies in Practice strategies emphasize (a) engaging stakeholders in creating an interdisciplinary, coordinated, and systematic approach to working with youth and their families, and (b) tailoring interventions to the complex and varied needs of adolescents (NDCI & NCJFCJ, 2003). These two strategies are similar to the third step in Reclaiming Futures’ six-step model, which emphasizes designing and coordinating interventions that are family-driven, span agency boundaries, draw on community-based resources, and include a mix of services appropriate for each youth (Reclaiming Futures National Program Office, 2013; Solovitch, 2009).

This integrative JDC/RF model was utilized by all of the five JDC/RF programs, though the clients they served varied considerably. As described in the results section, overall, the clients served by the five JDC/RF programs were primarily males from ethnic/racial minority backgrounds, with the majority using substances for 3 or more years beginning at 14 years or younger and presenting with symptoms of SUDs. Yet, substantial and significant variations in client characteristics were documented, illuminating the great variation in juvenile drug court clients depending on the program and the region of the country in which the juvenile drug court is located.

The first aim of this study was to examine the overall effectiveness of the five JDC/RF programs in providing appropriate levels of substance abuse treatment. Given the similarities between the Juvenile Drug Court: Strategies in Practice and the Reclaiming Futures six-step model, as well as the fact that the five JDC/RF programs all followed the JDC/RF integrated model, one would expect all of the JDC/RF programs to be somewhat similar in their effectiveness. The results of the simple model indicate that clients at all of the JDC/RF programs were more likely to receive treatment as needed (defined as successful completion of the JDC/RF program or continued treatment services via the juvenile drug court or a referral program) than not to receive it.

The rate of client receipt of treatment found in this study seems better than previously found with juvenile drug courts. In their meta-analysis of 41 juvenile drug courts, Stein and colleagues (2013) found that only slightly more than half of all juvenile drug court clients graduate successfully from juvenile drug court. The present study, however, found that JDC/RF program clients had a .85 probability of receiving substance abuse treatment. It is somewhat difficult to compare these rates, as one is of graduation from juvenile drug court and one is receipt of treatment from juvenile drug court, which includes graduates of juvenile drug court, those currently enrolled in juvenile drug court, and those referred to other substance abuse treatment. Regardless, a probability of receiving substance abuse treatment of .85 reflects a high rate of treatment provision in a population that has traditionally been difficult to engage in treatment (e.g., Dembo & Muck, 2010; Stein et al., 2013; Vourakis, 2005).

This high overall rate of substance abuse treatment provision might be related to the Juvenile Drug Court: Strategies in Practice focus on establishing a system for program monitoring and evaluation to maintain quality of service. This high rate of treatment provision could also be due to other specific strategies aimed at tailoring interventions to the complex and varied needs of youth, such as taking into account their developmental needs, gender, and culture; involving family in the juvenile drug court; and focusing on the strengths of the youth (NDCI & NCJFCJ, 2003). These positive findings might also be related to Reclaiming Futures’ focus on screening tools and appropriate assessments—two of Reclaiming Futures’ key components in their six-step model for juvenile drug courts focusing on achieving positive change (Reclaiming Futures National Program Office, 2013; Solovitch, 2009).

A more rigorous way to address the questions posed in this study would be to directly compare the rate at which youth receive the substance abuse treatment they need from JDC/RF programs against the rate at which they receive this treatment from other juvenile drug court programs and other intensive outpatient substance abuse treatment programs. The findings of the present study, however, do substantiate that, overall, the five juvenile drug courts utilizing this JDC/RF model were successful in providing their clients the substance abuse treatment they needed.

The second aim of this study was to identify JDC/RF program characteristics related to program effectiveness, as measured by whether clients received services as needed. While results indicated that overall program effectiveness was achieved, program effectiveness varied by JDC/RF program, suggesting that all JDC/RF programs are not the same. Results from the present study indicate that the five JDC/RF programs were similar on 12 of the 13 quality indices examined, likely reflecting the fact that all five JDC/RF programs utilized the same JDC/RF model and had similar access to training from the Reclaiming Futures National Program Office and technical and training support offered through the federal agencies supporting the JDC/RF initiative, as well as through drug court associations. The five JDC/RF programs varied, in particular, in the ease with which program clients accessed services as well as in the types of youth they served. Additional staff training might be helpful in addressing this discrepancy across JDC/RF programs. A modification of the process by which clients access services and/or a more extensive use of youth-serving agencies in the community might also help to address this discrepancy. Taking advantage of such support in relation to challenges to access to services, in particular, could be advantageous for JDC/RF programs struggling with program effectiveness.

Looking more closely at whether the observed variation across JDC/RF program in program effectiveness was affected by program characteristics, only two of 13 program characteristics examined significantly impacted clients’ receipt of treatment as needed. The first of these was an effort toward systems integration. Effort toward systems integration reflects how hard the community youth–serving agencies are working to integrate the systems. Because juvenile drug courts and other community youth–serving agencies that have already established integrated systems do not have to continue to work hard to integrate them but rather need to focus on maintaining their current system, more effort toward systems integration suggests a current lack of systems integration. The finding of this study, thus, indicates that a lack of systems integration is associated with a lower likelihood that JDC/RF clients receive the substance abuse treatment they need. This finding is consistent with present understanding that systems of care that address the needs of the whole adolescent are necessary to effectively address adolescent substance abuse (National Institute on Drug Abuse [NIDA], 2014). This finding also underscores the importance of the Juvenile Drug Court: Strategies in Practice focus on creating an interdisciplinary, coordinated, and systematic approach as well as building partnerships with community organizations (NDCI & NCJFCJ, 2003). Moreover, this finding corresponds to two of Reclaiming Futures’ key components in their six-step model for achieving positive change in juvenile drug courts—that is, integrated service coordination and transition (connecting youth to services upon completion of the service plan; Reclaiming Futures National Program Office, 2013; Solovitch, 2009). New juvenile drug courts and juvenile drug courts looking to improve program effectiveness should place an emphasis on integrating systems to create systems of care.

The second program characteristic that significantly impacted clients’ receipt of treatment as needed was access to targeted treatment. Access to targeted treatment reflects the adequacy of the community youth–serving agencies’ access to targeted treatment (such as developmentally appropriate treatment). The finding of the current study showed that JDC/RF programs with relatively greater access to targeted treatment were more effective at serving the substance abuse treatment needs of their youth clients. This finding is consistent with the present understanding that substance abuse treatment should be individualized and tailored to the needs of adolescents in need of treatment (NIDA, 2014). Furthermore, this finding underscores the importance of the Juvenile Drug Court: Strategies in Practice focus on several of the 16 strategies—including tailoring interventions to the complex and varied needs of youth, as well as addressing developmental needs, gender, and culture (NDCI & NCJFCJ, 2003). This finding also corresponds to several of Reclaiming Futures’ key components of their six-step model—particularly the initial assessment, which informs the service plan (Reclaiming Futures National Program Office, 2013; Solovitch, 2009). New juvenile drug courts and juvenile drug courts looking to improve program effectiveness should place an emphasis on developing and providing targeted treatment to their clients.

The final aim of this study was to examine whether the effect of system integration and targeted treatment (i.e., program characteristics) on program effectiveness is accounted for by client characteristics including gender, race/ethnicity, age, and substance abuse status at program intake. Results indicate that systems integration has a unique effect—over and above the effects of the characteristics of the clients—on JDC/RF client receipt of substance abuse treatment as needed. Thus, as both Juvenile Drug Court: Strategies in Practice and Reclaiming Futures emphasize, all communities should focus on system integration when designing, financing, and delivering services for adolescents with identified substance abuse treatment needs who are involved in the juvenile justice system.

Although the effect of targeted treatment on program effectiveness was accounted for by client characteristics, targeted treatment should remain a particular focus of juvenile drug courts. The overall effect of targeted treatment on client receipt of substance abuse treatment as needed indicates the importance of targeted treatment for program effectiveness. Furthermore, targeted treatment by its very nature is a response to client characteristics. Thus, the interrelatedness among client characteristics, targeted treatment, and program effectiveness is not surprising. Further research examining a possible mediational relationship between client characteristics, targeted treatment, and program effectiveness would illuminate the specific nature and importance of the effect of targeted treatment on JDC/RF, and juvenile drug court, program effectiveness.

There are several study limitations that are worth noting. First, while strategies were implemented to address expert informant respondent bias and the survey completion rate was similar across sites (40% to 52%), the overall response rate was 46%. Results might be different if the response rate had been higher. Second, this study included five juvenile drug courts, all of which used the JDC/RF model. Given the wide variation in juvenile drug court programs across the county and the clients they serve, these findings should be generalized with caution.

About the Authors

Josephine D. Korchmaros, PhD, is director of Research Methods and Statistics of the University of Arizona’s Southwest Institute for Research on Women.

Sally J. Stevens, PhD, is executive director of the University of Arizona’s Southwest Institute for Research on Women.

Alison R. Greene, MA, is director of Adolescent Research and Services of the University of Arizona’s Southwest Institute for Research on Women.

Monica Davis, BA, is an assistant research social scientist at the University of Arizona’s Southwest Institute for Research on Women.

Rachel Chalot, Esq., MSW, is a research technician at the University of Arizona’s Southwest Institute for Research on Women.

References

Belenko, S. (2001). Research on drug courts: A critical review. 2001 update. New York, NY: Columbia University, The National Center on Addiction and Substance Abuse.

Belenko, S., & Logan, T. K. (2003). Delivering more effective treatment to adolescents: Improving the juvenile drug court model. Journal of Substance Abuse Treatment, 25(3) 87–110. 

Butts, J. A., & Roman, J. (2007). Changing systems: Outcomes from the RWJF Reclaiming Futures initiative on juvenile justice and substance abuse. Portland, OR: Reclaiming Futures National Program Office.

Cooper, C. (May, 2001). Juvenile drug court programs. NCJ 184744. Retrieved from http://www.nchrs.gov/html/ojjdp/jaibg_2001_5_1/contents.html).

Dembo, R., & Muck, R. (2010). Adolescent outpatient treatment. In Leukefeld, C., Gullotta, T. P., & Staton-Tindall, M. (Eds.), Adolescent substance abuse: Evidence based approaches to prevention and treatment. New York, NY: Springer Science + Business Media LLC.

Dennis, M. L. (2013). Evaluating the Impact of Adding the Reclaiming Futures Approach to Juvenile Treatment Drug Courts. Reclaiming Futures Leadership Institute, Asheville, NC. Retrieved from http://gaincc.org/_data/files/Psychometrics_and_Publications/GAIN_Presentations/Dennis_RF-JTDC_vs_JTDC_5-8-13.pptx

Dennis, M. L., Babor, T., Roebuck, M. C., & Donaldson, J. (2002). Changing the focus: The case for recognizing and treating cannabis use disorders. Addiction, 97 (Supplement 1): 4–15.

Dennis, M. L., Funk, R., Godley, S. H., Godley, M. D., & Waldron, H. (2004). Cross-validation of the alcohol and cannabis use measures in the Global Appraisal of Individual Needs (GAIN) and Timeline Followback (TLFB; Form 90) among adolescents in substance abuse treatment. Addiction, 99 (Supplement 2), 120–128.

Dennis, M. L., Titus, J. C., White, M., Unsicker, J., & Hodgkins, D., (Eds.). (2003). Global Appraisal of Individual Needs (GAIN): Administration guide for the GAIN and related measures. Version 5 edition. Bloomington, IL: Chestnut Health Systems. Retrieved from www.gaincc.org/gaini

Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42–54.

Henggeler, S. W., McCart, M. R., Cunningham, P. B., & Chapman, J. E. (2012). Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practice. Journal of Consulting and Clinical Psychology, 80(2), 264–275.

Hora, P. F., Rosenthal, J. T. A., & Schman, W. G. (1999). Therapeutic jurisprudence and the drug treatment court movement: Revolutionizing the criminal justice system’s response to drug abuse and crime in America. Notre Dame Law Review, 74(2), 439–538.

Ives, M. L., Chan, Y., Modisette, K. C., & Dennis, M. L. (2010). Characteristics, needs, services, and outcomes of youths in juvenile treatment drug courts as compared to adolescent outpatient treatment. Drug Court Review, 7(1), 10–56.

Marlowe, D. (2010). Research update on juvenile drug treatment courts. Alexandria, VA: National Association of Drug Court Professionals. Retrieved from http://www.ndci.org/research on April 25, 2013.

Mitchell, O., Wilson, D. B., Eggers, A., & MacKenzie, D. L. (2012). Assessing the effectiveness of drug courts on recidivism: A meta-analytic review of tradition and non-traditional drug courts. Journal of Criminal Justice, 40, 60–71.

National Association of Drug Court Professionals Drug Court Standards Committee (1997). Defining drug courts: The key components. (Bureau of Justice Assistance Drug Court Resource Series). Rockville, MD: Bureau of Justice Clearinghouse.

National Council of Juvenile and Family Court Judges (2014). Practical Tips to Help Juvenile Drug Court Teams Implement the 16 Strategies in Practice. National Council of Juvenile and Family Court Judges. Retrieved from http://www.ncjfcj.org/sites/default/files/NCJFCJ_JDC_TipSheets_Final.pdf

National Drug Court Institute & National Council of Juvenile and Family Court Judges (2003). Juvenile Drug Courts: Strategies in Practice. (Bureau of Justice Assistance Monographs). Rockville, MD: Bureau of Justice Clearinghouse. Retrieved from https://www.ncjrs.gov/pdffiles1/bja/197866.pdf

National Institute on Drug Abuse (2014). Principles of adolescent substance abuse disorder treatment: A research-based guide. NIH Publication Number 14-7953.

Nissen, L. B., Butts, J. A., Merrigan, D., & Kraft, M. K. (2006). The RWJF Reclaiming Futures initiative: Improving substance abuse interventions for justice-involved youths. Juvenile and Family Court Journal, 57(4), 39–51.

Nissen, L. B., & Merrigan, D. (2011). Helping substance-involved young people in juvenile justice: Conceptual and structural foundations of the Reclaiming Futures model. Children & Youth Services Review, 33, S3–S8.

Office of National Drug Control Policy (2010). National Drug Control Strategy. Washington, DC: Executive Office of the President.

Peugh, J., & Belenko, S. (1999). Substance-involved women inmates: Challenges to providing effective treatment. The Prison Journal, 79(1), 23–44.

Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical Linear Models: Applications and Data Analysis Methods, 2nd edition. Thousand Oaks, CA: Sage Publications.

Raudenbush, S. W., Bryk, A. S., & Congdon, R. (2013). HLM 7.01 for Windows [Computer software]. Skokie, IL: Scientific Software International, Inc.

Reclaiming Futures National Program Office (2013). The Reclaiming Futures model. Retrieved from http://www.reclaimingfutures.org/members/sites/default/files/main_documents/RF-MODEL.pdf

Reclaiming Futures National Program Office (2014). A Team of Leaders. Retrieved from: http://reclaimingfutures.org/model/model-how-it-works/model-leadership

Rodriguez, N., & Webb, V. J. (2004). Multiple measures of juvenile drug court effectiveness: Results of a quasi-experimental design. Crime and Delinquency, 50(2), 292–314.

Roman, J., & DeStefano, C. (2004). Drug court effects and the quality of existing evidence. In J. Butts & J. Roman (Eds.), Juvenile Drug Courts and Teen Substance Abuse. Washington, DC: Urban Institute Press.

Sloan, J. J., Smykla, J. O., & Rush, J. P. (2004). Juvenile drug courts: Understanding the importance of dimensional variability. Criminal Justice Policy Review, 14, 339–360.

Solovitch, S. (2009). Reclaiming Futures. In S. L. Isaacs & D. C. Colby (Eds.), To Improve Health and Health Care, Volume XIII: The Robert Wood Johnson Foundation Anthology. San Francisco: Jossey-Bass.

Stein, D. M., Deberard, S., Homan, K. (2013). Predicting success and failure in juvenile drug treatment court: A meta-analytic review. Journal of Substance Abuse Treatment, 44, 159–168.

Substance Abuse and Mental Health Services Administration (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Swendsen, J., Burstein, M., Case, B., Conway, K. P., Dierker, L., He, J., & Merikangas, K. (2012). Use and abuse of alcohol and illicit drugs in US adolescents. Archives of General Psychiatry, 69(4), 390–398.

Tarter, R. E., Kirsci, L., Mezzich, A., & Patton, D. (2011). Multivariate comparison of male and female adolescent substance abusers with accompanying legal problems. Journal of Criminal Justice, 39(3), 207–211.

Van Wormer, J., & Lutze, F. E. (2010). Ensuring fidelity to the Juvenile Drug Courts Strategies in Practice—A Program Component Scale. Technical Assistance Bulletin. National Council of Juvenile and Family Court Judges & Office of Juvenile Justice and Delinquency Prevention.

Vourakis, C. (2005). Admission variables as predictors of completion in an adolescent residential drug treatment program. Journal of Child and Adolescent Psychiatric Nursing, 18, 161–170.

 

OJJDP Home | About OJJDP | E-News | Topics | Funding
Programs | State Contacts | Publications | Statistics | Events